|
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
|
|
|
HC MRI, JOINT UPPER EXTREM - MR SHOULDER LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322106
|
|
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 SHOULDER LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322106
|
|
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 SHOULDER RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322105
|
|
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 SHOULDER RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322105
|
|
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 WRIST LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322102
|
|
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 WRIST LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322102
|
|
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 WRIST RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322101
|
|
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 WRIST RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 73221
|
| Hospital Charge Code |
6147322101
|
|
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 UPR EXTREM W/DYE - CT SHOULDER ARTHROGRAM LEFT
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
3527322201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$785.18 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,396.50
|
| Rate for Payer: Aetna of WY Medicare |
$940.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,368.00
|
| Rate for Payer: Altius Commercial |
$1,368.00
|
| Rate for Payer: Beech Street Commercial |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,169.92
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,382.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,396.50
|
| Rate for Payer: Entrust Commercial |
$1,353.75
|
| Rate for Payer: First Choice Health Commercial |
$1,353.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,353.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$826.50
|
| Rate for Payer: HealthUtah PPO |
$1,425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,382.25
|
| Rate for Payer: Multiplan Medicare/VA |
$785.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,396.50
|
| Rate for Payer: PacificSource Commercial |
$1,282.50
|
| Rate for Payer: PHCS PPO |
$1,396.50
|
| Rate for Payer: Three Rivers PPO |
$1,068.75
|
| Rate for Payer: TriWest Veterans Administration |
$826.50
|
| Rate for Payer: United Healthcare Commercial |
$1,239.75
|
| Rate for Payer: United Healthcare Medicare |
$826.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,396.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,353.75
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - CT SHOULDER ARTHROGRAM LEFT
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
3527322201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$893.48 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,396.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,368.00
|
| Rate for Payer: Altius Commercial |
$1,368.00
|
| Rate for Payer: Beech Street Commercial |
$1,396.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,169.92
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,382.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,396.50
|
| Rate for Payer: Entrust Commercial |
$1,353.75
|
| Rate for Payer: First Choice Health Commercial |
$1,353.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,353.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$940.50
|
| Rate for Payer: HealthUtah PPO |
$1,425.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,382.25
|
| Rate for Payer: Multiplan Medicare/VA |
$893.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,396.50
|
| Rate for Payer: PacificSource Commercial |
$1,282.50
|
| Rate for Payer: PHCS PPO |
$1,396.50
|
| Rate for Payer: Three Rivers PPO |
$1,068.75
|
| Rate for Payer: TriWest Veterans Administration |
$940.50
|
| Rate for Payer: United Healthcare Commercial |
$1,239.75
|
| Rate for Payer: United Healthcare Medicare |
$940.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,353.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,353.75
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - CT SHOULDER ARTHROGRAM RIGHT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
3527322202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$940.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$990.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$940.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$990.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - CT SHOULDER ARTHROGRAM RIGHT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
3527322202
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$826.50 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,470.00
|
| Rate for Payer: Aetna of WY Medicare |
$990.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,440.00
|
| Rate for Payer: Altius Commercial |
$1,440.00
|
| Rate for Payer: Beech Street Commercial |
$1,470.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,231.50
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,455.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,470.00
|
| Rate for Payer: Entrust Commercial |
$1,425.00
|
| Rate for Payer: First Choice Health Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,425.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$870.00
|
| Rate for Payer: HealthUtah PPO |
$1,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,455.00
|
| Rate for Payer: Multiplan Medicare/VA |
$826.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,470.00
|
| Rate for Payer: PacificSource Commercial |
$1,350.00
|
| Rate for Payer: PHCS PPO |
$1,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,125.00
|
| Rate for Payer: TriWest Veterans Administration |
$870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,305.00
|
| Rate for Payer: United Healthcare Medicare |
$870.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,425.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR ELBOW LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322209
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,360.97 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,420.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,630.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,371.20
|
| Rate for Payer: Altius Commercial |
$2,371.20
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,027.87
|
| Rate for Payer: Cash Price |
$1,729.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,395.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,420.60
|
| Rate for Payer: Entrust Commercial |
$2,346.50
|
| Rate for Payer: First Choice Health Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,432.60
|
| Rate for Payer: HealthUtah PPO |
$2,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,395.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,360.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,420.60
|
| Rate for Payer: PacificSource Commercial |
$2,223.00
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,432.60
|
| Rate for Payer: United Healthcare Commercial |
$2,148.90
|
| Rate for Payer: United Healthcare Medicare |
$1,432.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,420.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,346.50
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR ELBOW LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322209
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,548.69 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,420.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,371.20
|
| Rate for Payer: Altius Commercial |
$2,371.20
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,027.87
|
| Rate for Payer: Cash Price |
$1,729.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,395.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,420.60
|
| Rate for Payer: Entrust Commercial |
$2,346.50
|
| Rate for Payer: First Choice Health Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,630.20
|
| Rate for Payer: HealthUtah PPO |
$2,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,395.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,548.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,420.60
|
| Rate for Payer: PacificSource Commercial |
$2,223.00
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,630.20
|
| Rate for Payer: United Healthcare Commercial |
$2,148.90
|
| Rate for Payer: United Healthcare Medicare |
$1,630.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,346.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,346.50
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR ELBOW RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322207
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,548.69 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,420.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,371.20
|
| Rate for Payer: Altius Commercial |
$2,371.20
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,027.87
|
| Rate for Payer: Cash Price |
$1,729.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,395.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,420.60
|
| Rate for Payer: Entrust Commercial |
$2,346.50
|
| Rate for Payer: First Choice Health Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,630.20
|
| Rate for Payer: HealthUtah PPO |
$2,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,395.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,548.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2,420.60
|
| Rate for Payer: PacificSource Commercial |
$2,223.00
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,630.20
|
| Rate for Payer: United Healthcare Commercial |
$2,148.90
|
| Rate for Payer: United Healthcare Medicare |
$1,630.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,346.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,346.50
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR ELBOW RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322207
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,360.97 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,420.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,630.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,371.20
|
| Rate for Payer: Altius Commercial |
$2,371.20
|
| Rate for Payer: Beech Street Commercial |
$2,420.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,027.87
|
| Rate for Payer: Cash Price |
$1,729.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,395.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,420.60
|
| Rate for Payer: Entrust Commercial |
$2,346.50
|
| Rate for Payer: First Choice Health Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,346.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,432.60
|
| Rate for Payer: HealthUtah PPO |
$2,470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,395.90
|
| Rate for Payer: Multiplan Medicare/VA |
$1,360.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,420.60
|
| Rate for Payer: PacificSource Commercial |
$2,223.00
|
| Rate for Payer: PHCS PPO |
$2,420.60
|
| Rate for Payer: Three Rivers PPO |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,432.60
|
| Rate for Payer: United Healthcare Commercial |
$2,148.90
|
| Rate for Payer: United Healthcare Medicare |
$1,432.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,420.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,346.50
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER ARTHROGRAM LEFT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322205
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,102.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,320.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,160.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,102.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,160.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,160.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER ARTHROGRAM LEFT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322205
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,320.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,254.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,320.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,320.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,900.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER ARTHROGRAM RIGHT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322203
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,102.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,320.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,160.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,102.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,160.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,160.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER ARTHROGRAM RIGHT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322203
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,320.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,254.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,320.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,320.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,900.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,102.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,320.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,160.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,102.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,160.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,160.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322210
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,320.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,254.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,320.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,320.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,900.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322208
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,320.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,254.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,320.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,320.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,900.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
|
HC MRI JOINT UPR EXTREM W/DYE - MR SHOULDER RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322208
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,102.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,960.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,320.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,920.00
|
| Rate for Payer: Altius Commercial |
$1,920.00
|
| Rate for Payer: Beech Street Commercial |
$1,960.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,642.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,940.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,960.00
|
| Rate for Payer: Entrust Commercial |
$1,900.00
|
| Rate for Payer: First Choice Health Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,900.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,160.00
|
| Rate for Payer: HealthUtah PPO |
$2,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,940.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,102.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,960.00
|
| Rate for Payer: PacificSource Commercial |
$1,800.00
|
| Rate for Payer: PHCS PPO |
$1,960.00
|
| Rate for Payer: Three Rivers PPO |
$1,500.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,160.00
|
| Rate for Payer: United Healthcare Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare Medicare |
$1,160.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,900.00
|
|
