|
HC X-RAY FOREARM 2 VW - XR FOREARM 2 VIEWS RIGHT
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
3207309002
|
|
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 HAND 2 VW - XR HAND 1-2 VIEWS BILATERAL
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$224.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.20
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$187.34
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$197.20
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$197.20
|
| Rate for Payer: WINHealth Partners Commercial |
$333.20
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS BILATERAL
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$326.40
|
| Rate for Payer: Altius Commercial |
$326.40
|
| Rate for Payer: Beech Street Commercial |
$333.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$279.14
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: Entrust Commercial |
$323.00
|
| Rate for Payer: First Choice Health Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.40
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$213.18
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$333.20
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.40
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$224.40
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
| Rate for Payer: Wise Provider Network Commercial |
$323.00
|
|
|
HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS LEFT
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS LEFT
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS RIGHT
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$155.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.30
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$129.48
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$136.30
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$136.30
|
| Rate for Payer: WINHealth Partners Commercial |
$230.30
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC X-RAY HAND 2 VW - XR HAND 1-2 VIEWS RIGHT
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
3207312002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.34 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.60
|
| Rate for Payer: Altius Commercial |
$225.60
|
| Rate for Payer: Beech Street Commercial |
$230.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.94
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: Entrust Commercial |
$223.25
|
| Rate for Payer: First Choice Health Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.10
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$147.34
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$230.30
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$155.10
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$155.10
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
| Rate for Payer: Wise Provider Network Commercial |
$223.25
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS BILATERAL
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.36 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.70
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$310.36
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$326.70
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
| Rate for Payer: WINHealth Partners Commercial |
$470.25
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS BILATERAL
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Aetna of WY Medicare |
$326.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.10
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$272.74
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.10
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$485.10
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS LEFT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Aetna of WY Medicare |
$326.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.10
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$272.74
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.10
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$485.10
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS LEFT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.36 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.70
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$310.36
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$326.70
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
| Rate for Payer: WINHealth Partners Commercial |
$470.25
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS RIGHT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Aetna of WY Medicare |
$326.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.10
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$272.74
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.10
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$485.10
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC X-RAY HAND 3+ VW - XR HAND 3+ VIEWS RIGHT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
3207313002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.36 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$475.20
|
| Rate for Payer: Altius Commercial |
$475.20
|
| Rate for Payer: Beech Street Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$406.40
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: Entrust Commercial |
$470.25
|
| Rate for Payer: First Choice Health Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.70
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$310.36
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$485.10
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$326.70
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
| Rate for Payer: WINHealth Partners Commercial |
$470.25
|
| Rate for Payer: Wise Provider Network Commercial |
$470.25
|
|
|
HC X-RAY HEEL - XR CALCANEUS 2 VIEWS BILATERAL
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365006
|
|
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 HEEL - XR CALCANEUS 2 VIEWS BILATERAL
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365006
|
|
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 HEEL - XR CALCANEUS 2 VIEWS LEFT
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$191.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.20
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$159.79
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$168.20
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$168.20
|
| Rate for Payer: WINHealth Partners Commercial |
$284.20
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC X-RAY HEEL - XR CALCANEUS 2 VIEWS LEFT
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC X-RAY HEEL - XR CALCANEUS 2 VIEWS RIGHT
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.79 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$191.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.20
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$159.79
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$168.20
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$168.20
|
| Rate for Payer: WINHealth Partners Commercial |
$284.20
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC X-RAY HEEL - XR CALCANEUS 2 VIEWS RIGHT
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
3207365002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$278.40
|
| Rate for Payer: Altius Commercial |
$278.40
|
| Rate for Payer: Beech Street Commercial |
$284.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.09
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: Entrust Commercial |
$275.50
|
| Rate for Payer: First Choice Health Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.40
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$181.83
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$284.20
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$191.40
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$191.40
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
| Rate for Payer: Wise Provider Network Commercial |
$275.50
|
|
|
HC X-RAY HUMERUS - XR HUMERUS BILATERAL
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306001
|
|
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 HUMERUS - XR HUMERUS BILATERAL
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306001
|
|
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 HUMERUS - XR HUMERUS LEFT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306002
|
|
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 HUMERUS - XR HUMERUS LEFT
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306002
|
|
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 HUMERUS - XR HUMERUS RIGHT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306003
|
|
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 HUMERUS - XR HUMERUS RIGHT
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
3207306003
|
|
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
|
|
