|
HC RADIOACTIVE TRACER IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
3433879201
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$495.90 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$594.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$864.00
|
| Rate for Payer: Altius Commercial |
$864.00
|
| Rate for Payer: Beech Street Commercial |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.90
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: Entrust Commercial |
$855.00
|
| Rate for Payer: First Choice Health Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.00
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$495.90
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$882.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$522.00
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$522.00
|
| Rate for Payer: WINHealth Partners Commercial |
$882.00
|
| Rate for Payer: Wise Provider Network Commercial |
$855.00
|
|
|
HC RADIOACTIVE TRACER IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
3403879201
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$495.90 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$594.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$864.00
|
| Rate for Payer: Altius Commercial |
$864.00
|
| Rate for Payer: Beech Street Commercial |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.90
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: Entrust Commercial |
$855.00
|
| Rate for Payer: First Choice Health Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.00
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$495.90
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$882.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$522.00
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$522.00
|
| Rate for Payer: WINHealth Partners Commercial |
$882.00
|
| Rate for Payer: Wise Provider Network Commercial |
$855.00
|
|
|
HC RADIOACTIVE TRACER IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
3203879201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.30 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$864.00
|
| Rate for Payer: Altius Commercial |
$864.00
|
| Rate for Payer: Beech Street Commercial |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.90
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: Entrust Commercial |
$855.00
|
| Rate for Payer: First Choice Health Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.00
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$564.30
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$882.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$594.00
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$594.00
|
| Rate for Payer: WINHealth Partners Commercial |
$855.00
|
| Rate for Payer: Wise Provider Network Commercial |
$855.00
|
|
|
HC RADIOACTIVE TRACER IDENTIFY SENTINEL NODE
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
3403879201
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$564.30 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$864.00
|
| Rate for Payer: Altius Commercial |
$864.00
|
| Rate for Payer: Beech Street Commercial |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.90
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: Entrust Commercial |
$855.00
|
| Rate for Payer: First Choice Health Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$594.00
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$564.30
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$882.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$594.00
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$594.00
|
| Rate for Payer: WINHealth Partners Commercial |
$855.00
|
| Rate for Payer: Wise Provider Network Commercial |
$855.00
|
|
|
HC RADIOACTIVE TRACER IDENTIFY SENTINEL NODE
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
3203879201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$495.90 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$594.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$864.00
|
| Rate for Payer: Altius Commercial |
$864.00
|
| Rate for Payer: Beech Street Commercial |
$882.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.90
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: Entrust Commercial |
$855.00
|
| Rate for Payer: First Choice Health Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.00
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$495.90
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$882.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$522.00
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$522.00
|
| Rate for Payer: WINHealth Partners Commercial |
$882.00
|
| Rate for Payer: Wise Provider Network Commercial |
$855.00
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
3207401802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.40
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.62
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.90
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$197.50
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$274.05
|
| Rate for Payer: United Healthcare Medicare |
$207.90
|
| Rate for Payer: WINHealth Partners Commercial |
$299.25
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
3207401802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Aetna of WY Medicare |
$207.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.40
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.62
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.70
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$173.56
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$182.70
|
| Rate for Payer: United Healthcare Commercial |
$274.05
|
| Rate for Payer: United Healthcare Medicare |
$182.70
|
| Rate for Payer: WINHealth Partners Commercial |
$308.70
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.66 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.70
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$247.66
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$260.70
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$260.70
|
| Rate for Payer: WINHealth Partners Commercial |
$375.25
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.64 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Aetna of WY Medicare |
$260.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.10
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$217.64
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$229.10
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$229.10
|
| Rate for Payer: WINHealth Partners Commercial |
$387.10
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
3207402101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.97 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Aetna of WY Medicare |
$310.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$272.60
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$258.97
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$272.60
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$272.60
|
| Rate for Payer: WINHealth Partners Commercial |
$460.60
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS - XR ABDOMEN 3+ VIEWS
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
3207402101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.69 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.20
|
| Rate for Payer: Altius Commercial |
$451.20
|
| Rate for Payer: Beech Street Commercial |
$460.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.87
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: Entrust Commercial |
$446.50
|
| Rate for Payer: First Choice Health Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.20
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$294.69
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$460.60
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$310.20
|
| Rate for Payer: United Healthcare Commercial |
$408.90
|
| Rate for Payer: United Healthcare Medicare |
$310.20
|
| Rate for Payer: WINHealth Partners Commercial |
$446.50
|
| Rate for Payer: Wise Provider Network Commercial |
$446.50
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104601
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104601
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC RADIOLOGIC EXAM CHEST 4+ VIEWS - FL/XR CHEST 4+ VIEWS WITH FLUORO
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
3247104803
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$652.08 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$998.40
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$853.84
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.40
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$652.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$686.40
|
| Rate for Payer: United Healthcare Commercial |
$904.80
|
| Rate for Payer: United Healthcare Medicare |
$686.40
|
| Rate for Payer: WINHealth Partners Commercial |
$988.00
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
HC RADIOLOGIC EXAM CHEST 4+ VIEWS - FL/XR CHEST 4+ VIEWS WITH FLUORO
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
3247104803
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$573.04 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Aetna of WY Medicare |
$686.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$998.40
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$853.84
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.20
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$573.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$603.20
|
| Rate for Payer: United Healthcare Commercial |
$904.80
|
| Rate for Payer: United Healthcare Medicare |
$603.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,019.20
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
HC RADIOLOGIC EXAM CHEST 4+ VIEWS - XR CHEST 4+ VIEWS
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
3247104801
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$573.04 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Aetna of WY Medicare |
$686.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$998.40
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$853.84
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.20
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$573.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$603.20
|
| Rate for Payer: United Healthcare Commercial |
$904.80
|
| Rate for Payer: United Healthcare Medicare |
$603.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,019.20
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
HC RADIOLOGIC EXAM CHEST 4+ VIEWS - XR CHEST 4+ VIEWS
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
3247104801
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$652.08 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$998.40
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$853.84
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.40
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$652.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$686.40
|
| Rate for Payer: United Healthcare Commercial |
$904.80
|
| Rate for Payer: United Healthcare Medicare |
$686.40
|
| Rate for Payer: WINHealth Partners Commercial |
$988.00
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW BILATERAL
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$595.08 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,058.40
|
| Rate for Payer: Aetna of WY Medicare |
$712.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,036.80
|
| Rate for Payer: Altius Commercial |
$1,036.80
|
| Rate for Payer: Beech Street Commercial |
$1,058.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$886.68
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,047.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,058.40
|
| Rate for Payer: Entrust Commercial |
$1,026.00
|
| Rate for Payer: First Choice Health Commercial |
$1,026.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,026.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$626.40
|
| Rate for Payer: HealthUtah PPO |
$1,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,047.60
|
| Rate for Payer: Multiplan Medicare/VA |
$595.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,058.40
|
| Rate for Payer: PacificSource Commercial |
$972.00
|
| Rate for Payer: PHCS PPO |
$1,058.40
|
| Rate for Payer: Three Rivers PPO |
$810.00
|
| Rate for Payer: TriWest Veterans Administration |
$626.40
|
| Rate for Payer: United Healthcare Commercial |
$939.60
|
| Rate for Payer: United Healthcare Medicare |
$626.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,058.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,026.00
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW BILATERAL
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$677.16 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,058.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,036.80
|
| Rate for Payer: Altius Commercial |
$1,036.80
|
| Rate for Payer: Beech Street Commercial |
$1,058.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$886.68
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,047.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,058.40
|
| Rate for Payer: Entrust Commercial |
$1,026.00
|
| Rate for Payer: First Choice Health Commercial |
$1,026.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,026.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.80
|
| Rate for Payer: HealthUtah PPO |
$1,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,047.60
|
| Rate for Payer: Multiplan Medicare/VA |
$677.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,058.40
|
| Rate for Payer: PacificSource Commercial |
$972.00
|
| Rate for Payer: PHCS PPO |
$1,058.40
|
| Rate for Payer: Three Rivers PPO |
$810.00
|
| Rate for Payer: TriWest Veterans Administration |
$712.80
|
| Rate for Payer: United Healthcare Commercial |
$939.60
|
| Rate for Payer: United Healthcare Medicare |
$712.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,026.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,026.00
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW LEFT
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW LEFT
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW RIGHT
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.05 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Aetna of WY Medicare |
$363.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$303.05
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$319.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$319.00
|
| Rate for Payer: WINHealth Partners Commercial |
$539.00
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW RIGHT
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.85 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$539.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$528.00
|
| Rate for Payer: Altius Commercial |
$528.00
|
| Rate for Payer: Beech Street Commercial |
$539.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$451.55
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$533.50
|
| Rate for Payer: Cigna of WY Commercial |
$539.00
|
| Rate for Payer: Entrust Commercial |
$522.50
|
| Rate for Payer: First Choice Health Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$522.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$363.00
|
| Rate for Payer: HealthUtah PPO |
$550.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$533.50
|
| Rate for Payer: Multiplan Medicare/VA |
$344.85
|
| Rate for Payer: One Health Plan of WY PPO |
$539.00
|
| Rate for Payer: PacificSource Commercial |
$495.00
|
| Rate for Payer: PHCS PPO |
$539.00
|
| Rate for Payer: Three Rivers PPO |
$412.50
|
| Rate for Payer: TriWest Veterans Administration |
$363.00
|
| Rate for Payer: United Healthcare Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
| Rate for Payer: WINHealth Partners Commercial |
$522.50
|
| Rate for Payer: Wise Provider Network Commercial |
$522.50
|
|
