|
HC MRI UPPER EXTREMITY COMBO - MR FOREARM LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322002
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,115.84 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,763.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,534.40
|
| 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 |
$2,227.20
|
| Rate for Payer: HealthUtah PPO |
$3,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,724.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,115.84
|
| 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 |
$2,227.20
|
| Rate for Payer: United Healthcare Commercial |
$3,340.80
|
| Rate for Payer: United Healthcare Medicare |
$2,227.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,763.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,648.00
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR FOREARM RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322001
|
|
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
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR FOREARM RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322001
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,115.84 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,763.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,534.40
|
| 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 |
$2,227.20
|
| Rate for Payer: HealthUtah PPO |
$3,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,724.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,115.84
|
| 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 |
$2,227.20
|
| Rate for Payer: United Healthcare Commercial |
$3,340.80
|
| Rate for Payer: United Healthcare Medicare |
$2,227.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,763.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,648.00
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HAND LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322004
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,115.84 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,763.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,534.40
|
| 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 |
$2,227.20
|
| Rate for Payer: HealthUtah PPO |
$3,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,724.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,115.84
|
| 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 |
$2,227.20
|
| Rate for Payer: United Healthcare Commercial |
$3,340.80
|
| Rate for Payer: United Healthcare Medicare |
$2,227.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,763.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,648.00
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HAND LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322004
|
|
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
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HAND RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322003
|
|
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
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HAND RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322003
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,115.84 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,763.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,534.40
|
| 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 |
$2,227.20
|
| Rate for Payer: HealthUtah PPO |
$3,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,724.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,115.84
|
| 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 |
$2,227.20
|
| Rate for Payer: United Healthcare Commercial |
$3,340.80
|
| Rate for Payer: United Healthcare Medicare |
$2,227.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,763.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,648.00
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HUMERUS LEFT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322005
|
|
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
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HUMERUS LEFT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322005
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,115.84 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,763.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,534.40
|
| 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 |
$2,227.20
|
| Rate for Payer: HealthUtah PPO |
$3,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,724.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,115.84
|
| 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 |
$2,227.20
|
| Rate for Payer: United Healthcare Commercial |
$3,340.80
|
| Rate for Payer: United Healthcare Medicare |
$2,227.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,763.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,648.00
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HUMERUS RIGHT W AND WO IV CONTRAST
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322006
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,115.84 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,763.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,534.40
|
| 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 |
$2,227.20
|
| Rate for Payer: HealthUtah PPO |
$3,840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,724.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,115.84
|
| 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 |
$2,227.20
|
| Rate for Payer: United Healthcare Commercial |
$3,340.80
|
| Rate for Payer: United Healthcare Medicare |
$2,227.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3,763.20
|
| Rate for Payer: Wise Provider Network Commercial |
$3,648.00
|
|
|
HC MRI UPPER EXTREMITY COMBO - MR HUMERUS RIGHT W AND WO IV CONTRAST
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
6147322006
|
|
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
|
|
|
HC MRI, UPPER EXTREMITY W/CONTRAST - MR HAND LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321903
|
|
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, UPPER EXTREMITY W/CONTRAST - MR HAND LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321903
|
|
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, UPPER EXTREMITY W/CONTRAST - MR HAND RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321904
|
|
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, UPPER EXTREMITY W/CONTRAST - MR HAND RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321904
|
|
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, UPPER EXTREMITY W/CONTRAST - MR HUMERUS LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321905
|
|
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, UPPER EXTREMITY W/CONTRAST - MR HUMERUS LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321905
|
|
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, UPPER EXTREMITY W/CONTRAST - MR HUMERUS RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321906
|
|
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, UPPER EXTREMITY W/CONTRAST - MR HUMERUS RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321906
|
|
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, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA LEFT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321901
|
|
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, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA LEFT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321901
|
|
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, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA RIGHT W IV CONTRAST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321902
|
|
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, UPPER EXTREMITY W/CONTRAST - MR RADIUS ULNA RIGHT W IV CONTRAST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
6147321902
|
|
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, UPPER EXTREMITY W/O CONTRAST - MR HAND LEFT WO IV CONTRAST
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321803
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$779.66 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Aetna of WY Medicare |
$933.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$820.70
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$779.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$820.70
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$820.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
|
HC MRI, UPPER EXTREMITY W/O CONTRAST - MR HAND LEFT WO IV CONTRAST
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
6147321803
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$1,415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,386.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,358.40
|
| Rate for Payer: Altius Commercial |
$1,358.40
|
| Rate for Payer: Beech Street Commercial |
$1,386.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,161.72
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,372.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,386.70
|
| Rate for Payer: Entrust Commercial |
$1,344.25
|
| Rate for Payer: First Choice Health Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,344.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$933.90
|
| Rate for Payer: HealthUtah PPO |
$1,415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,372.55
|
| Rate for Payer: Multiplan Medicare/VA |
$887.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,386.70
|
| Rate for Payer: PacificSource Commercial |
$1,273.50
|
| Rate for Payer: PHCS PPO |
$1,386.70
|
| Rate for Payer: Three Rivers PPO |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration |
$933.90
|
| Rate for Payer: United Healthcare Commercial |
$1,231.05
|
| Rate for Payer: United Healthcare Medicare |
$933.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,344.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,344.25
|
|
