|
HC MRI, JOINT OF LEG. COMBO - MR ANKLE RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372305
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,116.12 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,227.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,116.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$2,227.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,206.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR ANKLE RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372305
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,859.62 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,227.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,957.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,859.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,957.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$1,957.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR HIP LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372302
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,859.62 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,227.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,957.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,859.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,957.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$1,957.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR HIP LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372302
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,116.12 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,227.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,116.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$2,227.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,206.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR HIP RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372301
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,116.12 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,227.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,116.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$2,227.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,206.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR HIP RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372301
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,859.62 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,227.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,957.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,859.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,957.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$1,957.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR KNEE LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372304
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,859.62 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,227.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,957.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,859.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,957.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$1,957.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR KNEE LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372304
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,116.12 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,227.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,116.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$2,227.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,206.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR KNEE RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372303
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,116.12 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,227.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,116.12
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$2,227.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,206.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG. COMBO - MR KNEE RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
6147372303
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,859.62 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,307.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,227.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,240.00
|
| Rate for Payer: Altius Commercial |
$3,240.00
|
| Rate for Payer: Beech Street Commercial |
$3,307.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,770.88
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,273.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,307.50
|
| Rate for Payer: Entrust Commercial |
$3,206.25
|
| Rate for Payer: First Choice Health Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,206.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,957.50
|
| Rate for Payer: HealthUtah PPO |
$3,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,273.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1,859.62
|
| Rate for Payer: One Health Plan of WY PPO |
$3,307.50
|
| Rate for Payer: PacificSource Commercial |
$3,037.50
|
| Rate for Payer: PHCS PPO |
$3,307.50
|
| Rate for Payer: Three Rivers PPO |
$2,531.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,957.50
|
| Rate for Payer: United Healthcare Commercial |
$2,936.25
|
| Rate for Payer: United Healthcare Medicare |
$1,957.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,307.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,206.25
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - CT KNEE ARTHROGRAM RIGHT
|
Facility
|
OP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
3527372204
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,110.33 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,527.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,221.40
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,110.33
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,221.40
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,221.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,753.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - CT KNEE ARTHROGRAM RIGHT
|
Facility
|
IP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
3527372204
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,401.41 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,527.80
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,401.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,527.80
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,527.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,638.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR ANKLE ARTHROGRAM LEFT
|
Facility
|
OP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372207
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,110.33 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,527.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,221.40
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,110.33
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,221.40
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,221.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,753.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR ANKLE ARTHROGRAM LEFT
|
Facility
|
IP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372207
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,401.41 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,527.80
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,401.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,527.80
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,527.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,638.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR ANKLE ARTHROGRAM RIGHT
|
Facility
|
IP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372208
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,401.41 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,527.80
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,401.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,527.80
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,527.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,638.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR ANKLE ARTHROGRAM RIGHT
|
Facility
|
OP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372208
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,110.33 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,527.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,221.40
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,110.33
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,221.40
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,221.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,753.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR HIP ARTHROGRAM LEFT
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372202
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR HIP ARTHROGRAM LEFT
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372202
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR HIP ARTHROGRAM RIGHT
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372204
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,085.47 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,300.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,142.60
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,085.47
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,142.60
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,142.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,930.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR HIP ARTHROGRAM RIGHT
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372204
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,235.19 |
| Max. Negotiated Rate |
$1,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,930.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,891.20
|
| Rate for Payer: Altius Commercial |
$1,891.20
|
| Rate for Payer: Beech Street Commercial |
$1,930.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,617.37
|
| Rate for Payer: Cash Price |
$1,379.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,910.90
|
| Rate for Payer: Cigna of WY Commercial |
$1,930.60
|
| Rate for Payer: Entrust Commercial |
$1,871.50
|
| Rate for Payer: First Choice Health Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,871.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,300.20
|
| Rate for Payer: HealthUtah PPO |
$1,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,910.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,235.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,930.60
|
| Rate for Payer: PacificSource Commercial |
$1,773.00
|
| Rate for Payer: PHCS PPO |
$1,930.60
|
| Rate for Payer: Three Rivers PPO |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,300.20
|
| Rate for Payer: United Healthcare Commercial |
$1,713.90
|
| Rate for Payer: United Healthcare Medicare |
$1,300.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,871.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,871.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR KNEE ARTHROGRAM RIGHT
|
Facility
|
IP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372203
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,401.41 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,527.80
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,401.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,527.80
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,527.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,638.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT OF LEG W/CONTRAST - MR KNEE ARTHROGRAM RIGHT
|
Facility
|
OP
|
$3,830.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
6147372203
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,110.33 |
| Max. Negotiated Rate |
$3,830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,753.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,527.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,676.80
|
| Rate for Payer: Altius Commercial |
$3,676.80
|
| Rate for Payer: Beech Street Commercial |
$3,753.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,144.43
|
| Rate for Payer: Cash Price |
$2,681.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,715.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,753.40
|
| Rate for Payer: Entrust Commercial |
$3,638.50
|
| Rate for Payer: First Choice Health Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,638.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,221.40
|
| Rate for Payer: HealthUtah PPO |
$3,830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,715.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,110.33
|
| Rate for Payer: One Health Plan of WY PPO |
$3,753.40
|
| Rate for Payer: PacificSource Commercial |
$3,447.00
|
| Rate for Payer: PHCS PPO |
$3,753.40
|
| Rate for Payer: Three Rivers PPO |
$2,872.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,221.40
|
| Rate for Payer: United Healthcare Commercial |
$3,332.10
|
| Rate for Payer: United Healthcare Medicare |
$2,221.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,753.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,638.50
|
|
|
HC MRI, JOINT UPPER EXTREM - MR ELBOW LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322104
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,495.40 |
| Max. Negotiated Rate |
$2,385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,337.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,289.60
|
| Rate for Payer: Altius Commercial |
$2,289.60
|
| Rate for Payer: Beech Street Commercial |
$2,337.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,958.08
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,313.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,337.30
|
| Rate for Payer: Entrust Commercial |
$2,265.75
|
| Rate for Payer: First Choice Health Commercial |
$2,265.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,265.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,574.10
|
| Rate for Payer: HealthUtah PPO |
$2,385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,313.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,495.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,337.30
|
| Rate for Payer: PacificSource Commercial |
$2,146.50
|
| Rate for Payer: PHCS PPO |
$2,337.30
|
| Rate for Payer: Three Rivers PPO |
$1,788.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,574.10
|
| Rate for Payer: United Healthcare Commercial |
$2,074.95
|
| Rate for Payer: United Healthcare Medicare |
$1,574.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,265.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,265.75
|
|
|
HC MRI, JOINT UPPER EXTREM - MR ELBOW LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322104
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,314.14 |
| Max. Negotiated Rate |
$2,385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,337.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,574.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,289.60
|
| Rate for Payer: Altius Commercial |
$2,289.60
|
| Rate for Payer: Beech Street Commercial |
$2,337.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,958.08
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,313.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,337.30
|
| Rate for Payer: Entrust Commercial |
$2,265.75
|
| Rate for Payer: First Choice Health Commercial |
$2,265.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,265.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,383.30
|
| Rate for Payer: HealthUtah PPO |
$2,385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,313.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,314.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,337.30
|
| Rate for Payer: PacificSource Commercial |
$2,146.50
|
| Rate for Payer: PHCS PPO |
$2,337.30
|
| Rate for Payer: Three Rivers PPO |
$1,788.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,383.30
|
| Rate for Payer: United Healthcare Commercial |
$2,074.95
|
| Rate for Payer: United Healthcare Medicare |
$1,383.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,337.30
|
| Rate for Payer: Wise Provider Network Commercial |
$2,265.75
|
|
|
HC MRI, JOINT UPPER EXTREM - MR ELBOW RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322103
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,314.14 |
| Max. Negotiated Rate |
$2,385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,337.30
|
| Rate for Payer: Aetna of WY Medicare |
$1,574.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,289.60
|
| Rate for Payer: Altius Commercial |
$2,289.60
|
| Rate for Payer: Beech Street Commercial |
$2,337.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,958.08
|
| Rate for Payer: Cash Price |
$1,669.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,313.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,337.30
|
| Rate for Payer: Entrust Commercial |
$2,265.75
|
| Rate for Payer: First Choice Health Commercial |
$2,265.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,265.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,383.30
|
| Rate for Payer: HealthUtah PPO |
$2,385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,313.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,314.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,337.30
|
| Rate for Payer: PacificSource Commercial |
$2,146.50
|
| Rate for Payer: PHCS PPO |
$2,337.30
|
| Rate for Payer: Three Rivers PPO |
$1,788.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,383.30
|
| Rate for Payer: United Healthcare Commercial |
$2,074.95
|
| Rate for Payer: United Healthcare Medicare |
$1,383.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,337.30
|
| Rate for Payer: Wise Provider Network Commercial |
$2,265.75
|
|
