|
HC X-RAY CLAVICLE - XR CLAVICLE LEFT
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300001
|
|
Hospital Revenue Code
|
320
|
| 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 X-RAY CLAVICLE - XR CLAVICLE LEFT
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300001
|
|
Hospital Revenue Code
|
320
|
| 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 X-RAY CLAVICLE - XR CLAVICLE RIGHT
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300002
|
|
Hospital Revenue Code
|
320
|
| 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 X-RAY CLAVICLE - XR CLAVICLE RIGHT
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
3207300002
|
|
Hospital Revenue Code
|
320
|
| 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 X-RAY COLON AIR CONTRAST - FL BARIUM ENEMA AIR CONTRAST
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
3207428001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$724.56 |
| Max. Negotiated Rate |
$1,315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,288.70
|
| Rate for Payer: Aetna of WY Medicare |
$867.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,262.40
|
| Rate for Payer: Altius Commercial |
$1,262.40
|
| Rate for Payer: Beech Street Commercial |
$1,288.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,079.62
|
| Rate for Payer: Cash Price |
$920.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,275.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,288.70
|
| Rate for Payer: Entrust Commercial |
$1,249.25
|
| Rate for Payer: First Choice Health Commercial |
$1,249.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,249.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$762.70
|
| Rate for Payer: HealthUtah PPO |
$1,315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,275.55
|
| Rate for Payer: Multiplan Medicare/VA |
$724.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,288.70
|
| Rate for Payer: PacificSource Commercial |
$1,183.50
|
| Rate for Payer: PHCS PPO |
$1,288.70
|
| Rate for Payer: Three Rivers PPO |
$986.25
|
| Rate for Payer: TriWest Veterans Administration |
$762.70
|
| Rate for Payer: United Healthcare Commercial |
$1,144.05
|
| Rate for Payer: United Healthcare Medicare |
$762.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,288.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1,249.25
|
|
|
HC X-RAY COLON AIR CONTRAST - FL BARIUM ENEMA AIR CONTRAST
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
3207428001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$824.50 |
| Max. Negotiated Rate |
$1,315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,288.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,262.40
|
| Rate for Payer: Altius Commercial |
$1,262.40
|
| Rate for Payer: Beech Street Commercial |
$1,288.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,079.62
|
| Rate for Payer: Cash Price |
$920.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,275.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,288.70
|
| Rate for Payer: Entrust Commercial |
$1,249.25
|
| Rate for Payer: First Choice Health Commercial |
$1,249.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,249.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.90
|
| Rate for Payer: HealthUtah PPO |
$1,315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,275.55
|
| Rate for Payer: Multiplan Medicare/VA |
$824.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,288.70
|
| Rate for Payer: PacificSource Commercial |
$1,183.50
|
| Rate for Payer: PHCS PPO |
$1,288.70
|
| Rate for Payer: Three Rivers PPO |
$986.25
|
| Rate for Payer: TriWest Veterans Administration |
$867.90
|
| Rate for Payer: United Healthcare Commercial |
$1,144.05
|
| Rate for Payer: United Healthcare Medicare |
$867.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,249.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,249.25
|
|
|
HC X-RAY COLON CONTRAST - FL BARIUM ENEMA SINGLE CONTRAST WATER SOLUBLE
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
3207427001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$545.49 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$852.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$835.20
|
| Rate for Payer: Altius Commercial |
$835.20
|
| Rate for Payer: Beech Street Commercial |
$852.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$714.27
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$843.90
|
| Rate for Payer: Cigna of WY Commercial |
$852.60
|
| Rate for Payer: Entrust Commercial |
$826.50
|
| Rate for Payer: First Choice Health Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$574.20
|
| Rate for Payer: HealthUtah PPO |
$870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$843.90
|
| Rate for Payer: Multiplan Medicare/VA |
$545.49
|
| Rate for Payer: One Health Plan of WY PPO |
$852.60
|
| Rate for Payer: PacificSource Commercial |
$783.00
|
| Rate for Payer: PHCS PPO |
$852.60
|
| Rate for Payer: Three Rivers PPO |
$652.50
|
| Rate for Payer: TriWest Veterans Administration |
$574.20
|
| Rate for Payer: United Healthcare Commercial |
$756.90
|
| Rate for Payer: United Healthcare Medicare |
$574.20
|
| Rate for Payer: WINHealth Partners Commercial |
$826.50
|
| Rate for Payer: Wise Provider Network Commercial |
$826.50
|
|
|
HC X-RAY COLON CONTRAST - FL BARIUM ENEMA SINGLE CONTRAST WATER SOLUBLE
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
HCPCS 74270
|
| Hospital Charge Code |
3207427001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$479.37 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$852.60
|
| Rate for Payer: Aetna of WY Medicare |
$574.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$835.20
|
| Rate for Payer: Altius Commercial |
$835.20
|
| Rate for Payer: Beech Street Commercial |
$852.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$714.27
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$843.90
|
| Rate for Payer: Cigna of WY Commercial |
$852.60
|
| Rate for Payer: Entrust Commercial |
$826.50
|
| Rate for Payer: First Choice Health Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$504.60
|
| Rate for Payer: HealthUtah PPO |
$870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$843.90
|
| Rate for Payer: Multiplan Medicare/VA |
$479.37
|
| Rate for Payer: One Health Plan of WY PPO |
$852.60
|
| Rate for Payer: PacificSource Commercial |
$783.00
|
| Rate for Payer: PHCS PPO |
$852.60
|
| Rate for Payer: Three Rivers PPO |
$652.50
|
| Rate for Payer: TriWest Veterans Administration |
$504.60
|
| Rate for Payer: United Healthcare Commercial |
$756.90
|
| Rate for Payer: United Healthcare Medicare |
$504.60
|
| Rate for Payer: WINHealth Partners Commercial |
$852.60
|
| Rate for Payer: Wise Provider Network Commercial |
$826.50
|
|
|
HC X-RAY CYSTOGRAM, MIN 3 VIEW - FL CYSTOGRAM 3V
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 74430
|
| Hospital Charge Code |
3207443001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$991.80 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,188.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,044.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$991.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,044.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,044.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,764.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC X-RAY CYSTOGRAM, MIN 3 VIEW - FL CYSTOGRAM 3V
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 74430
|
| Hospital Charge Code |
3207443001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.60 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,188.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,128.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,188.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,710.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS BILATERAL
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$250.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$364.80
|
| Rate for Payer: Altius Commercial |
$364.80
|
| Rate for Payer: Beech Street Commercial |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$311.98
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: Entrust Commercial |
$361.00
|
| Rate for Payer: First Choice Health Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.40
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$209.38
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$372.40
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$220.40
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$220.40
|
| Rate for Payer: WINHealth Partners Commercial |
$372.40
|
| Rate for Payer: Wise Provider Network Commercial |
$361.00
|
|
|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS BILATERAL
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.26 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$364.80
|
| Rate for Payer: Altius Commercial |
$364.80
|
| Rate for Payer: Beech Street Commercial |
$372.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$311.98
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: Entrust Commercial |
$361.00
|
| Rate for Payer: First Choice Health Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$250.80
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$238.26
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$372.40
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$250.80
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$250.80
|
| Rate for Payer: WINHealth Partners Commercial |
$361.00
|
| Rate for Payer: Wise Provider Network Commercial |
$361.00
|
|
|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS LEFT
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$470.40
|
| Rate for Payer: Aetna of WY Medicare |
$316.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$460.80
|
| Rate for Payer: Altius Commercial |
$460.80
|
| Rate for Payer: Beech Street Commercial |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.08
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$465.60
|
| Rate for Payer: Cigna of WY Commercial |
$470.40
|
| Rate for Payer: Entrust Commercial |
$456.00
|
| Rate for Payer: First Choice Health Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.40
|
| Rate for Payer: HealthUtah PPO |
$480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$465.60
|
| Rate for Payer: Multiplan Medicare/VA |
$264.48
|
| Rate for Payer: One Health Plan of WY PPO |
$470.40
|
| Rate for Payer: PacificSource Commercial |
$432.00
|
| Rate for Payer: PHCS PPO |
$470.40
|
| Rate for Payer: Three Rivers PPO |
$360.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.40
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Medicare |
$278.40
|
| Rate for Payer: WINHealth Partners Commercial |
$470.40
|
| Rate for Payer: Wise Provider Network Commercial |
$456.00
|
|
|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS LEFT
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.96 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$470.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$460.80
|
| Rate for Payer: Altius Commercial |
$460.80
|
| Rate for Payer: Beech Street Commercial |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.08
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$465.60
|
| Rate for Payer: Cigna of WY Commercial |
$470.40
|
| Rate for Payer: Entrust Commercial |
$456.00
|
| Rate for Payer: First Choice Health Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.80
|
| Rate for Payer: HealthUtah PPO |
$480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$465.60
|
| Rate for Payer: Multiplan Medicare/VA |
$300.96
|
| Rate for Payer: One Health Plan of WY PPO |
$470.40
|
| Rate for Payer: PacificSource Commercial |
$432.00
|
| Rate for Payer: PHCS PPO |
$470.40
|
| Rate for Payer: Three Rivers PPO |
$360.00
|
| Rate for Payer: TriWest Veterans Administration |
$316.80
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Medicare |
$316.80
|
| Rate for Payer: WINHealth Partners Commercial |
$456.00
|
| Rate for Payer: Wise Provider Network Commercial |
$456.00
|
|
|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS RIGHT
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$470.40
|
| Rate for Payer: Aetna of WY Medicare |
$316.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$460.80
|
| Rate for Payer: Altius Commercial |
$460.80
|
| Rate for Payer: Beech Street Commercial |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.08
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$465.60
|
| Rate for Payer: Cigna of WY Commercial |
$470.40
|
| Rate for Payer: Entrust Commercial |
$456.00
|
| Rate for Payer: First Choice Health Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.40
|
| Rate for Payer: HealthUtah PPO |
$480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$465.60
|
| Rate for Payer: Multiplan Medicare/VA |
$264.48
|
| Rate for Payer: One Health Plan of WY PPO |
$470.40
|
| Rate for Payer: PacificSource Commercial |
$432.00
|
| Rate for Payer: PHCS PPO |
$470.40
|
| Rate for Payer: Three Rivers PPO |
$360.00
|
| Rate for Payer: TriWest Veterans Administration |
$278.40
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Medicare |
$278.40
|
| Rate for Payer: WINHealth Partners Commercial |
$470.40
|
| Rate for Payer: Wise Provider Network Commercial |
$456.00
|
|
|
HC X-RAY ELBOW 2 VW - XR ELBOW 1-2 VIEWS RIGHT
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
3207307003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.96 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$470.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$460.80
|
| Rate for Payer: Altius Commercial |
$460.80
|
| Rate for Payer: Beech Street Commercial |
$470.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.08
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$465.60
|
| Rate for Payer: Cigna of WY Commercial |
$470.40
|
| Rate for Payer: Entrust Commercial |
$456.00
|
| Rate for Payer: First Choice Health Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$316.80
|
| Rate for Payer: HealthUtah PPO |
$480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$465.60
|
| Rate for Payer: Multiplan Medicare/VA |
$300.96
|
| Rate for Payer: One Health Plan of WY PPO |
$470.40
|
| Rate for Payer: PacificSource Commercial |
$432.00
|
| Rate for Payer: PHCS PPO |
$470.40
|
| Rate for Payer: Three Rivers PPO |
$360.00
|
| Rate for Payer: TriWest Veterans Administration |
$316.80
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Medicare |
$316.80
|
| Rate for Payer: WINHealth Partners Commercial |
$456.00
|
| Rate for Payer: Wise Provider Network Commercial |
$456.00
|
|
|
HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS BILATERAL
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$691.20
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$591.12
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.20
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$451.44
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$475.20
|
| Rate for Payer: United Healthcare Commercial |
$626.40
|
| Rate for Payer: United Healthcare Medicare |
$475.20
|
| Rate for Payer: WINHealth Partners Commercial |
$684.00
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS BILATERAL
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$396.72 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Aetna of WY Medicare |
$475.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$691.20
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$591.12
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$417.60
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$396.72
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$417.60
|
| Rate for Payer: United Healthcare Commercial |
$626.40
|
| Rate for Payer: United Healthcare Medicare |
$417.60
|
| Rate for Payer: WINHealth Partners Commercial |
$705.60
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS LEFT
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$396.72 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Aetna of WY Medicare |
$475.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$691.20
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$591.12
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$417.60
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$396.72
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$417.60
|
| Rate for Payer: United Healthcare Commercial |
$626.40
|
| Rate for Payer: United Healthcare Medicare |
$417.60
|
| Rate for Payer: WINHealth Partners Commercial |
$705.60
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS LEFT
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$691.20
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$591.12
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.20
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$451.44
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$475.20
|
| Rate for Payer: United Healthcare Commercial |
$626.40
|
| Rate for Payer: United Healthcare Medicare |
$475.20
|
| Rate for Payer: WINHealth Partners Commercial |
$684.00
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS RIGHT
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$691.20
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$591.12
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.20
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$451.44
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$475.20
|
| Rate for Payer: United Healthcare Commercial |
$626.40
|
| Rate for Payer: United Healthcare Medicare |
$475.20
|
| Rate for Payer: WINHealth Partners Commercial |
$684.00
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC X-RAY ELBOW 3+ VW - XR ELBOW 3+ VIEWS RIGHT
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
3207308003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$396.72 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Aetna of WY Medicare |
$475.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$691.20
|
| Rate for Payer: Altius Commercial |
$691.20
|
| Rate for Payer: Beech Street Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$591.12
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: Entrust Commercial |
$684.00
|
| Rate for Payer: First Choice Health Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$417.60
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$396.72
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$705.60
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$417.60
|
| Rate for Payer: United Healthcare Commercial |
$626.40
|
| Rate for Payer: United Healthcare Medicare |
$417.60
|
| Rate for Payer: WINHealth Partners Commercial |
$705.60
|
| Rate for Payer: Wise Provider Network Commercial |
$684.00
|
|
|
HC X-RAY EXAM, BREAST SPECIMEN - MAMMO BREAST SPECIMEN
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
4017609801
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$479.37 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$852.60
|
| Rate for Payer: Aetna of WY Medicare |
$574.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$835.20
|
| Rate for Payer: Altius Commercial |
$835.20
|
| Rate for Payer: Beech Street Commercial |
$852.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$714.27
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$843.90
|
| Rate for Payer: Cigna of WY Commercial |
$852.60
|
| Rate for Payer: Entrust Commercial |
$826.50
|
| Rate for Payer: First Choice Health Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$504.60
|
| Rate for Payer: HealthUtah PPO |
$870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$843.90
|
| Rate for Payer: Multiplan Medicare/VA |
$479.37
|
| Rate for Payer: One Health Plan of WY PPO |
$852.60
|
| Rate for Payer: PacificSource Commercial |
$783.00
|
| Rate for Payer: PHCS PPO |
$852.60
|
| Rate for Payer: Three Rivers PPO |
$652.50
|
| Rate for Payer: TriWest Veterans Administration |
$504.60
|
| Rate for Payer: United Healthcare Commercial |
$756.90
|
| Rate for Payer: United Healthcare Medicare |
$504.60
|
| Rate for Payer: WINHealth Partners Commercial |
$852.60
|
| Rate for Payer: Wise Provider Network Commercial |
$826.50
|
|
|
HC X-RAY EXAM, BREAST SPECIMEN - MAMMO BREAST SPECIMEN
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
4017609801
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$545.49 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$852.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$835.20
|
| Rate for Payer: Altius Commercial |
$835.20
|
| Rate for Payer: Beech Street Commercial |
$852.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$714.27
|
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$843.90
|
| Rate for Payer: Cigna of WY Commercial |
$852.60
|
| Rate for Payer: Entrust Commercial |
$826.50
|
| Rate for Payer: First Choice Health Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$826.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$574.20
|
| Rate for Payer: HealthUtah PPO |
$870.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$843.90
|
| Rate for Payer: Multiplan Medicare/VA |
$545.49
|
| Rate for Payer: One Health Plan of WY PPO |
$852.60
|
| Rate for Payer: PacificSource Commercial |
$783.00
|
| Rate for Payer: PHCS PPO |
$852.60
|
| Rate for Payer: Three Rivers PPO |
$652.50
|
| Rate for Payer: TriWest Veterans Administration |
$574.20
|
| Rate for Payer: United Healthcare Commercial |
$756.90
|
| Rate for Payer: United Healthcare Medicare |
$574.20
|
| Rate for Payer: WINHealth Partners Commercial |
$826.50
|
| Rate for Payer: Wise Provider Network Commercial |
$826.50
|
|
|
HC X-RAY EXAM HIP 1 VIEW - XR HIP 1 VW BILATERAL
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$195.60
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$205.90
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$205.90
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
