|
HC CT SCAN OF LEG COMBO - CT TIBIA FIBULA LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,027.62 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.70
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.70
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,081.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,827.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF LEG COMBO - CT TIBIA FIBULA RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370208
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,169.36 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,230.90
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,169.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,230.90
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,230.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF LEG COMBO - CT TIBIA FIBULA RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370208
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,027.62 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,230.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,790.40
|
| Rate for Payer: Altius Commercial |
$1,790.40
|
| Rate for Payer: Beech Street Commercial |
$1,827.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,531.16
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: Entrust Commercial |
$1,771.75
|
| Rate for Payer: First Choice Health Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.70
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,827.70
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.70
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$1,081.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,827.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,771.75
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FEMUR LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370108
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FEMUR LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370108
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FEMUR RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FEMUR RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FOOT LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FOOT LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FOOT RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370109
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT FOOT RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370109
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT HIP LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370110
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT HIP LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370110
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT HIP RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370102
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT HIP RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370102
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT KNEE LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370105
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT KNEE LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370105
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT KNEE RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370111
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT KNEE RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370111
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT LOWER EXTREMITY W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370107
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT LOWER EXTREMITY W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370107
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT TIBIA FIBULA LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370106
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT TIBIA FIBULA LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370106
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT TIBIA FIBULA RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$942.21 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,128.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$991.80
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$942.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$991.80
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$991.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,675.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
|
HC CT SCAN OF LEG CONTRAST - CT TIBIA FIBULA RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
3527370104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,675.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,641.60
|
| Rate for Payer: Altius Commercial |
$1,641.60
|
| Rate for Payer: Beech Street Commercial |
$1,675.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,403.91
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,658.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,675.80
|
| Rate for Payer: Entrust Commercial |
$1,624.50
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,128.60
|
| Rate for Payer: HealthUtah PPO |
$1,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,658.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,072.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,675.80
|
| Rate for Payer: PacificSource Commercial |
$1,539.00
|
| Rate for Payer: PHCS PPO |
$1,675.80
|
| Rate for Payer: Three Rivers PPO |
$1,282.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,128.60
|
| Rate for Payer: United Healthcare Commercial |
$1,487.70
|
| Rate for Payer: United Healthcare Medicare |
$1,128.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,624.50
|
|
