|
HC MRI JOINT UPR EXTREM W/DYE - MR WRIST ARTHROGRAM LEFT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322206
|
|
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 WRIST ARTHROGRAM LEFT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322206
|
|
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 WRIST ARTHROGRAM RIGHT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322201
|
|
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 WRIST ARTHROGRAM RIGHT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322201
|
|
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 WRIST LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322213
|
|
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 WRIST LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322213
|
|
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 WRIST RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322214
|
|
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 WRIST RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 73222
|
| Hospital Charge Code |
6147322214
|
|
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 EXTR W/O&W/DYE - MR ELBOW LT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322305
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,889.93 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,263.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.40
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,889.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.40
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$1,989.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,361.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR ELBOW LT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322305
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,150.61 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,263.80
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,150.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,263.80
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$2,263.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR ELBOW RT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322302
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,889.93 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,263.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.40
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,889.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.40
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$1,989.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,361.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR ELBOW RT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322302
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,150.61 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,263.80
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,150.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,263.80
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$2,263.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR SHOULDER LT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322306
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,150.61 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,263.80
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,150.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,263.80
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$2,263.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR SHOULDER LT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322306
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,889.93 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,263.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.40
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,889.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.40
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$1,989.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,361.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR SHOULDER RT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322303
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,150.61 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,263.80
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,150.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,263.80
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$2,263.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR SHOULDER RT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322303
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,889.93 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,263.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.40
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,889.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.40
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$1,989.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,361.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR WRIST LT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322304
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,889.93 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,263.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.40
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,889.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.40
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$1,989.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,361.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR WRIST LT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322304
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,150.61 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,263.80
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,150.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,263.80
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$2,263.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR WRIST RT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322301
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,150.61 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,263.80
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2,150.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,263.80
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$2,263.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI JOINT UPR EXTR W/O&W/DYE - MR WRIST RT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,430.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
6147322301
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,889.93 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,263.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,292.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,816.03
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,989.40
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,889.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,989.40
|
| Rate for Payer: United Healthcare Commercial |
$2,984.10
|
| Rate for Payer: United Healthcare Medicare |
$1,989.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,361.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
HC MRI, LOWER EXTREM - MR FEMUR LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371805
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,333.42 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,371.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,597.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,323.20
|
| Rate for Payer: Altius Commercial |
$2,323.20
|
| Rate for Payer: Beech Street Commercial |
$2,371.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,986.82
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,347.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,371.60
|
| Rate for Payer: Entrust Commercial |
$2,299.00
|
| Rate for Payer: First Choice Health Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,403.60
|
| Rate for Payer: HealthUtah PPO |
$2,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,347.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,333.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,371.60
|
| Rate for Payer: PacificSource Commercial |
$2,178.00
|
| Rate for Payer: PHCS PPO |
$2,371.60
|
| Rate for Payer: Three Rivers PPO |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,403.60
|
| Rate for Payer: United Healthcare Commercial |
$2,105.40
|
| Rate for Payer: United Healthcare Medicare |
$1,403.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,371.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,299.00
|
|
|
HC MRI, LOWER EXTREM - MR FEMUR LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371805
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,517.34 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,371.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,323.20
|
| Rate for Payer: Altius Commercial |
$2,323.20
|
| Rate for Payer: Beech Street Commercial |
$2,371.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,986.82
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,347.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,371.60
|
| Rate for Payer: Entrust Commercial |
$2,299.00
|
| Rate for Payer: First Choice Health Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,597.20
|
| Rate for Payer: HealthUtah PPO |
$2,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,347.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,517.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,371.60
|
| Rate for Payer: PacificSource Commercial |
$2,178.00
|
| Rate for Payer: PHCS PPO |
$2,371.60
|
| Rate for Payer: Three Rivers PPO |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,597.20
|
| Rate for Payer: United Healthcare Commercial |
$2,105.40
|
| Rate for Payer: United Healthcare Medicare |
$1,597.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,299.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,299.00
|
|
|
HC MRI, LOWER EXTREM - MR FEMUR RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,333.42 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,371.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,597.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,323.20
|
| Rate for Payer: Altius Commercial |
$2,323.20
|
| Rate for Payer: Beech Street Commercial |
$2,371.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,986.82
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,347.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,371.60
|
| Rate for Payer: Entrust Commercial |
$2,299.00
|
| Rate for Payer: First Choice Health Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,403.60
|
| Rate for Payer: HealthUtah PPO |
$2,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,347.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,333.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,371.60
|
| Rate for Payer: PacificSource Commercial |
$2,178.00
|
| Rate for Payer: PHCS PPO |
$2,371.60
|
| Rate for Payer: Three Rivers PPO |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,403.60
|
| Rate for Payer: United Healthcare Commercial |
$2,105.40
|
| Rate for Payer: United Healthcare Medicare |
$1,403.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,371.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,299.00
|
|
|
HC MRI, LOWER EXTREM - MR FEMUR RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371802
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,517.34 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,371.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,323.20
|
| Rate for Payer: Altius Commercial |
$2,323.20
|
| Rate for Payer: Beech Street Commercial |
$2,371.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,986.82
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,347.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,371.60
|
| Rate for Payer: Entrust Commercial |
$2,299.00
|
| Rate for Payer: First Choice Health Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,597.20
|
| Rate for Payer: HealthUtah PPO |
$2,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,347.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,517.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,371.60
|
| Rate for Payer: PacificSource Commercial |
$2,178.00
|
| Rate for Payer: PHCS PPO |
$2,371.60
|
| Rate for Payer: Three Rivers PPO |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,597.20
|
| Rate for Payer: United Healthcare Commercial |
$2,105.40
|
| Rate for Payer: United Healthcare Medicare |
$1,597.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,299.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,299.00
|
|
|
HC MRI, LOWER EXTREM - MR FOOT LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371806
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,333.42 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,371.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,597.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,323.20
|
| Rate for Payer: Altius Commercial |
$2,323.20
|
| Rate for Payer: Beech Street Commercial |
$2,371.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,986.82
|
| Rate for Payer: Cash Price |
$1,694.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,347.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,371.60
|
| Rate for Payer: Entrust Commercial |
$2,299.00
|
| Rate for Payer: First Choice Health Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,299.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,403.60
|
| Rate for Payer: HealthUtah PPO |
$2,420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,347.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,333.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,371.60
|
| Rate for Payer: PacificSource Commercial |
$2,178.00
|
| Rate for Payer: PHCS PPO |
$2,371.60
|
| Rate for Payer: Three Rivers PPO |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,403.60
|
| Rate for Payer: United Healthcare Commercial |
$2,105.40
|
| Rate for Payer: United Healthcare Medicare |
$1,403.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,371.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,299.00
|
|
