|
HC CT SCAN OF ARM CONTRAST - CT HAND LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HAND LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HAND RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320109
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HAND RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320109
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320117
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320117
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320118
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT HUMERUS RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320118
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320105
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320105
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320106
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320106
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER LEFT W IV CONTRAST
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$539.51 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$595.84
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$567.91
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$539.51
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$567.91
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$567.91
|
| Rate for Payer: WINHealth Partners Commercial |
$884.45
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER LEFT W IV CONTRAST
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$504.14 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$614.46
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$530.67
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$504.14
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$530.67
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$530.67
|
| Rate for Payer: WINHealth Partners Commercial |
$912.38
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER RIGHT W IV CONTRAST
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$539.51 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$595.84
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$567.91
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$539.51
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$567.91
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$567.91
|
| Rate for Payer: WINHealth Partners Commercial |
$884.45
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT SHOULDER RIGHT W IV CONTRAST
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320104
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$504.14 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$614.46
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$530.67
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$504.14
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$530.67
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$530.67
|
| Rate for Payer: WINHealth Partners Commercial |
$912.38
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY LEFT W IV CONTRAST
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320112
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$504.14 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$614.46
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$530.67
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$504.14
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$530.67
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$530.67
|
| Rate for Payer: WINHealth Partners Commercial |
$912.38
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY LEFT W IV CONTRAST
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320112
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$539.51 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$595.84
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$567.91
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$539.51
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$567.91
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$567.91
|
| Rate for Payer: WINHealth Partners Commercial |
$884.45
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY RIGHT W IV CONTRAST
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320113
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$539.51 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$595.84
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$567.91
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$539.51
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$567.91
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$567.91
|
| Rate for Payer: WINHealth Partners Commercial |
$884.45
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY RIGHT W IV CONTRAST
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320113
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$504.14 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$912.38
|
| Rate for Payer: Aetna of WY Medicare |
$614.46
|
| Rate for Payer: Altius Commercial |
$893.76
|
| Rate for Payer: Beech Street Commercial |
$912.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$903.07
|
| Rate for Payer: Cash Price |
$651.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$903.07
|
| Rate for Payer: Cigna of WY Commercial |
$912.38
|
| Rate for Payer: Entrust Commercial |
$884.45
|
| Rate for Payer: First Choice Health Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$884.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$530.67
|
| Rate for Payer: HealthUtah PPO |
$931.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$903.07
|
| Rate for Payer: Multiplan Medicare/VA |
$504.14
|
| Rate for Payer: One Health Plan of WY PPO |
$912.38
|
| Rate for Payer: PacificSource Commercial |
$837.90
|
| Rate for Payer: PHCS PPO |
$912.38
|
| Rate for Payer: Three Rivers PPO |
$698.25
|
| Rate for Payer: TriWest Veterans Administration |
$530.67
|
| Rate for Payer: United Healthcare Commercial |
$889.10
|
| Rate for Payer: United Healthcare Medicare |
$530.67
|
| Rate for Payer: WINHealth Partners Commercial |
$912.38
|
| Rate for Payer: Wise Provider Network Commercial |
$884.45
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST LEFT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320107
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST LEFT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320107
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST RIGHT W IV CONTRAST
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320108
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,108.58 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,224.32
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,166.93
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,108.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,166.93
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,166.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,817.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF ARM CONTRAST - CT WRIST RIGHT W IV CONTRAST
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
3527320108
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.89 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,874.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,262.58
|
| Rate for Payer: Altius Commercial |
$1,836.48
|
| Rate for Payer: Beech Street Commercial |
$1,874.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.61
|
| Rate for Payer: Cash Price |
$1,339.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,855.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,874.74
|
| Rate for Payer: Entrust Commercial |
$1,817.35
|
| Rate for Payer: First Choice Health Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,817.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,090.41
|
| Rate for Payer: HealthUtah PPO |
$1,913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,855.61
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,874.74
|
| Rate for Payer: PacificSource Commercial |
$1,721.70
|
| Rate for Payer: PHCS PPO |
$1,874.74
|
| Rate for Payer: Three Rivers PPO |
$1,434.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,090.41
|
| Rate for Payer: United Healthcare Commercial |
$1,826.92
|
| Rate for Payer: United Healthcare Medicare |
$1,090.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,874.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,817.35
|
|
|
HC CT SCAN OF LEG COMBO - CT ANKLE LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
3527370211
|
|
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
|
|
