|
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
|
|
|
HC MRI, LOWER EXTREM - MR FOOT RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371803
|
|
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 FOOT RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371803
|
|
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 - MRI ANKLE LEFT W WO CONTRAST
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371808
|
|
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 - MRI ANKLE LEFT W WO CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371808
|
|
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 - MRI ANKLE RIGHT W WO CONTRAST
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371807
|
|
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 - MRI ANKLE RIGHT W WO CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371807
|
|
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 TIBIA FIBULA LEFT WO IV CONTRAST
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371804
|
|
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 TIBIA FIBULA LEFT WO IV CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371804
|
|
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 TIBIA FIBULA RIGHT WO IV CONTRAST
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371801
|
|
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 TIBIA FIBULA RIGHT WO IV CONTRAST
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
6147371801
|
|
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 W/CONTRAST - MR FEMUR LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371905
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,245.26 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,491.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,310.80
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,245.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,310.80
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,310.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,214.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR FEMUR LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371905
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,417.02 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,491.60
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,491.60
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,491.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR FEMUR RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371906
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,417.02 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,491.60
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,491.60
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,491.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR FEMUR RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371906
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,245.26 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,491.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,310.80
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,245.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,310.80
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,310.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,214.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR FOOT LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371902
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,417.02 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,491.60
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,491.60
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,491.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR FOOT LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371902
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,245.26 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,491.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,310.80
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,245.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,310.80
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,310.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,214.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR FOOT RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371901
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,417.02 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,491.60
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,491.60
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,491.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR FOOT RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371901
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,245.26 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,491.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,310.80
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,245.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,310.80
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,310.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,214.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR TIBIA FIBULA LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371904
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,245.26 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,491.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,310.80
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,245.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,310.80
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,310.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,214.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR TIBIA FIBULA LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371904
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,417.02 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,491.60
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,491.60
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,491.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR TIBIA FIBULA RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371903
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,245.26 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,491.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,310.80
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,245.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,310.80
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,310.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,214.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LOWER EXTREM W/CONTRAST - MR TIBIA FIBULA RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
6147371903
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,417.02 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,214.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,169.60
|
| Rate for Payer: Altius Commercial |
$2,169.60
|
| Rate for Payer: Beech Street Commercial |
$2,214.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,855.46
|
| Rate for Payer: Cash Price |
$1,582.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,192.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,214.80
|
| Rate for Payer: Entrust Commercial |
$2,147.00
|
| Rate for Payer: First Choice Health Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,147.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,491.60
|
| Rate for Payer: HealthUtah PPO |
$2,260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,192.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,214.80
|
| Rate for Payer: PacificSource Commercial |
$2,034.00
|
| Rate for Payer: PHCS PPO |
$2,214.80
|
| Rate for Payer: Three Rivers PPO |
$1,695.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,491.60
|
| Rate for Payer: United Healthcare Commercial |
$1,966.20
|
| Rate for Payer: United Healthcare Medicare |
$1,491.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,147.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,147.00
|
|
|
HC MRI, LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST
|
Facility
|
OP
|
$4,215.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
6127215801
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,322.46 |
| Max. Negotiated Rate |
$4,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,130.70
|
| Rate for Payer: Aetna of WY Medicare |
$2,781.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,046.40
|
| Rate for Payer: Altius Commercial |
$4,046.40
|
| Rate for Payer: Beech Street Commercial |
$4,130.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,460.52
|
| Rate for Payer: Cash Price |
$2,950.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,088.55
|
| Rate for Payer: Cigna of WY Commercial |
$4,130.70
|
| Rate for Payer: Entrust Commercial |
$4,004.25
|
| Rate for Payer: First Choice Health Commercial |
$4,004.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,004.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,444.70
|
| Rate for Payer: HealthUtah PPO |
$4,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,088.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2,322.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4,130.70
|
| Rate for Payer: PacificSource Commercial |
$3,793.50
|
| Rate for Payer: PHCS PPO |
$4,130.70
|
| Rate for Payer: Three Rivers PPO |
$3,161.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,444.70
|
| Rate for Payer: United Healthcare Commercial |
$3,667.05
|
| Rate for Payer: United Healthcare Medicare |
$2,444.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,130.70
|
| Rate for Payer: Wise Provider Network Commercial |
$4,004.25
|
|
|
HC MRI, LUMBAR SPINE COMBO - MRI LUMBAR SPINE W WO CONTRAST
|
Facility
|
IP
|
$4,215.00
|
|
|
Service Code
|
HCPCS 72158
|
| Hospital Charge Code |
6127215801
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,642.80 |
| Max. Negotiated Rate |
$4,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,130.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,046.40
|
| Rate for Payer: Altius Commercial |
$4,046.40
|
| Rate for Payer: Beech Street Commercial |
$4,130.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,460.52
|
| Rate for Payer: Cash Price |
$2,950.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,088.55
|
| Rate for Payer: Cigna of WY Commercial |
$4,130.70
|
| Rate for Payer: Entrust Commercial |
$4,004.25
|
| Rate for Payer: First Choice Health Commercial |
$4,004.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,004.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,781.90
|
| Rate for Payer: HealthUtah PPO |
$4,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,088.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2,642.80
|
| Rate for Payer: One Health Plan of WY PPO |
$4,130.70
|
| Rate for Payer: PacificSource Commercial |
$3,793.50
|
| Rate for Payer: PHCS PPO |
$4,130.70
|
| Rate for Payer: Three Rivers PPO |
$3,161.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,781.90
|
| Rate for Payer: United Healthcare Commercial |
$3,667.05
|
| Rate for Payer: United Healthcare Medicare |
$2,781.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,004.25
|
| Rate for Payer: Wise Provider Network Commercial |
$4,004.25
|
|
