|
HC MR ANGIO LOWER EXTREM (MRA) - MR LOWER EXT ANGIO W IV CONT RT
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
6167372505
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,479.72 |
| Max. Negotiated Rate |
$2,360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,312.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,265.60
|
| Rate for Payer: Altius Commercial |
$2,265.60
|
| Rate for Payer: Beech Street Commercial |
$2,312.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,937.56
|
| Rate for Payer: Cash Price |
$1,652.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,289.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,312.80
|
| Rate for Payer: Entrust Commercial |
$2,242.00
|
| Rate for Payer: First Choice Health Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,242.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,557.60
|
| Rate for Payer: HealthUtah PPO |
$2,360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,289.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,479.72
|
| Rate for Payer: One Health Plan of WY PPO |
$2,312.80
|
| Rate for Payer: PacificSource Commercial |
$2,124.00
|
| Rate for Payer: PHCS PPO |
$2,312.80
|
| Rate for Payer: Three Rivers PPO |
$1,770.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,557.60
|
| Rate for Payer: United Healthcare Commercial |
$2,053.20
|
| Rate for Payer: United Healthcare Medicare |
$1,557.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,242.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,242.00
|
|
|
HC MR ANGIO, NECK, COMBO - MR NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$5,300.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
6157054901
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,920.30 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,194.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,498.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,088.00
|
| Rate for Payer: Altius Commercial |
$5,088.00
|
| Rate for Payer: Beech Street Commercial |
$5,194.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,351.30
|
| Rate for Payer: Cash Price |
$3,710.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,141.00
|
| Rate for Payer: Cigna of WY Commercial |
$5,194.00
|
| Rate for Payer: Entrust Commercial |
$5,035.00
|
| Rate for Payer: First Choice Health Commercial |
$5,035.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,035.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,074.00
|
| Rate for Payer: HealthUtah PPO |
$5,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,141.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,920.30
|
| Rate for Payer: One Health Plan of WY PPO |
$5,194.00
|
| Rate for Payer: PacificSource Commercial |
$4,770.00
|
| Rate for Payer: PHCS PPO |
$5,194.00
|
| Rate for Payer: Three Rivers PPO |
$3,975.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,074.00
|
| Rate for Payer: United Healthcare Commercial |
$4,611.00
|
| Rate for Payer: United Healthcare Medicare |
$3,074.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,194.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,035.00
|
|
|
HC MR ANGIO, NECK, COMBO - MR NECK ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$5,300.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
6157054901
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,323.10 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,194.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,088.00
|
| Rate for Payer: Altius Commercial |
$5,088.00
|
| Rate for Payer: Beech Street Commercial |
$5,194.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,351.30
|
| Rate for Payer: Cash Price |
$3,710.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,141.00
|
| Rate for Payer: Cigna of WY Commercial |
$5,194.00
|
| Rate for Payer: Entrust Commercial |
$5,035.00
|
| Rate for Payer: First Choice Health Commercial |
$5,035.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,035.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,498.00
|
| Rate for Payer: HealthUtah PPO |
$5,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,141.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3,323.10
|
| Rate for Payer: One Health Plan of WY PPO |
$5,194.00
|
| Rate for Payer: PacificSource Commercial |
$4,770.00
|
| Rate for Payer: PHCS PPO |
$5,194.00
|
| Rate for Payer: Three Rivers PPO |
$3,975.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,498.00
|
| Rate for Payer: United Healthcare Commercial |
$4,611.00
|
| Rate for Payer: United Healthcare Medicare |
$3,498.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,035.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,035.00
|
|
|
HC MR ANGIO, NECK - MR NECK ANGIO WO IV CONTRAST
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
6157054701
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$933.90
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$887.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$933.90
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$933.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,344.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MR ANGIO, NECK - MR NECK ANGIO WO IV CONTRAST
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
6157054701
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$779.66 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Aetna of WY Medicare |
$933.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.70
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$779.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$820.70
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$820.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MR ANGIO, NECK W/CONTRAST - MR NECK ANGIO W IV CONTRAST
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
6157054801
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,881.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,940.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,880.00
|
| Rate for Payer: Altius Commercial |
$2,880.00
|
| Rate for Payer: Beech Street Commercial |
$2,940.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,910.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,940.00
|
| Rate for Payer: Entrust Commercial |
$2,850.00
|
| Rate for Payer: First Choice Health Commercial |
$2,850.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,850.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,980.00
|
| Rate for Payer: HealthUtah PPO |
$3,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,910.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,881.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,940.00
|
| Rate for Payer: PacificSource Commercial |
$2,700.00
|
| Rate for Payer: PHCS PPO |
$2,940.00
|
| Rate for Payer: Three Rivers PPO |
$2,250.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,980.00
|
| Rate for Payer: United Healthcare Commercial |
$2,610.00
|
| Rate for Payer: United Healthcare Medicare |
$1,980.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,850.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,850.00
|
|
|
HC MR ANGIO, NECK W/CONTRAST - MR NECK ANGIO W IV CONTRAST
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
6157054801
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,653.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,940.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,980.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,880.00
|
| Rate for Payer: Altius Commercial |
$2,880.00
|
| Rate for Payer: Beech Street Commercial |
$2,940.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,910.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,940.00
|
| Rate for Payer: Entrust Commercial |
$2,850.00
|
| Rate for Payer: First Choice Health Commercial |
$2,850.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,850.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,740.00
|
| Rate for Payer: HealthUtah PPO |
$3,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,910.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,653.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,940.00
|
| Rate for Payer: PacificSource Commercial |
$2,700.00
|
| Rate for Payer: PHCS PPO |
$2,940.00
|
| Rate for Payer: Three Rivers PPO |
$2,250.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,740.00
|
| Rate for Payer: United Healthcare Commercial |
$2,610.00
|
| Rate for Payer: United Healthcare Medicare |
$1,740.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,940.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,850.00
|
|
|
HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO W AND WO IV CONTRAST
|
Facility
|
OP
|
$2,365.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
6147219802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,303.12 |
| Max. Negotiated Rate |
$2,365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,317.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,560.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,270.40
|
| Rate for Payer: Altius Commercial |
$2,270.40
|
| Rate for Payer: Beech Street Commercial |
$2,317.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,941.66
|
| Rate for Payer: Cash Price |
$1,655.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,294.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,317.70
|
| Rate for Payer: Entrust Commercial |
$2,246.75
|
| Rate for Payer: First Choice Health Commercial |
$2,246.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,246.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,371.70
|
| Rate for Payer: HealthUtah PPO |
$2,365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,294.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,303.12
|
| Rate for Payer: One Health Plan of WY PPO |
$2,317.70
|
| Rate for Payer: PacificSource Commercial |
$2,128.50
|
| Rate for Payer: PHCS PPO |
$2,317.70
|
| Rate for Payer: Three Rivers PPO |
$1,773.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,371.70
|
| Rate for Payer: United Healthcare Commercial |
$2,057.55
|
| Rate for Payer: United Healthcare Medicare |
$1,371.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,317.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,246.75
|
|
|
HC MR ANGIO PELVIS(MRA) - MR PELVIS ANGIO W AND WO IV CONTRAST
|
Facility
|
IP
|
$2,365.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
6147219802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,482.86 |
| Max. Negotiated Rate |
$2,365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,317.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,270.40
|
| Rate for Payer: Altius Commercial |
$2,270.40
|
| Rate for Payer: Beech Street Commercial |
$2,317.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,941.66
|
| Rate for Payer: Cash Price |
$1,655.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,294.05
|
| Rate for Payer: Cigna of WY Commercial |
$2,317.70
|
| Rate for Payer: Entrust Commercial |
$2,246.75
|
| Rate for Payer: First Choice Health Commercial |
$2,246.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,246.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,560.90
|
| Rate for Payer: HealthUtah PPO |
$2,365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,294.05
|
| Rate for Payer: Multiplan Medicare/VA |
$1,482.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2,317.70
|
| Rate for Payer: PacificSource Commercial |
$2,128.50
|
| Rate for Payer: PHCS PPO |
$2,317.70
|
| Rate for Payer: Three Rivers PPO |
$1,773.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,560.90
|
| Rate for Payer: United Healthcare Commercial |
$2,057.55
|
| Rate for Payer: United Healthcare Medicare |
$1,560.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,246.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,246.75
|
|
|
HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST LEFT
|
Facility
|
OP
|
$2,410.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
6107322504
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,327.91 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,361.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,590.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,313.60
|
| Rate for Payer: Altius Commercial |
$2,313.60
|
| Rate for Payer: Beech Street Commercial |
$2,361.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,978.61
|
| Rate for Payer: Cash Price |
$1,687.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,337.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,361.80
|
| Rate for Payer: Entrust Commercial |
$2,289.50
|
| Rate for Payer: First Choice Health Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,397.80
|
| Rate for Payer: HealthUtah PPO |
$2,410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,337.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,327.91
|
| Rate for Payer: One Health Plan of WY PPO |
$2,361.80
|
| Rate for Payer: PacificSource Commercial |
$2,169.00
|
| Rate for Payer: PHCS PPO |
$2,361.80
|
| Rate for Payer: Three Rivers PPO |
$1,807.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,397.80
|
| Rate for Payer: United Healthcare Commercial |
$2,096.70
|
| Rate for Payer: United Healthcare Medicare |
$1,397.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,361.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,289.50
|
|
|
HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST LEFT
|
Facility
|
IP
|
$2,410.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
6107322504
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,511.07 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,361.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,313.60
|
| Rate for Payer: Altius Commercial |
$2,313.60
|
| Rate for Payer: Beech Street Commercial |
$2,361.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,978.61
|
| Rate for Payer: Cash Price |
$1,687.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,337.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,361.80
|
| Rate for Payer: Entrust Commercial |
$2,289.50
|
| Rate for Payer: First Choice Health Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,590.60
|
| Rate for Payer: HealthUtah PPO |
$2,410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,337.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,511.07
|
| Rate for Payer: One Health Plan of WY PPO |
$2,361.80
|
| Rate for Payer: PacificSource Commercial |
$2,169.00
|
| Rate for Payer: PHCS PPO |
$2,361.80
|
| Rate for Payer: Three Rivers PPO |
$1,807.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,590.60
|
| Rate for Payer: United Healthcare Commercial |
$2,096.70
|
| Rate for Payer: United Healthcare Medicare |
$1,590.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,289.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,289.50
|
|
|
HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST RIGHT
|
Facility
|
OP
|
$2,410.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
6107322506
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,327.91 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,361.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,590.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,313.60
|
| Rate for Payer: Altius Commercial |
$2,313.60
|
| Rate for Payer: Beech Street Commercial |
$2,361.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,978.61
|
| Rate for Payer: Cash Price |
$1,687.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,337.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,361.80
|
| Rate for Payer: Entrust Commercial |
$2,289.50
|
| Rate for Payer: First Choice Health Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,397.80
|
| Rate for Payer: HealthUtah PPO |
$2,410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,337.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,327.91
|
| Rate for Payer: One Health Plan of WY PPO |
$2,361.80
|
| Rate for Payer: PacificSource Commercial |
$2,169.00
|
| Rate for Payer: PHCS PPO |
$2,361.80
|
| Rate for Payer: Three Rivers PPO |
$1,807.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,397.80
|
| Rate for Payer: United Healthcare Commercial |
$2,096.70
|
| Rate for Payer: United Healthcare Medicare |
$1,397.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,361.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,289.50
|
|
|
HC MR ANGIO UPPER EXTREM - MR UPPER EXTREMITY ANGIO W IV CONTRAST RIGHT
|
Facility
|
IP
|
$2,410.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
6107322506
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,511.07 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,361.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,313.60
|
| Rate for Payer: Altius Commercial |
$2,313.60
|
| Rate for Payer: Beech Street Commercial |
$2,361.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,978.61
|
| Rate for Payer: Cash Price |
$1,687.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,337.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,361.80
|
| Rate for Payer: Entrust Commercial |
$2,289.50
|
| Rate for Payer: First Choice Health Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,289.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,590.60
|
| Rate for Payer: HealthUtah PPO |
$2,410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,337.70
|
| Rate for Payer: Multiplan Medicare/VA |
$1,511.07
|
| Rate for Payer: One Health Plan of WY PPO |
$2,361.80
|
| Rate for Payer: PacificSource Commercial |
$2,169.00
|
| Rate for Payer: PHCS PPO |
$2,361.80
|
| Rate for Payer: Three Rivers PPO |
$1,807.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,590.60
|
| Rate for Payer: United Healthcare Commercial |
$2,096.70
|
| Rate for Payer: United Healthcare Medicare |
$1,590.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,289.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,289.50
|
|
|
HC MRA RENAL ABD +/- CONT
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
6107418503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,467.18 |
| Max. Negotiated Rate |
$2,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,293.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,246.40
|
| Rate for Payer: Altius Commercial |
$2,246.40
|
| Rate for Payer: Beech Street Commercial |
$2,293.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,921.14
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,269.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,293.20
|
| Rate for Payer: Entrust Commercial |
$2,223.00
|
| Rate for Payer: First Choice Health Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,544.40
|
| Rate for Payer: HealthUtah PPO |
$2,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,269.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,467.18
|
| Rate for Payer: One Health Plan of WY PPO |
$2,293.20
|
| Rate for Payer: PacificSource Commercial |
$2,106.00
|
| Rate for Payer: PHCS PPO |
$2,293.20
|
| Rate for Payer: Three Rivers PPO |
$1,755.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,544.40
|
| Rate for Payer: United Healthcare Commercial |
$2,035.80
|
| Rate for Payer: United Healthcare Medicare |
$1,544.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,223.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,223.00
|
|
|
HC MRA RENAL ABD +/- CONT
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
HCPCS 74185
|
| Hospital Charge Code |
6107418503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,289.34 |
| Max. Negotiated Rate |
$2,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,293.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,544.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,246.40
|
| Rate for Payer: Altius Commercial |
$2,246.40
|
| Rate for Payer: Beech Street Commercial |
$2,293.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,921.14
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,269.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,293.20
|
| Rate for Payer: Entrust Commercial |
$2,223.00
|
| Rate for Payer: First Choice Health Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,223.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,357.20
|
| Rate for Payer: HealthUtah PPO |
$2,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,269.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,289.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,293.20
|
| Rate for Payer: PacificSource Commercial |
$2,106.00
|
| Rate for Payer: PHCS PPO |
$2,293.20
|
| Rate for Payer: Three Rivers PPO |
$1,755.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,357.20
|
| Rate for Payer: United Healthcare Commercial |
$2,035.80
|
| Rate for Payer: United Healthcare Medicare |
$1,357.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,293.20
|
| Rate for Payer: Wise Provider Network Commercial |
$2,223.00
|
|
|
HC MRI, ABDOMEN, COMBO - MRI ABDOMEN RENAL W WO CONTRAST
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
6147418302
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,066.25 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,675.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,475.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,600.00
|
| Rate for Payer: Altius Commercial |
$3,600.00
|
| Rate for Payer: Beech Street Commercial |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,078.75
|
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,637.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,675.00
|
| Rate for Payer: Entrust Commercial |
$3,562.50
|
| Rate for Payer: First Choice Health Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,175.00
|
| Rate for Payer: HealthUtah PPO |
$3,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,637.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,066.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,675.00
|
| Rate for Payer: PacificSource Commercial |
$3,375.00
|
| Rate for Payer: PHCS PPO |
$3,675.00
|
| Rate for Payer: Three Rivers PPO |
$2,812.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,175.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare Medicare |
$2,175.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,675.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,562.50
|
|
|
HC MRI, ABDOMEN, COMBO - MRI ABDOMEN RENAL W WO CONTRAST
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
6147418302
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,351.25 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,675.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,600.00
|
| Rate for Payer: Altius Commercial |
$3,600.00
|
| Rate for Payer: Beech Street Commercial |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,078.75
|
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,637.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,675.00
|
| Rate for Payer: Entrust Commercial |
$3,562.50
|
| Rate for Payer: First Choice Health Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,475.00
|
| Rate for Payer: HealthUtah PPO |
$3,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,637.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,351.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,675.00
|
| Rate for Payer: PacificSource Commercial |
$3,375.00
|
| Rate for Payer: PHCS PPO |
$3,675.00
|
| Rate for Payer: Three Rivers PPO |
$2,812.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,475.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare Medicare |
$2,475.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,562.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,562.50
|
|
|
HC MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
6147418303
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,351.25 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,675.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,600.00
|
| Rate for Payer: Altius Commercial |
$3,600.00
|
| Rate for Payer: Beech Street Commercial |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,078.75
|
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,637.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,675.00
|
| Rate for Payer: Entrust Commercial |
$3,562.50
|
| Rate for Payer: First Choice Health Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,475.00
|
| Rate for Payer: HealthUtah PPO |
$3,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,637.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,351.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,675.00
|
| Rate for Payer: PacificSource Commercial |
$3,375.00
|
| Rate for Payer: PHCS PPO |
$3,675.00
|
| Rate for Payer: Three Rivers PPO |
$2,812.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,475.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare Medicare |
$2,475.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,562.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,562.50
|
|
|
HC MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
6147418303
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,066.25 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,675.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,475.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,600.00
|
| Rate for Payer: Altius Commercial |
$3,600.00
|
| Rate for Payer: Beech Street Commercial |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,078.75
|
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,637.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,675.00
|
| Rate for Payer: Entrust Commercial |
$3,562.50
|
| Rate for Payer: First Choice Health Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,175.00
|
| Rate for Payer: HealthUtah PPO |
$3,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,637.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,066.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,675.00
|
| Rate for Payer: PacificSource Commercial |
$3,375.00
|
| Rate for Payer: PHCS PPO |
$3,675.00
|
| Rate for Payer: Three Rivers PPO |
$2,812.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,175.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare Medicare |
$2,175.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,675.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,562.50
|
|
|
HC MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST MRCP
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
6147418301
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,066.25 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,675.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,475.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,600.00
|
| Rate for Payer: Altius Commercial |
$3,600.00
|
| Rate for Payer: Beech Street Commercial |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,078.75
|
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,637.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,675.00
|
| Rate for Payer: Entrust Commercial |
$3,562.50
|
| Rate for Payer: First Choice Health Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,175.00
|
| Rate for Payer: HealthUtah PPO |
$3,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,637.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,066.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,675.00
|
| Rate for Payer: PacificSource Commercial |
$3,375.00
|
| Rate for Payer: PHCS PPO |
$3,675.00
|
| Rate for Payer: Three Rivers PPO |
$2,812.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,175.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare Medicare |
$2,175.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,675.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,562.50
|
|
|
HC MRI, ABDOMEN, COMBO - MRI ABDOMEN W WO CONTRAST MRCP
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
6147418301
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,351.25 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,675.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,600.00
|
| Rate for Payer: Altius Commercial |
$3,600.00
|
| Rate for Payer: Beech Street Commercial |
$3,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,078.75
|
| Rate for Payer: Cash Price |
$2,625.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,637.50
|
| Rate for Payer: Cigna of WY Commercial |
$3,675.00
|
| Rate for Payer: Entrust Commercial |
$3,562.50
|
| Rate for Payer: First Choice Health Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,562.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,475.00
|
| Rate for Payer: HealthUtah PPO |
$3,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,637.50
|
| Rate for Payer: Multiplan Medicare/VA |
$2,351.25
|
| Rate for Payer: One Health Plan of WY PPO |
$3,675.00
|
| Rate for Payer: PacificSource Commercial |
$3,375.00
|
| Rate for Payer: PHCS PPO |
$3,675.00
|
| Rate for Payer: Three Rivers PPO |
$2,812.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,475.00
|
| Rate for Payer: United Healthcare Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare Medicare |
$2,475.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,562.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,562.50
|
|
|
HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST
|
Facility
|
OP
|
$3,580.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
6147418102
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,972.58 |
| Max. Negotiated Rate |
$3,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,508.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,362.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,436.80
|
| Rate for Payer: Altius Commercial |
$3,436.80
|
| Rate for Payer: Beech Street Commercial |
$3,508.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,939.18
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,472.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,508.40
|
| Rate for Payer: Entrust Commercial |
$3,401.00
|
| Rate for Payer: First Choice Health Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,076.40
|
| Rate for Payer: HealthUtah PPO |
$3,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,472.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,972.58
|
| Rate for Payer: One Health Plan of WY PPO |
$3,508.40
|
| Rate for Payer: PacificSource Commercial |
$3,222.00
|
| Rate for Payer: PHCS PPO |
$3,508.40
|
| Rate for Payer: Three Rivers PPO |
$2,685.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,076.40
|
| Rate for Payer: United Healthcare Commercial |
$3,114.60
|
| Rate for Payer: United Healthcare Medicare |
$2,076.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,508.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,401.00
|
|
|
HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST
|
Facility
|
IP
|
$3,580.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
6147418102
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,244.66 |
| Max. Negotiated Rate |
$3,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,508.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,436.80
|
| Rate for Payer: Altius Commercial |
$3,436.80
|
| Rate for Payer: Beech Street Commercial |
$3,508.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,939.18
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,472.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,508.40
|
| Rate for Payer: Entrust Commercial |
$3,401.00
|
| Rate for Payer: First Choice Health Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,362.80
|
| Rate for Payer: HealthUtah PPO |
$3,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,472.60
|
| Rate for Payer: Multiplan Medicare/VA |
$2,244.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,508.40
|
| Rate for Payer: PacificSource Commercial |
$3,222.00
|
| Rate for Payer: PHCS PPO |
$3,508.40
|
| Rate for Payer: Three Rivers PPO |
$2,685.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,362.80
|
| Rate for Payer: United Healthcare Commercial |
$3,114.60
|
| Rate for Payer: United Healthcare Medicare |
$2,362.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,401.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,401.00
|
|
|
HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST MRCP
|
Facility
|
IP
|
$3,580.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
6147418101
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,244.66 |
| Max. Negotiated Rate |
$3,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,508.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,436.80
|
| Rate for Payer: Altius Commercial |
$3,436.80
|
| Rate for Payer: Beech Street Commercial |
$3,508.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,939.18
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,472.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,508.40
|
| Rate for Payer: Entrust Commercial |
$3,401.00
|
| Rate for Payer: First Choice Health Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,362.80
|
| Rate for Payer: HealthUtah PPO |
$3,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,472.60
|
| Rate for Payer: Multiplan Medicare/VA |
$2,244.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,508.40
|
| Rate for Payer: PacificSource Commercial |
$3,222.00
|
| Rate for Payer: PHCS PPO |
$3,508.40
|
| Rate for Payer: Three Rivers PPO |
$2,685.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,362.80
|
| Rate for Payer: United Healthcare Commercial |
$3,114.60
|
| Rate for Payer: United Healthcare Medicare |
$2,362.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,401.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,401.00
|
|
|
HC MRI, ABDOMEN (MRI) - MRI ABDOMEN WO CONTRAST MRCP
|
Facility
|
OP
|
$3,580.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
6147418101
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,972.58 |
| Max. Negotiated Rate |
$3,580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,508.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,362.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,436.80
|
| Rate for Payer: Altius Commercial |
$3,436.80
|
| Rate for Payer: Beech Street Commercial |
$3,508.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,939.18
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,472.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,508.40
|
| Rate for Payer: Entrust Commercial |
$3,401.00
|
| Rate for Payer: First Choice Health Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,401.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,076.40
|
| Rate for Payer: HealthUtah PPO |
$3,580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,472.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,972.58
|
| Rate for Payer: One Health Plan of WY PPO |
$3,508.40
|
| Rate for Payer: PacificSource Commercial |
$3,222.00
|
| Rate for Payer: PHCS PPO |
$3,508.40
|
| Rate for Payer: Three Rivers PPO |
$2,685.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,076.40
|
| Rate for Payer: United Healthcare Commercial |
$3,114.60
|
| Rate for Payer: United Healthcare Medicare |
$2,076.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,508.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,401.00
|
|
