|
HC X-RAY EXAM HIP 1 VIEW - XR HIP 1 VW BILATERAL
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.58 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| 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 |
$234.30
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$222.58
|
| 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 |
$234.30
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$234.30
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC X-RAY EXAM HIPS BI 2 VWS - XR HIPS BILAT 2 VW W/ OR W/O PELVIS
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
3207352101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$429.78 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$764.40
|
| Rate for Payer: Aetna of WY Medicare |
$514.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$748.80
|
| Rate for Payer: Altius Commercial |
$748.80
|
| Rate for Payer: Beech Street Commercial |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$640.38
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$756.60
|
| Rate for Payer: Cigna of WY Commercial |
$764.40
|
| Rate for Payer: Entrust Commercial |
$741.00
|
| Rate for Payer: First Choice Health Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.40
|
| Rate for Payer: HealthUtah PPO |
$780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$756.60
|
| Rate for Payer: Multiplan Medicare/VA |
$429.78
|
| Rate for Payer: One Health Plan of WY PPO |
$764.40
|
| Rate for Payer: PacificSource Commercial |
$702.00
|
| Rate for Payer: PHCS PPO |
$764.40
|
| Rate for Payer: Three Rivers PPO |
$585.00
|
| Rate for Payer: TriWest Veterans Administration |
$452.40
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
| Rate for Payer: United Healthcare Medicare |
$452.40
|
| Rate for Payer: WINHealth Partners Commercial |
$764.40
|
| Rate for Payer: Wise Provider Network Commercial |
$741.00
|
|
|
HC X-RAY EXAM HIPS BI 2 VWS - XR HIPS BILAT 2 VW W/ OR W/O PELVIS
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 73521
|
| Hospital Charge Code |
3207352101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$489.06 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$764.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$748.80
|
| Rate for Payer: Altius Commercial |
$748.80
|
| Rate for Payer: Beech Street Commercial |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$640.38
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$756.60
|
| Rate for Payer: Cigna of WY Commercial |
$764.40
|
| Rate for Payer: Entrust Commercial |
$741.00
|
| Rate for Payer: First Choice Health Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$741.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.80
|
| Rate for Payer: HealthUtah PPO |
$780.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$756.60
|
| Rate for Payer: Multiplan Medicare/VA |
$489.06
|
| Rate for Payer: One Health Plan of WY PPO |
$764.40
|
| Rate for Payer: PacificSource Commercial |
$702.00
|
| Rate for Payer: PHCS PPO |
$764.40
|
| Rate for Payer: Three Rivers PPO |
$585.00
|
| Rate for Payer: TriWest Veterans Administration |
$514.80
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
| Rate for Payer: United Healthcare Medicare |
$514.80
|
| Rate for Payer: WINHealth Partners Commercial |
$741.00
|
| Rate for Payer: Wise Provider Network Commercial |
$741.00
|
|
|
HC X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
3207352201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$514.14 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$803.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$787.20
|
| Rate for Payer: Altius Commercial |
$787.20
|
| Rate for Payer: Beech Street Commercial |
$803.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$673.22
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$795.40
|
| Rate for Payer: Cigna of WY Commercial |
$803.60
|
| Rate for Payer: Entrust Commercial |
$779.00
|
| Rate for Payer: First Choice Health Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$541.20
|
| Rate for Payer: HealthUtah PPO |
$820.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$795.40
|
| Rate for Payer: Multiplan Medicare/VA |
$514.14
|
| Rate for Payer: One Health Plan of WY PPO |
$803.60
|
| Rate for Payer: PacificSource Commercial |
$738.00
|
| Rate for Payer: PHCS PPO |
$803.60
|
| Rate for Payer: Three Rivers PPO |
$615.00
|
| Rate for Payer: TriWest Veterans Administration |
$541.20
|
| Rate for Payer: United Healthcare Commercial |
$713.40
|
| Rate for Payer: United Healthcare Medicare |
$541.20
|
| Rate for Payer: WINHealth Partners Commercial |
$779.00
|
| Rate for Payer: Wise Provider Network Commercial |
$779.00
|
|
|
HC X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS 73522
|
| Hospital Charge Code |
3207352201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$451.82 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$803.60
|
| Rate for Payer: Aetna of WY Medicare |
$541.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$787.20
|
| Rate for Payer: Altius Commercial |
$787.20
|
| Rate for Payer: Beech Street Commercial |
$803.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$673.22
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$795.40
|
| Rate for Payer: Cigna of WY Commercial |
$803.60
|
| Rate for Payer: Entrust Commercial |
$779.00
|
| Rate for Payer: First Choice Health Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$779.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.60
|
| Rate for Payer: HealthUtah PPO |
$820.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$795.40
|
| Rate for Payer: Multiplan Medicare/VA |
$451.82
|
| Rate for Payer: One Health Plan of WY PPO |
$803.60
|
| Rate for Payer: PacificSource Commercial |
$738.00
|
| Rate for Payer: PHCS PPO |
$803.60
|
| Rate for Payer: Three Rivers PPO |
$615.00
|
| Rate for Payer: TriWest Veterans Administration |
$475.60
|
| Rate for Payer: United Healthcare Commercial |
$713.40
|
| Rate for Payer: United Healthcare Medicare |
$475.60
|
| Rate for Payer: WINHealth Partners Commercial |
$803.60
|
| Rate for Payer: Wise Provider Network Commercial |
$779.00
|
|
|
HC X-RAY EXAM HIPS BI 5+ VWS - XR HIPS BILAT 5+ VW W/ OR W/O PELVIS
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
3207352301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$663.96 |
| Max. Negotiated Rate |
$1,205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,180.90
|
| Rate for Payer: Aetna of WY Medicare |
$795.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,156.80
|
| Rate for Payer: Altius Commercial |
$1,156.80
|
| Rate for Payer: Beech Street Commercial |
$1,180.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$989.30
|
| Rate for Payer: Cash Price |
$843.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,168.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,180.90
|
| Rate for Payer: Entrust Commercial |
$1,144.75
|
| Rate for Payer: First Choice Health Commercial |
$1,144.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,144.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.90
|
| Rate for Payer: HealthUtah PPO |
$1,205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,168.85
|
| Rate for Payer: Multiplan Medicare/VA |
$663.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,180.90
|
| Rate for Payer: PacificSource Commercial |
$1,084.50
|
| Rate for Payer: PHCS PPO |
$1,180.90
|
| Rate for Payer: Three Rivers PPO |
$903.75
|
| Rate for Payer: TriWest Veterans Administration |
$698.90
|
| Rate for Payer: United Healthcare Commercial |
$1,048.35
|
| Rate for Payer: United Healthcare Medicare |
$698.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,180.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,144.75
|
|
|
HC X-RAY EXAM HIPS BI 5+ VWS - XR HIPS BILAT 5+ VW W/ OR W/O PELVIS
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS 73523
|
| Hospital Charge Code |
3207352301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$755.54 |
| Max. Negotiated Rate |
$1,205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,180.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,156.80
|
| Rate for Payer: Altius Commercial |
$1,156.80
|
| Rate for Payer: Beech Street Commercial |
$1,180.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$989.30
|
| Rate for Payer: Cash Price |
$843.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,168.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,180.90
|
| Rate for Payer: Entrust Commercial |
$1,144.75
|
| Rate for Payer: First Choice Health Commercial |
$1,144.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,144.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$795.30
|
| Rate for Payer: HealthUtah PPO |
$1,205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,168.85
|
| Rate for Payer: Multiplan Medicare/VA |
$755.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,180.90
|
| Rate for Payer: PacificSource Commercial |
$1,084.50
|
| Rate for Payer: PHCS PPO |
$1,180.90
|
| Rate for Payer: Three Rivers PPO |
$903.75
|
| Rate for Payer: TriWest Veterans Administration |
$795.30
|
| Rate for Payer: United Healthcare Commercial |
$1,048.35
|
| Rate for Payer: United Healthcare Medicare |
$795.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,144.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,144.75
|
|
|
HC X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW LEFT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350101
|
|
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 X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW LEFT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350101
|
|
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 X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW RIGHT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350102
|
|
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 X-RAY EXAM HIP UNI 1 VIEW - XR HIP 1 VW RIGHT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
3207350102
|
|
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 X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW LEFT
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
3207350201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$432.63 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.40
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$432.63
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$455.40
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$455.40
|
| Rate for Payer: WINHealth Partners Commercial |
$655.50
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW LEFT
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
3207350201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.19 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Aetna of WY Medicare |
$455.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.20
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$380.19
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$400.20
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$400.20
|
| Rate for Payer: WINHealth Partners Commercial |
$676.20
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW RIGHT
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
3207350202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$432.63 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.40
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$432.63
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$455.40
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$455.40
|
| Rate for Payer: WINHealth Partners Commercial |
$655.50
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS - XR HIP 2 OR 3 VW RIGHT
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
3207350202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.19 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Aetna of WY Medicare |
$455.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$662.40
|
| Rate for Payer: Altius Commercial |
$662.40
|
| Rate for Payer: Beech Street Commercial |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.49
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: Entrust Commercial |
$655.50
|
| Rate for Payer: First Choice Health Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.20
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$380.19
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$676.20
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$400.20
|
| Rate for Payer: United Healthcare Commercial |
$600.30
|
| Rate for Payer: United Healthcare Medicare |
$400.20
|
| Rate for Payer: WINHealth Partners Commercial |
$676.20
|
| Rate for Payer: Wise Provider Network Commercial |
$655.50
|
|
|
HC X-RAY EXAM HIP UNI 4+ VIEWS - XR HIP 4+ VW LEFT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
3207350301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$537.22 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$955.50
|
| Rate for Payer: Aetna of WY Medicare |
$643.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$936.00
|
| Rate for Payer: Altius Commercial |
$936.00
|
| Rate for Payer: Beech Street Commercial |
$955.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$800.48
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$945.75
|
| Rate for Payer: Cigna of WY Commercial |
$955.50
|
| Rate for Payer: Entrust Commercial |
$926.25
|
| Rate for Payer: First Choice Health Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.50
|
| Rate for Payer: HealthUtah PPO |
$975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$945.75
|
| Rate for Payer: Multiplan Medicare/VA |
$537.22
|
| Rate for Payer: One Health Plan of WY PPO |
$955.50
|
| Rate for Payer: PacificSource Commercial |
$877.50
|
| Rate for Payer: PHCS PPO |
$955.50
|
| Rate for Payer: Three Rivers PPO |
$731.25
|
| Rate for Payer: TriWest Veterans Administration |
$565.50
|
| Rate for Payer: United Healthcare Commercial |
$848.25
|
| Rate for Payer: United Healthcare Medicare |
$565.50
|
| Rate for Payer: WINHealth Partners Commercial |
$955.50
|
| Rate for Payer: Wise Provider Network Commercial |
$926.25
|
|
|
HC X-RAY EXAM HIP UNI 4+ VIEWS - XR HIP 4+ VW LEFT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
3207350301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$611.32 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$955.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$936.00
|
| Rate for Payer: Altius Commercial |
$936.00
|
| Rate for Payer: Beech Street Commercial |
$955.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$800.48
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$945.75
|
| Rate for Payer: Cigna of WY Commercial |
$955.50
|
| Rate for Payer: Entrust Commercial |
$926.25
|
| Rate for Payer: First Choice Health Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.50
|
| Rate for Payer: HealthUtah PPO |
$975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$945.75
|
| Rate for Payer: Multiplan Medicare/VA |
$611.32
|
| Rate for Payer: One Health Plan of WY PPO |
$955.50
|
| Rate for Payer: PacificSource Commercial |
$877.50
|
| Rate for Payer: PHCS PPO |
$955.50
|
| Rate for Payer: Three Rivers PPO |
$731.25
|
| Rate for Payer: TriWest Veterans Administration |
$643.50
|
| Rate for Payer: United Healthcare Commercial |
$848.25
|
| Rate for Payer: United Healthcare Medicare |
$643.50
|
| Rate for Payer: WINHealth Partners Commercial |
$926.25
|
| Rate for Payer: Wise Provider Network Commercial |
$926.25
|
|
|
HC X-RAY EXAM HIP UNI 4+ VIEWS - XR HIP 4+ VW RIGHT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
3207350302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$537.22 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$955.50
|
| Rate for Payer: Aetna of WY Medicare |
$643.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$936.00
|
| Rate for Payer: Altius Commercial |
$936.00
|
| Rate for Payer: Beech Street Commercial |
$955.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$800.48
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$945.75
|
| Rate for Payer: Cigna of WY Commercial |
$955.50
|
| Rate for Payer: Entrust Commercial |
$926.25
|
| Rate for Payer: First Choice Health Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.50
|
| Rate for Payer: HealthUtah PPO |
$975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$945.75
|
| Rate for Payer: Multiplan Medicare/VA |
$537.22
|
| Rate for Payer: One Health Plan of WY PPO |
$955.50
|
| Rate for Payer: PacificSource Commercial |
$877.50
|
| Rate for Payer: PHCS PPO |
$955.50
|
| Rate for Payer: Three Rivers PPO |
$731.25
|
| Rate for Payer: TriWest Veterans Administration |
$565.50
|
| Rate for Payer: United Healthcare Commercial |
$848.25
|
| Rate for Payer: United Healthcare Medicare |
$565.50
|
| Rate for Payer: WINHealth Partners Commercial |
$955.50
|
| Rate for Payer: Wise Provider Network Commercial |
$926.25
|
|
|
HC X-RAY EXAM HIP UNI 4+ VIEWS - XR HIP 4+ VW RIGHT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
3207350302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$611.32 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$955.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$936.00
|
| Rate for Payer: Altius Commercial |
$936.00
|
| Rate for Payer: Beech Street Commercial |
$955.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$800.48
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$945.75
|
| Rate for Payer: Cigna of WY Commercial |
$955.50
|
| Rate for Payer: Entrust Commercial |
$926.25
|
| Rate for Payer: First Choice Health Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.50
|
| Rate for Payer: HealthUtah PPO |
$975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$945.75
|
| Rate for Payer: Multiplan Medicare/VA |
$611.32
|
| Rate for Payer: One Health Plan of WY PPO |
$955.50
|
| Rate for Payer: PacificSource Commercial |
$877.50
|
| Rate for Payer: PHCS PPO |
$955.50
|
| Rate for Payer: Three Rivers PPO |
$731.25
|
| Rate for Payer: TriWest Veterans Administration |
$643.50
|
| Rate for Payer: United Healthcare Commercial |
$848.25
|
| Rate for Payer: United Healthcare Medicare |
$643.50
|
| Rate for Payer: WINHealth Partners Commercial |
$926.25
|
| Rate for Payer: Wise Provider Network Commercial |
$926.25
|
|
|
HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS BILATERAL
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS BILATERAL
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS LEFT
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS LEFT
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS RIGHT
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$184.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.40
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$154.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.40
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$162.40
|
| Rate for Payer: WINHealth Partners Commercial |
$274.40
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
|
HC X-RAY EXAM OF FINGER(S) - XR FINGERS 2+ VIEWS RIGHT
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
3207314001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$268.80
|
| Rate for Payer: Altius Commercial |
$268.80
|
| Rate for Payer: Beech Street Commercial |
$274.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$229.88
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: Entrust Commercial |
$266.00
|
| Rate for Payer: First Choice Health Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.80
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$175.56
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$274.40
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$184.80
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
| Rate for Payer: WINHealth Partners Commercial |
$266.00
|
| Rate for Payer: Wise Provider Network Commercial |
$266.00
|
|
