|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT KNEE LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,060.26 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,292.28
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,116.06
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,060.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,116.06
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,116.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,918.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT KNEE LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.66 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,253.12
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,194.38
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,134.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,194.38
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,194.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,860.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT KNEE RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.66 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,253.12
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,194.38
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,134.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,194.38
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,194.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,860.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT KNEE RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,060.26 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,292.28
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,116.06
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,060.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,116.06
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,116.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,918.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT TIBIA FIBULA LT WO IV CONT
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,060.26 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,292.28
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,116.06
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,060.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,116.06
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,116.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,918.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT TIBIA FIBULA LT WO IV CONT
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370005
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.66 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,253.12
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,194.38
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,134.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,194.38
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,194.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,860.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT TIBIA FIBULA RT WO IV CONT
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,134.66 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,253.12
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,194.38
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,134.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,194.38
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,194.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,860.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - CT TIBIA FIBULA RT WO IV CONT
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
3527370006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,060.26 |
| Max. Negotiated Rate |
$1,958.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,918.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,292.28
|
| Rate for Payer: Altius Commercial |
$1,879.68
|
| Rate for Payer: Beech Street Commercial |
$1,918.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,899.26
|
| Rate for Payer: Cash Price |
$1,370.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,899.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,918.84
|
| Rate for Payer: Entrust Commercial |
$1,860.10
|
| Rate for Payer: First Choice Health Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,860.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,116.06
|
| Rate for Payer: HealthUtah PPO |
$1,958.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,899.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,060.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,918.84
|
| Rate for Payer: PacificSource Commercial |
$1,762.20
|
| Rate for Payer: PHCS PPO |
$1,918.84
|
| Rate for Payer: Three Rivers PPO |
$1,468.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,116.06
|
| Rate for Payer: United Healthcare Commercial |
$1,869.89
|
| Rate for Payer: United Healthcare Medicare |
$1,116.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,918.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,860.10
|
|
|
HC CT SCAN LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
3527213301
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,157.12
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.88
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.88
|
| Rate for Payer: United Healthcare Medicare |
$1,102.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN LUMBAR SP COMBO - CT LUMBAR SPINE W WO CONTRAST
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
3527213301
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$979.03 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,193.28
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.56
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$979.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.56
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,030.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$2,607.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,554.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,720.62
|
| Rate for Payer: Altius Commercial |
$2,502.72
|
| Rate for Payer: Beech Street Commercial |
$2,554.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,528.79
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,528.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,554.86
|
| Rate for Payer: Entrust Commercial |
$2,476.65
|
| Rate for Payer: First Choice Health Commercial |
$2,476.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,476.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,485.99
|
| Rate for Payer: HealthUtah PPO |
$2,607.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,528.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1,411.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,554.86
|
| Rate for Payer: PacificSource Commercial |
$2,346.30
|
| Rate for Payer: PHCS PPO |
$2,554.86
|
| Rate for Payer: Three Rivers PPO |
$1,955.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,485.99
|
| Rate for Payer: United Healthcare Commercial |
$2,489.68
|
| Rate for Payer: United Healthcare Medicare |
$1,485.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2,554.86
|
| Rate for Payer: Wise Provider Network Commercial |
$2,476.65
|
|
|
HC CT SCAN LUMBAR SP CONTRAST - CT LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
3527213201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,510.76 |
| Max. Negotiated Rate |
$2,607.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,554.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,668.48
|
| Rate for Payer: Altius Commercial |
$2,502.72
|
| Rate for Payer: Beech Street Commercial |
$2,554.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,528.79
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,528.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,554.86
|
| Rate for Payer: Entrust Commercial |
$2,476.65
|
| Rate for Payer: First Choice Health Commercial |
$2,476.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,476.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,590.27
|
| Rate for Payer: HealthUtah PPO |
$2,607.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,528.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1,510.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,554.86
|
| Rate for Payer: PacificSource Commercial |
$2,346.30
|
| Rate for Payer: PHCS PPO |
$2,554.86
|
| Rate for Payer: Three Rivers PPO |
$1,955.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,590.27
|
| Rate for Payer: United Healthcare Commercial |
$2,489.68
|
| Rate for Payer: United Healthcare Medicare |
$1,590.27
|
| Rate for Payer: WINHealth Partners Commercial |
$2,476.65
|
| Rate for Payer: Wise Provider Network Commercial |
$2,476.65
|
|
|
HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST
|
Facility
|
OP
|
$1,991.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,078.13 |
| Max. Negotiated Rate |
$1,991.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,951.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,314.06
|
| Rate for Payer: Altius Commercial |
$1,911.36
|
| Rate for Payer: Beech Street Commercial |
$1,951.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,931.27
|
| Rate for Payer: Cash Price |
$1,393.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,931.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,951.18
|
| Rate for Payer: Entrust Commercial |
$1,891.45
|
| Rate for Payer: First Choice Health Commercial |
$1,891.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,891.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,134.87
|
| Rate for Payer: HealthUtah PPO |
$1,991.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,931.27
|
| Rate for Payer: Multiplan Medicare/VA |
$1,078.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,951.18
|
| Rate for Payer: PacificSource Commercial |
$1,791.90
|
| Rate for Payer: PHCS PPO |
$1,951.18
|
| Rate for Payer: Three Rivers PPO |
$1,493.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,134.87
|
| Rate for Payer: United Healthcare Commercial |
$1,901.40
|
| Rate for Payer: United Healthcare Medicare |
$1,134.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,951.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1,891.45
|
|
|
HC CT SCAN,LUMBAR SPINE,W/O CONTRAST - CT LUMBAR SPINE WO CONTRAST
|
Facility
|
IP
|
$1,991.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
3527213101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,153.78 |
| Max. Negotiated Rate |
$1,991.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,951.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,274.24
|
| Rate for Payer: Altius Commercial |
$1,911.36
|
| Rate for Payer: Beech Street Commercial |
$1,951.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,931.27
|
| Rate for Payer: Cash Price |
$1,393.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,931.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,951.18
|
| Rate for Payer: Entrust Commercial |
$1,891.45
|
| Rate for Payer: First Choice Health Commercial |
$1,891.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,891.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,214.51
|
| Rate for Payer: HealthUtah PPO |
$1,991.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,931.27
|
| Rate for Payer: Multiplan Medicare/VA |
$1,153.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,951.18
|
| Rate for Payer: PacificSource Commercial |
$1,791.90
|
| Rate for Payer: PHCS PPO |
$1,951.18
|
| Rate for Payer: Three Rivers PPO |
$1,493.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,214.51
|
| Rate for Payer: United Healthcare Commercial |
$1,901.40
|
| Rate for Payer: United Healthcare Medicare |
$1,214.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,891.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,891.45
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$703.51 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,189.72
|
| Rate for Payer: Aetna of WY Medicare |
$776.96
|
| Rate for Payer: Altius Commercial |
$1,165.44
|
| Rate for Payer: Beech Street Commercial |
$1,189.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,177.58
|
| Rate for Payer: Cash Price |
$849.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,177.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,189.72
|
| Rate for Payer: Entrust Commercial |
$1,153.30
|
| Rate for Payer: First Choice Health Commercial |
$1,153.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,153.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$740.54
|
| Rate for Payer: HealthUtah PPO |
$1,214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,177.58
|
| Rate for Payer: Multiplan Medicare/VA |
$703.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,189.72
|
| Rate for Payer: PacificSource Commercial |
$1,092.60
|
| Rate for Payer: PHCS PPO |
$1,189.72
|
| Rate for Payer: Three Rivers PPO |
$910.50
|
| Rate for Payer: TriWest Veterans Administration |
$740.54
|
| Rate for Payer: United Healthcare Commercial |
$1,159.37
|
| Rate for Payer: United Healthcare Medicare |
$740.54
|
| Rate for Payer: WINHealth Partners Commercial |
$1,153.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,153.30
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS FACIAL BONES WO CONT
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048602
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$1,214.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,189.72
|
| Rate for Payer: Aetna of WY Medicare |
$801.24
|
| Rate for Payer: Altius Commercial |
$1,165.44
|
| Rate for Payer: Beech Street Commercial |
$1,189.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,177.58
|
| Rate for Payer: Cash Price |
$849.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,177.58
|
| Rate for Payer: Cigna of WY Commercial |
$1,189.72
|
| Rate for Payer: Entrust Commercial |
$1,153.30
|
| Rate for Payer: First Choice Health Commercial |
$1,153.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,153.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$691.98
|
| Rate for Payer: HealthUtah PPO |
$1,214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,177.58
|
| Rate for Payer: Multiplan Medicare/VA |
$657.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,189.72
|
| Rate for Payer: PacificSource Commercial |
$1,092.60
|
| Rate for Payer: PHCS PPO |
$1,189.72
|
| Rate for Payer: Three Rivers PPO |
$910.50
|
| Rate for Payer: TriWest Veterans Administration |
$691.98
|
| Rate for Payer: United Healthcare Commercial |
$1,159.37
|
| Rate for Payer: United Healthcare Medicare |
$691.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,189.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1,153.30
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS WO CONTRAST
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,198.34 |
| Max. Negotiated Rate |
$2,213.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,168.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,460.58
|
| Rate for Payer: Altius Commercial |
$2,124.48
|
| Rate for Payer: Beech Street Commercial |
$2,168.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,146.61
|
| Rate for Payer: Cash Price |
$1,549.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,146.61
|
| Rate for Payer: Cigna of WY Commercial |
$2,168.74
|
| Rate for Payer: Entrust Commercial |
$2,102.35
|
| Rate for Payer: First Choice Health Commercial |
$2,102.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,102.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,261.41
|
| Rate for Payer: HealthUtah PPO |
$2,213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,146.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,198.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,168.74
|
| Rate for Payer: PacificSource Commercial |
$1,991.70
|
| Rate for Payer: PHCS PPO |
$2,168.74
|
| Rate for Payer: Three Rivers PPO |
$1,659.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,261.41
|
| Rate for Payer: United Healthcare Commercial |
$2,113.42
|
| Rate for Payer: United Healthcare Medicare |
$1,261.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2,168.74
|
| Rate for Payer: Wise Provider Network Commercial |
$2,102.35
|
|
|
HC CT SCAN,MAXILLOFACIAL W/O CONTRAST - CT SINUS WO CONTRAST
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
HCPCS 70486
|
| Hospital Charge Code |
3517048601
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,282.43 |
| Max. Negotiated Rate |
$2,213.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,168.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,416.32
|
| Rate for Payer: Altius Commercial |
$2,124.48
|
| Rate for Payer: Beech Street Commercial |
$2,168.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,146.61
|
| Rate for Payer: Cash Price |
$1,549.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,146.61
|
| Rate for Payer: Cigna of WY Commercial |
$2,168.74
|
| Rate for Payer: Entrust Commercial |
$2,102.35
|
| Rate for Payer: First Choice Health Commercial |
$2,102.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,102.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,349.93
|
| Rate for Payer: HealthUtah PPO |
$2,213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,146.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,282.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,168.74
|
| Rate for Payer: PacificSource Commercial |
$1,991.70
|
| Rate for Payer: PHCS PPO |
$2,168.74
|
| Rate for Payer: Three Rivers PPO |
$1,659.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,349.93
|
| Rate for Payer: United Healthcare Commercial |
$2,113.42
|
| Rate for Payer: United Healthcare Medicare |
$1,349.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,102.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2,102.35
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$979.03 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,193.28
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.56
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$979.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.56
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,030.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320211
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,157.12
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.88
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.88
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,102.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320212
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,157.12
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.88
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.88
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,102.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN OF ARM COMBO - CT ELBOW RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320212
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$979.03 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,193.28
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.56
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$979.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.56
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,030.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN OF ARM COMBO - CT HAND LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320207
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,157.12
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.88
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.88
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,102.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN OF ARM COMBO - CT HAND LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320207
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$979.03 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,193.28
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.56
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$979.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.56
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,030.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,771.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
|
HC CT SCAN OF ARM COMBO - CT HAND RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
3527320208
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,047.74 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,771.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,157.12
|
| Rate for Payer: Altius Commercial |
$1,735.68
|
| Rate for Payer: Beech Street Commercial |
$1,771.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,753.76
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,753.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,771.84
|
| Rate for Payer: Entrust Commercial |
$1,717.60
|
| Rate for Payer: First Choice Health Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,717.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,102.88
|
| Rate for Payer: HealthUtah PPO |
$1,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,753.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,047.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,771.84
|
| Rate for Payer: PacificSource Commercial |
$1,627.20
|
| Rate for Payer: PHCS PPO |
$1,771.84
|
| Rate for Payer: Three Rivers PPO |
$1,356.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,102.88
|
| Rate for Payer: United Healthcare Commercial |
$1,726.64
|
| Rate for Payer: United Healthcare Medicare |
$1,102.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,717.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,717.60
|
|
