|
HC MRI, LUMBAR SPINE CONTRAST - MRI LUMBAR SPINE W CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
6127214901
|
|
Hospital Revenue Code
|
612
|
| 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 CONTRAST - MRI LUMBAR SPINE W CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
6127214901
|
|
Hospital Revenue Code
|
612
|
| 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, LUMBAR SPINE - MRI LUMBAR SPINE WO CONTRAST
|
Facility
|
IP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
6127214802
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,642.74 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,567.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,515.20
|
| Rate for Payer: Altius Commercial |
$2,515.20
|
| Rate for Payer: Beech Street Commercial |
$2,567.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,151.02
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,541.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,567.60
|
| Rate for Payer: Entrust Commercial |
$2,489.00
|
| Rate for Payer: First Choice Health Commercial |
$2,489.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,489.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,729.20
|
| Rate for Payer: HealthUtah PPO |
$2,620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,541.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,642.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,567.60
|
| Rate for Payer: PacificSource Commercial |
$2,358.00
|
| Rate for Payer: PHCS PPO |
$2,567.60
|
| Rate for Payer: Three Rivers PPO |
$1,965.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,729.20
|
| Rate for Payer: United Healthcare Commercial |
$2,279.40
|
| Rate for Payer: United Healthcare Medicare |
$1,729.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,489.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,489.00
|
|
|
HC MRI, LUMBAR SPINE - MRI LUMBAR SPINE WO CONTRAST
|
Facility
|
OP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 72148
|
| Hospital Charge Code |
6127214802
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,443.62 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,567.60
|
| Rate for Payer: Aetna of WY Medicare |
$1,729.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,515.20
|
| Rate for Payer: Altius Commercial |
$2,515.20
|
| Rate for Payer: Beech Street Commercial |
$2,567.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,151.02
|
| Rate for Payer: Cash Price |
$1,834.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,541.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,567.60
|
| Rate for Payer: Entrust Commercial |
$2,489.00
|
| Rate for Payer: First Choice Health Commercial |
$2,489.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,489.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,519.60
|
| Rate for Payer: HealthUtah PPO |
$2,620.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,541.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,443.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,567.60
|
| Rate for Payer: PacificSource Commercial |
$2,358.00
|
| Rate for Payer: PHCS PPO |
$2,567.60
|
| Rate for Payer: Three Rivers PPO |
$1,965.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,519.60
|
| Rate for Payer: United Healthcare Commercial |
$2,279.40
|
| Rate for Payer: United Healthcare Medicare |
$1,519.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,567.60
|
| Rate for Payer: Wise Provider Network Commercial |
$2,489.00
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FEMUR LT W AND WO IV CONT
|
Facility
|
IP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372006
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,285.42 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,405.70
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,285.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,405.70
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,405.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FEMUR LT W AND WO IV CONT
|
Facility
|
OP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372006
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Aetna of WY Medicare |
$2,405.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,008.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,114.10
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,572.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FEMUR RT W AND WO IV CONT
|
Facility
|
IP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372003
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,285.42 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,405.70
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,285.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,405.70
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,405.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FEMUR RT W AND WO IV CONT
|
Facility
|
OP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372003
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Aetna of WY Medicare |
$2,405.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,008.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,114.10
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,572.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FOOT LT W AND WO IV CONT
|
Facility
|
OP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372004
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Aetna of WY Medicare |
$2,405.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,008.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,114.10
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,572.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FOOT LT W AND WO IV CONT
|
Facility
|
IP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372004
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,285.42 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,405.70
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,285.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,405.70
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,405.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FOOT RT W AND WO IV CONT
|
Facility
|
IP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372001
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,285.42 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,405.70
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,285.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,405.70
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,405.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR FOOT RT W AND WO IV CONT
|
Facility
|
OP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372001
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Aetna of WY Medicare |
$2,405.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,008.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,114.10
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,572.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR TIBIA FIBULA LT W AND WO IV CONT
|
Facility
|
IP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372005
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,285.42 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,405.70
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,285.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,405.70
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,405.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR TIBIA FIBULA LT W AND WO IV CONT
|
Facility
|
OP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372005
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Aetna of WY Medicare |
$2,405.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,008.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,114.10
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,572.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR TIBIA FIBULA RT W AND WO IV CONT
|
Facility
|
OP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372002
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,008.40 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Aetna of WY Medicare |
$2,405.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,114.10
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,008.40
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,114.10
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,114.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,572.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI LWR EXTREMITY W/O&W/DYE - MR TIBIA FIBULA RT W AND WO IV CONT
|
Facility
|
IP
|
$3,645.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
6147372002
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,285.42 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,572.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,499.20
|
| Rate for Payer: Altius Commercial |
$3,499.20
|
| Rate for Payer: Beech Street Commercial |
$3,572.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,992.54
|
| Rate for Payer: Cash Price |
$2,551.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,535.65
|
| Rate for Payer: Cigna of WY Commercial |
$3,572.10
|
| Rate for Payer: Entrust Commercial |
$3,462.75
|
| Rate for Payer: First Choice Health Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,462.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,405.70
|
| Rate for Payer: HealthUtah PPO |
$3,645.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,535.65
|
| Rate for Payer: Multiplan Medicare/VA |
$2,285.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,572.10
|
| Rate for Payer: PacificSource Commercial |
$3,280.50
|
| Rate for Payer: PHCS PPO |
$3,572.10
|
| Rate for Payer: Three Rivers PPO |
$2,733.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,405.70
|
| Rate for Payer: United Healthcare Commercial |
$3,171.15
|
| Rate for Payer: United Healthcare Medicare |
$2,405.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,462.75
|
| Rate for Payer: Wise Provider Network Commercial |
$3,462.75
|
|
|
HC MRI, PELVIS, COMBO - MRI PELVIS W WO CONTRAST
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
6147219701
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,906.46 |
| Max. Negotiated Rate |
$3,460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,390.80
|
| Rate for Payer: Aetna of WY Medicare |
$2,283.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,321.60
|
| Rate for Payer: Altius Commercial |
$3,321.60
|
| Rate for Payer: Beech Street Commercial |
$3,390.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,840.66
|
| Rate for Payer: Cash Price |
$2,422.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,356.20
|
| Rate for Payer: Cigna of WY Commercial |
$3,390.80
|
| Rate for Payer: Entrust Commercial |
$3,287.00
|
| Rate for Payer: First Choice Health Commercial |
$3,287.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,287.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,006.80
|
| Rate for Payer: HealthUtah PPO |
$3,460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,356.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,906.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3,390.80
|
| Rate for Payer: PacificSource Commercial |
$3,114.00
|
| Rate for Payer: PHCS PPO |
$3,390.80
|
| Rate for Payer: Three Rivers PPO |
$2,595.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,006.80
|
| Rate for Payer: United Healthcare Commercial |
$3,010.20
|
| Rate for Payer: United Healthcare Medicare |
$2,006.80
|
| Rate for Payer: WINHealth Partners Commercial |
$3,390.80
|
| Rate for Payer: Wise Provider Network Commercial |
$3,287.00
|
|
|
HC MRI, PELVIS, COMBO - MRI PELVIS W WO CONTRAST
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
6147219701
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,169.42 |
| Max. Negotiated Rate |
$3,460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,390.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,321.60
|
| Rate for Payer: Altius Commercial |
$3,321.60
|
| Rate for Payer: Beech Street Commercial |
$3,390.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,840.66
|
| Rate for Payer: Cash Price |
$2,422.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,356.20
|
| Rate for Payer: Cigna of WY Commercial |
$3,390.80
|
| Rate for Payer: Entrust Commercial |
$3,287.00
|
| Rate for Payer: First Choice Health Commercial |
$3,287.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,287.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,283.60
|
| Rate for Payer: HealthUtah PPO |
$3,460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,356.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2,169.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,390.80
|
| Rate for Payer: PacificSource Commercial |
$3,114.00
|
| Rate for Payer: PHCS PPO |
$3,390.80
|
| Rate for Payer: Three Rivers PPO |
$2,595.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,283.60
|
| Rate for Payer: United Healthcare Commercial |
$3,010.20
|
| Rate for Payer: United Healthcare Medicare |
$2,283.60
|
| Rate for Payer: WINHealth Partners Commercial |
$3,287.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,287.00
|
|
|
HC MRI, PELVIS W/CONTRAST - MRI PELVIS W CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
6147219601
|
|
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, PELVIS W/CONTRAST - MRI PELVIS W CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 72196
|
| Hospital Charge Code |
6147219601
|
|
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, PELVIS, W/O CONTRAST - MRI PELVIS WO CONTRAST
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
6147219501
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,630.20 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,496.00
|
| Rate for Payer: Altius Commercial |
$2,496.00
|
| Rate for Payer: Beech Street Commercial |
$2,548.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,134.60
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: Entrust Commercial |
$2,470.00
|
| Rate for Payer: First Choice Health Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,716.00
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,630.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,548.00
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,716.00
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$1,716.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,470.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,470.00
|
|
|
HC MRI, PELVIS, W/O CONTRAST - MRI PELVIS WO CONTRAST
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
6147219501
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,432.60 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,716.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,496.00
|
| Rate for Payer: Altius Commercial |
$2,496.00
|
| Rate for Payer: Beech Street Commercial |
$2,548.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,134.60
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: Entrust Commercial |
$2,470.00
|
| Rate for Payer: First Choice Health Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,508.00
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,432.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,548.00
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,508.00
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$1,508.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,548.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2,470.00
|
|
|
HC MRI, TMJ - MR TEMPOROMANDIBULAR JOINTS WO IV CONTRAST
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
6147033601
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$971.85 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,519.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,488.00
|
| Rate for Payer: Altius Commercial |
$1,488.00
|
| Rate for Payer: Beech Street Commercial |
$1,519.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,272.55
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,503.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,519.00
|
| Rate for Payer: Entrust Commercial |
$1,472.50
|
| Rate for Payer: First Choice Health Commercial |
$1,472.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,472.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,023.00
|
| Rate for Payer: HealthUtah PPO |
$1,550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,503.50
|
| Rate for Payer: Multiplan Medicare/VA |
$971.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,519.00
|
| Rate for Payer: PacificSource Commercial |
$1,395.00
|
| Rate for Payer: PHCS PPO |
$1,519.00
|
| Rate for Payer: Three Rivers PPO |
$1,162.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,023.00
|
| Rate for Payer: United Healthcare Commercial |
$1,348.50
|
| Rate for Payer: United Healthcare Medicare |
$1,023.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,472.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,472.50
|
|
|
HC MRI, TMJ - MR TEMPOROMANDIBULAR JOINTS WO IV CONTRAST
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 70336
|
| Hospital Charge Code |
6147033601
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$854.05 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,519.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,023.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,488.00
|
| Rate for Payer: Altius Commercial |
$1,488.00
|
| Rate for Payer: Beech Street Commercial |
$1,519.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,272.55
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,503.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,519.00
|
| Rate for Payer: Entrust Commercial |
$1,472.50
|
| Rate for Payer: First Choice Health Commercial |
$1,472.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,472.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$899.00
|
| Rate for Payer: HealthUtah PPO |
$1,550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,503.50
|
| Rate for Payer: Multiplan Medicare/VA |
$854.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,519.00
|
| Rate for Payer: PacificSource Commercial |
$1,395.00
|
| Rate for Payer: PHCS PPO |
$1,519.00
|
| Rate for Payer: Three Rivers PPO |
$1,162.50
|
| Rate for Payer: TriWest Veterans Administration |
$899.00
|
| Rate for Payer: United Healthcare Commercial |
$1,348.50
|
| Rate for Payer: United Healthcare Medicare |
$899.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,519.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,472.50
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR FOREARM LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322002
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,407.68 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,763.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,686.40
|
| Rate for Payer: Altius Commercial |
$3,686.40
|
| Rate for Payer: Beech Street Commercial |
$3,763.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,152.64
|
| Rate for Payer: Cash Price |
$2,688.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,724.80
|
| Rate for Payer: Cigna of WY Commercial |
$3,763.20
|
| Rate for Payer: Entrust Commercial |
$3,648.00
|
| Rate for Payer: First Choice Health Commercial |
$3,648.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,648.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,534.40
|
| Rate for Payer: HealthUtah PPO |
$3,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,724.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,407.68
|
| Rate for Payer: One Health Plan of WY PPO |
$3,763.20
|
| Rate for Payer: PacificSource Commercial |
$3,456.00
|
| Rate for Payer: PHCS PPO |
$3,763.20
|
| Rate for Payer: Three Rivers PPO |
$2,880.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,534.40
|
| Rate for Payer: United Healthcare Commercial |
$3,340.80
|
| Rate for Payer: United Healthcare Medicare |
$2,534.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,648.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,648.00
|
|
