|
HC WOUND PREP PED TRK/ARM/LG 1ST 100 CM
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
HCPCS 15002
|
| Hospital Charge Code |
5101500201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$702.87 |
| Max. Negotiated Rate |
$1,121.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,098.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,076.16
|
| Rate for Payer: Altius Commercial |
$1,076.16
|
| Rate for Payer: Beech Street Commercial |
$1,098.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$920.34
|
| Rate for Payer: Cash Price |
$784.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,087.37
|
| Rate for Payer: Cigna of WY Commercial |
$1,098.58
|
| Rate for Payer: Entrust Commercial |
$1,064.95
|
| Rate for Payer: First Choice Health Commercial |
$1,064.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.86
|
| Rate for Payer: HealthUtah PPO |
$1,121.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,087.37
|
| Rate for Payer: Multiplan Medicare/VA |
$702.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,098.58
|
| Rate for Payer: PacificSource Commercial |
$1,008.90
|
| Rate for Payer: PHCS PPO |
$1,098.58
|
| Rate for Payer: Three Rivers PPO |
$840.75
|
| Rate for Payer: TriWest Veterans Administration |
$739.86
|
| Rate for Payer: United Healthcare Commercial |
$975.27
|
| Rate for Payer: United Healthcare Medicare |
$739.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1,064.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.95
|
|
|
HC X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.33 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$813.40
|
| Rate for Payer: Aetna of WY Medicare |
$547.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$796.80
|
| Rate for Payer: Altius Commercial |
$796.80
|
| Rate for Payer: Beech Street Commercial |
$813.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$681.43
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$805.10
|
| Rate for Payer: Cigna of WY Commercial |
$813.40
|
| Rate for Payer: Entrust Commercial |
$788.50
|
| Rate for Payer: First Choice Health Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.40
|
| Rate for Payer: HealthUtah PPO |
$830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$805.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.33
|
| Rate for Payer: One Health Plan of WY PPO |
$813.40
|
| Rate for Payer: PacificSource Commercial |
$747.00
|
| Rate for Payer: PHCS PPO |
$813.40
|
| Rate for Payer: Three Rivers PPO |
$622.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.40
|
| Rate for Payer: United Healthcare Commercial |
$722.10
|
| Rate for Payer: United Healthcare Medicare |
$481.40
|
| Rate for Payer: WINHealth Partners Commercial |
$813.40
|
| Rate for Payer: Wise Provider Network Commercial |
$788.50
|
|
|
HC X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$520.41 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$813.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$796.80
|
| Rate for Payer: Altius Commercial |
$796.80
|
| Rate for Payer: Beech Street Commercial |
$813.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$681.43
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$805.10
|
| Rate for Payer: Cigna of WY Commercial |
$813.40
|
| Rate for Payer: Entrust Commercial |
$788.50
|
| Rate for Payer: First Choice Health Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$788.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$547.80
|
| Rate for Payer: HealthUtah PPO |
$830.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$805.10
|
| Rate for Payer: Multiplan Medicare/VA |
$520.41
|
| Rate for Payer: One Health Plan of WY PPO |
$813.40
|
| Rate for Payer: PacificSource Commercial |
$747.00
|
| Rate for Payer: PHCS PPO |
$813.40
|
| Rate for Payer: Three Rivers PPO |
$622.50
|
| Rate for Payer: TriWest Veterans Administration |
$547.80
|
| Rate for Payer: United Healthcare Commercial |
$722.10
|
| Rate for Payer: United Healthcare Medicare |
$547.80
|
| Rate for Payer: WINHealth Partners Commercial |
$788.50
|
| Rate for Payer: Wise Provider Network Commercial |
$788.50
|
|
|
HC X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
3207305001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.68 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$426.30
|
| Rate for Payer: Aetna of WY Medicare |
$287.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$417.60
|
| Rate for Payer: Altius Commercial |
$417.60
|
| Rate for Payer: Beech Street Commercial |
$426.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.14
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$421.95
|
| Rate for Payer: Cigna of WY Commercial |
$426.30
|
| Rate for Payer: Entrust Commercial |
$413.25
|
| Rate for Payer: First Choice Health Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$252.30
|
| Rate for Payer: HealthUtah PPO |
$435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$421.95
|
| Rate for Payer: Multiplan Medicare/VA |
$239.68
|
| Rate for Payer: One Health Plan of WY PPO |
$426.30
|
| Rate for Payer: PacificSource Commercial |
$391.50
|
| Rate for Payer: PHCS PPO |
$426.30
|
| Rate for Payer: Three Rivers PPO |
$326.25
|
| Rate for Payer: TriWest Veterans Administration |
$252.30
|
| Rate for Payer: United Healthcare Commercial |
$378.45
|
| Rate for Payer: United Healthcare Medicare |
$252.30
|
| Rate for Payer: WINHealth Partners Commercial |
$426.30
|
| Rate for Payer: Wise Provider Network Commercial |
$413.25
|
|
|
HC X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
3207305001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$426.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$417.60
|
| Rate for Payer: Altius Commercial |
$417.60
|
| Rate for Payer: Beech Street Commercial |
$426.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.14
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$421.95
|
| Rate for Payer: Cigna of WY Commercial |
$426.30
|
| Rate for Payer: Entrust Commercial |
$413.25
|
| Rate for Payer: First Choice Health Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.10
|
| Rate for Payer: HealthUtah PPO |
$435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$421.95
|
| Rate for Payer: Multiplan Medicare/VA |
$272.74
|
| Rate for Payer: One Health Plan of WY PPO |
$426.30
|
| Rate for Payer: PacificSource Commercial |
$391.50
|
| Rate for Payer: PHCS PPO |
$426.30
|
| Rate for Payer: Three Rivers PPO |
$326.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.10
|
| Rate for Payer: United Healthcare Commercial |
$378.45
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$413.25
|
| Rate for Payer: Wise Provider Network Commercial |
$413.25
|
|
|
HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS BILATERAL
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
3207360003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.20
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$231.99
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$244.20
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$244.20
|
| Rate for Payer: WINHealth Partners Commercial |
$351.50
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS BILATERAL
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
3207360003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.87 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$244.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$355.20
|
| Rate for Payer: Altius Commercial |
$355.20
|
| Rate for Payer: Beech Street Commercial |
$362.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$303.77
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: Entrust Commercial |
$351.50
|
| Rate for Payer: First Choice Health Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.60
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$203.87
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$362.60
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$214.60
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$214.60
|
| Rate for Payer: WINHealth Partners Commercial |
$362.60
|
| Rate for Payer: Wise Provider Network Commercial |
$351.50
|
|
|
HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS LEFT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
3207360001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.12 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Aetna of WY Medicare |
$240.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.70
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$201.12
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$211.70
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$211.70
|
| Rate for Payer: WINHealth Partners Commercial |
$357.70
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS LEFT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
3207360001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.86 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.90
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$228.86
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$240.90
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$240.90
|
| Rate for Payer: WINHealth Partners Commercial |
$346.75
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS RIGHT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
3207360002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.86 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.90
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$228.86
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$240.90
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$240.90
|
| Rate for Payer: WINHealth Partners Commercial |
$346.75
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS RIGHT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
3207360002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.12 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Aetna of WY Medicare |
$240.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.40
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.66
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.70
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$201.12
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$211.70
|
| Rate for Payer: United Healthcare Commercial |
$317.55
|
| Rate for Payer: United Healthcare Medicare |
$211.70
|
| Rate for Payer: WINHealth Partners Commercial |
$357.70
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS BILATERAL
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.72 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.70
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$341.72
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$359.70
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$359.70
|
| Rate for Payer: WINHealth Partners Commercial |
$517.75
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS BILATERAL
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Aetna of WY Medicare |
$359.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.10
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$300.30
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$316.10
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$316.10
|
| Rate for Payer: WINHealth Partners Commercial |
$534.10
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS LEFT
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.72 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.70
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$341.72
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$359.70
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$359.70
|
| Rate for Payer: WINHealth Partners Commercial |
$517.75
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS LEFT
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Aetna of WY Medicare |
$359.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.10
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$300.30
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$316.10
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$316.10
|
| Rate for Payer: WINHealth Partners Commercial |
$534.10
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS RIGHT
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Aetna of WY Medicare |
$359.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.10
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$300.30
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$316.10
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$316.10
|
| Rate for Payer: WINHealth Partners Commercial |
$534.10
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC X-RAY ANKLE 3+ VW - XR ANKLE 3+ VIEWS RIGHT
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
3207361002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.72 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$523.20
|
| Rate for Payer: Altius Commercial |
$523.20
|
| Rate for Payer: Beech Street Commercial |
$534.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$447.44
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: Entrust Commercial |
$517.75
|
| Rate for Payer: First Choice Health Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$359.70
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$341.72
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$534.10
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$359.70
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$359.70
|
| Rate for Payer: WINHealth Partners Commercial |
$517.75
|
| Rate for Payer: Wise Provider Network Commercial |
$517.75
|
|
|
HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT BILATERAL
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
3207309203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$801.70 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Aetna of WY Medicare |
$960.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$843.90
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$801.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$843.90
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$843.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,425.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT BILATERAL
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
3207309203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$912.28 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,425.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,396.80
|
| Rate for Payer: Altius Commercial |
$1,396.80
|
| Rate for Payer: Beech Street Commercial |
$1,425.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,194.56
|
| Rate for Payer: Cash Price |
$1,018.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,411.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,425.90
|
| Rate for Payer: Entrust Commercial |
$1,382.25
|
| Rate for Payer: First Choice Health Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,382.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$960.30
|
| Rate for Payer: HealthUtah PPO |
$1,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,411.35
|
| Rate for Payer: Multiplan Medicare/VA |
$912.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,425.90
|
| Rate for Payer: PacificSource Commercial |
$1,309.50
|
| Rate for Payer: PHCS PPO |
$1,425.90
|
| Rate for Payer: Three Rivers PPO |
$1,091.25
|
| Rate for Payer: TriWest Veterans Administration |
$960.30
|
| Rate for Payer: United Healthcare Commercial |
$1,265.85
|
| Rate for Payer: United Healthcare Medicare |
$960.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,382.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,382.25
|
|
|
HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT LEFT
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
3207309201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT LEFT
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
3207309201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT RIGHT
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
3207309202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$457.71 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$481.80
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$457.71
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$481.80
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$481.80
|
| Rate for Payer: WINHealth Partners Commercial |
$693.50
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC X-RAY ARM, INFANT - XR UPPER EXTREMITY 2+ VIEWS INFANT RIGHT
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
3207309202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.23 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$481.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$700.80
|
| Rate for Payer: Altius Commercial |
$700.80
|
| Rate for Payer: Beech Street Commercial |
$715.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$599.33
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: Entrust Commercial |
$693.50
|
| Rate for Payer: First Choice Health Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.40
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$402.23
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$715.40
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.40
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$423.40
|
| Rate for Payer: WINHealth Partners Commercial |
$715.40
|
| Rate for Payer: Wise Provider Network Commercial |
$693.50
|
|
|
HC X-RAY CLAVICLE - XR CLAVICLE BILATERAL
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Aetna of WY Medicare |
$283.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$417.10
|
| Rate for Payer: Cigna of WY Commercial |
$421.40
|
| Rate for Payer: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.40
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$236.93
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.40
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$249.40
|
| Rate for Payer: WINHealth Partners Commercial |
$421.40
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
|
HC X-RAY CLAVICLE - XR CLAVICLE BILATERAL
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.61 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$417.10
|
| Rate for Payer: Cigna of WY Commercial |
$421.40
|
| Rate for Payer: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$283.80
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$269.61
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$283.80
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$283.80
|
| Rate for Payer: WINHealth Partners Commercial |
$408.50
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
