|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT ELBOW LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT ELBOW RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT ELBOW RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320009
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HAND LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HAND LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320007
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HAND RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HAND RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320008
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HUMERUS LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$826.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Aetna of WY Medicare |
$990.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$826.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$870.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HUMERUS LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320013
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$990.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$940.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$990.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HUMERUS RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$826.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Aetna of WY Medicare |
$990.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$826.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$870.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT HUMERUS RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320014
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$990.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$940.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$990.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT RADIUS ULNA LEFT WO IV CONT
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT RADIUS ULNA LEFT WO IV CONT
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320003
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT RADIUS ULNA RIGHT WO IV CONT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$990.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$940.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$990.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT RADIUS ULNA RIGHT WO IV CONT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320004
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$826.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Aetna of WY Medicare |
$990.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$826.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$870.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT SHOULDER LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT SHOULDER LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT SHOULDER RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT SHOULDER RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320002
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT UPPER EXT LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$990.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$940.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$990.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT UPPER EXT LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$826.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Aetna of WY Medicare |
$990.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$826.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$870.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT UPPER EXT RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$990.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$940.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$990.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT UPPER EXT RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$826.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Aetna of WY Medicare |
$990.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$826.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$870.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT WRIST LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,172.49 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,234.20
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,172.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,234.20
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,234.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,776.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
|
HC CT SCAN UPPER EXTREMITY W/O DYE - CT WRIST LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
3527320005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,030.37 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,832.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,234.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,795.20
|
| Rate for Payer: Altius Commercial |
$1,795.20
|
| Rate for Payer: Beech Street Commercial |
$1,832.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,535.27
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,813.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,832.60
|
| Rate for Payer: Entrust Commercial |
$1,776.50
|
| Rate for Payer: First Choice Health Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,776.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,084.60
|
| Rate for Payer: HealthUtah PPO |
$1,870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,813.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,030.37
|
| Rate for Payer: One Health Plan of WY PPO |
$1,832.60
|
| Rate for Payer: PacificSource Commercial |
$1,683.00
|
| Rate for Payer: PHCS PPO |
$1,832.60
|
| Rate for Payer: Three Rivers PPO |
$1,402.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,084.60
|
| Rate for Payer: United Healthcare Commercial |
$1,626.90
|
| Rate for Payer: United Healthcare Medicare |
$1,084.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,832.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,776.50
|
|
