|
HC X-RAY EXAM OF SMALL BOWEL - FL SMALL BOWEL SERIES
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
3207425001
|
|
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 SMALL BOWEL - FL SMALL BOWEL SERIES
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
3207425001
|
|
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 EYE FOR FOREIGN BODY - XR EYE FOREIGN BODY
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 70030
|
| Hospital Charge Code |
3207003001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$78.38
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$82.50
|
| Rate for Payer: WINHealth Partners Commercial |
$118.75
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC X-RAY EYE FOR FOREIGN BODY - XR EYE FOREIGN BODY
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 70030
|
| Hospital Charge Code |
3207003001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$120.00
|
| Rate for Payer: Altius Commercial |
$120.00
|
| Rate for Payer: Beech Street Commercial |
$122.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$121.25
|
| Rate for Payer: Cigna of WY Commercial |
$122.50
|
| Rate for Payer: Entrust Commercial |
$118.75
|
| Rate for Payer: First Choice Health Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.50
|
| Rate for Payer: HealthUtah PPO |
$125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$121.25
|
| Rate for Payer: Multiplan Medicare/VA |
$68.88
|
| Rate for Payer: One Health Plan of WY PPO |
$122.50
|
| Rate for Payer: PacificSource Commercial |
$112.50
|
| Rate for Payer: PHCS PPO |
$122.50
|
| Rate for Payer: Three Rivers PPO |
$93.75
|
| Rate for Payer: TriWest Veterans Administration |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$108.75
|
| Rate for Payer: United Healthcare Medicare |
$72.50
|
| Rate for Payer: WINHealth Partners Commercial |
$122.50
|
| Rate for Payer: Wise Provider Network Commercial |
$118.75
|
|
|
HC X-RAY FACIAL BONES <3 VW - XR FACIAL BONES 1-2 VIEWS
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 70140
|
| Hospital Charge Code |
3207014001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC X-RAY FACIAL BONES <3 VW - XR FACIAL BONES 1-2 VIEWS
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 70140
|
| Hospital Charge Code |
3207014001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
3207015001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Aetna of WY Medicare |
$386.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.30
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$322.34
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$339.30
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$339.30
|
| Rate for Payer: WINHealth Partners Commercial |
$573.30
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC X-RAY FACIAL BONES 3+ VW - XR FACIAL BONES 3+ VIEWS
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
3207015001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$386.10
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$366.80
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$386.10
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$386.10
|
| Rate for Payer: WINHealth Partners Commercial |
$555.75
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS BILATERAL
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362003
|
|
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 FOOT 2 VW - XR FOOT 1-2 VIEWS BILATERAL
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362003
|
|
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
|
|
|
HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS LEFT
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$204.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.80
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$170.81
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$179.80
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$179.80
|
| Rate for Payer: WINHealth Partners Commercial |
$303.80
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS LEFT
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.60
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$204.60
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$204.60
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS RIGHT
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.81 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$204.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.80
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$170.81
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$179.80
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$179.80
|
| Rate for Payer: WINHealth Partners Commercial |
$303.80
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC X-RAY FOOT 2 VW - XR FOOT 1-2 VIEWS RIGHT
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
3207362002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$297.60
|
| Rate for Payer: Altius Commercial |
$297.60
|
| Rate for Payer: Beech Street Commercial |
$303.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$254.51
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: Entrust Commercial |
$294.50
|
| Rate for Payer: First Choice Health Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.60
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$194.37
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$303.80
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$204.60
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$204.60
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
| Rate for Payer: Wise Provider Network Commercial |
$294.50
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS BILATERAL
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS LEFT
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS LEFT
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS RIGHT
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.60
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$257.07
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.60
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$270.60
|
| Rate for Payer: WINHealth Partners Commercial |
$389.50
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC X-RAY FOOT 3+ VW - XR FOOT 3+ VIEWS RIGHT
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
3207363002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.91 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$401.80
|
| Rate for Payer: Aetna of WY Medicare |
$270.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$393.60
|
| Rate for Payer: Altius Commercial |
$393.60
|
| Rate for Payer: Beech Street Commercial |
$401.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.61
|
| Rate for Payer: Cash Price |
$287.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$397.70
|
| Rate for Payer: Cigna of WY Commercial |
$401.80
|
| Rate for Payer: Entrust Commercial |
$389.50
|
| Rate for Payer: First Choice Health Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$389.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.80
|
| Rate for Payer: HealthUtah PPO |
$410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$397.70
|
| Rate for Payer: Multiplan Medicare/VA |
$225.91
|
| Rate for Payer: One Health Plan of WY PPO |
$401.80
|
| Rate for Payer: PacificSource Commercial |
$369.00
|
| Rate for Payer: PHCS PPO |
$401.80
|
| Rate for Payer: Three Rivers PPO |
$307.50
|
| Rate for Payer: TriWest Veterans Administration |
$237.80
|
| Rate for Payer: United Healthcare Commercial |
$356.70
|
| Rate for Payer: United Healthcare Medicare |
$237.80
|
| Rate for Payer: WINHealth Partners Commercial |
$401.80
|
| Rate for Payer: Wise Provider Network Commercial |
$389.50
|
|
|
HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS BILATERAL
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$652.08 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$998.40
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$853.84
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$686.40
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$652.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$686.40
|
| Rate for Payer: United Healthcare Commercial |
$904.80
|
| Rate for Payer: United Healthcare Medicare |
$686.40
|
| Rate for Payer: WINHealth Partners Commercial |
$988.00
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS BILATERAL
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$573.04 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,019.20
|
| Rate for Payer: Aetna of WY Medicare |
$686.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$998.40
|
| Rate for Payer: Altius Commercial |
$998.40
|
| Rate for Payer: Beech Street Commercial |
$1,019.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$853.84
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,008.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,019.20
|
| Rate for Payer: Entrust Commercial |
$988.00
|
| Rate for Payer: First Choice Health Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$603.20
|
| Rate for Payer: HealthUtah PPO |
$1,040.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,008.80
|
| Rate for Payer: Multiplan Medicare/VA |
$573.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,019.20
|
| Rate for Payer: PacificSource Commercial |
$936.00
|
| Rate for Payer: PHCS PPO |
$1,019.20
|
| Rate for Payer: Three Rivers PPO |
$780.00
|
| Rate for Payer: TriWest Veterans Administration |
$603.20
|
| Rate for Payer: United Healthcare Commercial |
$904.80
|
| Rate for Payer: United Healthcare Medicare |
$603.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,019.20
|
| Rate for Payer: Wise Provider Network Commercial |
$988.00
|
|
|
HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS LEFT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.26 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Aetna of WY Medicare |
$333.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$484.80
|
| Rate for Payer: Altius Commercial |
$484.80
|
| Rate for Payer: Beech Street Commercial |
$494.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: Entrust Commercial |
$479.75
|
| Rate for Payer: First Choice Health Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.90
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: Multiplan Medicare/VA |
$278.26
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$494.90
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: TriWest Veterans Administration |
$292.90
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: United Healthcare Medicare |
$292.90
|
| Rate for Payer: WINHealth Partners Commercial |
$494.90
|
| Rate for Payer: Wise Provider Network Commercial |
$479.75
|
|
|
HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS LEFT
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.64 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$484.80
|
| Rate for Payer: Altius Commercial |
$484.80
|
| Rate for Payer: Beech Street Commercial |
$494.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: Entrust Commercial |
$479.75
|
| Rate for Payer: First Choice Health Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$333.30
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: Multiplan Medicare/VA |
$316.64
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$494.90
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: TriWest Veterans Administration |
$333.30
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: United Healthcare Medicare |
$333.30
|
| Rate for Payer: WINHealth Partners Commercial |
$479.75
|
| Rate for Payer: Wise Provider Network Commercial |
$479.75
|
|
|
HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS RIGHT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.26 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Aetna of WY Medicare |
$333.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$484.80
|
| Rate for Payer: Altius Commercial |
$484.80
|
| Rate for Payer: Beech Street Commercial |
$494.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: Entrust Commercial |
$479.75
|
| Rate for Payer: First Choice Health Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.90
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: Multiplan Medicare/VA |
$278.26
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$494.90
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: TriWest Veterans Administration |
$292.90
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: United Healthcare Medicare |
$292.90
|
| Rate for Payer: WINHealth Partners Commercial |
$494.90
|
| Rate for Payer: Wise Provider Network Commercial |
$479.75
|
|
