|
HC X-RAY HYSTEROSALPINGOGRAM - XR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
3207474001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$617.12 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.60
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$617.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$649.60
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC X-RAY HYSTEROSALPINGOGRAM - XR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
3207474001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$702.24 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.20
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$702.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$739.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,064.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC X-RAY IV PYELOGRAM (IVP) - FL INTRAVENOUS PYELOGRAM
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS 74400
|
| Hospital Charge Code |
3207440002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$749.26 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,171.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,147.20
|
| Rate for Payer: Altius Commercial |
$1,147.20
|
| Rate for Payer: Beech Street Commercial |
$1,171.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$981.10
|
| Rate for Payer: Cash Price |
$836.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,159.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,171.10
|
| Rate for Payer: Entrust Commercial |
$1,135.25
|
| Rate for Payer: First Choice Health Commercial |
$1,135.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,135.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.70
|
| Rate for Payer: HealthUtah PPO |
$1,195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,159.15
|
| Rate for Payer: Multiplan Medicare/VA |
$749.26
|
| Rate for Payer: One Health Plan of WY PPO |
$1,171.10
|
| Rate for Payer: PacificSource Commercial |
$1,075.50
|
| Rate for Payer: PHCS PPO |
$1,171.10
|
| Rate for Payer: Three Rivers PPO |
$896.25
|
| Rate for Payer: TriWest Veterans Administration |
$788.70
|
| Rate for Payer: United Healthcare Commercial |
$1,039.65
|
| Rate for Payer: United Healthcare Medicare |
$788.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,135.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,135.25
|
|
|
HC X-RAY IV PYELOGRAM (IVP) - FL INTRAVENOUS PYELOGRAM
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS 74400
|
| Hospital Charge Code |
3207440002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$658.44 |
| Max. Negotiated Rate |
$1,195.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,171.10
|
| Rate for Payer: Aetna of WY Medicare |
$788.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,147.20
|
| Rate for Payer: Altius Commercial |
$1,147.20
|
| Rate for Payer: Beech Street Commercial |
$1,171.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$981.10
|
| Rate for Payer: Cash Price |
$836.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,159.15
|
| Rate for Payer: Cigna of WY Commercial |
$1,171.10
|
| Rate for Payer: Entrust Commercial |
$1,135.25
|
| Rate for Payer: First Choice Health Commercial |
$1,135.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,135.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$693.10
|
| Rate for Payer: HealthUtah PPO |
$1,195.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,159.15
|
| Rate for Payer: Multiplan Medicare/VA |
$658.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,171.10
|
| Rate for Payer: PacificSource Commercial |
$1,075.50
|
| Rate for Payer: PHCS PPO |
$1,171.10
|
| Rate for Payer: Three Rivers PPO |
$896.25
|
| Rate for Payer: TriWest Veterans Administration |
$693.10
|
| Rate for Payer: United Healthcare Commercial |
$1,039.65
|
| Rate for Payer: United Healthcare Medicare |
$693.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,171.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,135.25
|
|
|
HC X-RAY JAW <4 VW - XR MANDIBLE < 4 VIEWS
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
3207010001
|
|
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 JAW <4 VW - XR MANDIBLE < 4 VIEWS
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 70100
|
| Hospital Charge Code |
3207010001
|
|
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 JAW 4+ VW - XR MANDIBLE 4+ VIEWS
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
3207011001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Aetna of WY Medicare |
$171.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.80
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$143.26
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.80
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$150.80
|
| Rate for Payer: WINHealth Partners Commercial |
$254.80
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC X-RAY JAW 4+ VW - XR MANDIBLE 4+ VIEWS
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
3207011001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$254.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$249.60
|
| Rate for Payer: Altius Commercial |
$249.60
|
| Rate for Payer: Beech Street Commercial |
$254.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$213.46
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.20
|
| Rate for Payer: Cigna of WY Commercial |
$254.80
|
| Rate for Payer: Entrust Commercial |
$247.00
|
| Rate for Payer: First Choice Health Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.60
|
| Rate for Payer: HealthUtah PPO |
$260.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.20
|
| Rate for Payer: Multiplan Medicare/VA |
$163.02
|
| Rate for Payer: One Health Plan of WY PPO |
$254.80
|
| Rate for Payer: PacificSource Commercial |
$234.00
|
| Rate for Payer: PHCS PPO |
$254.80
|
| Rate for Payer: Three Rivers PPO |
$195.00
|
| Rate for Payer: TriWest Veterans Administration |
$171.60
|
| Rate for Payer: United Healthcare Commercial |
$226.20
|
| Rate for Payer: United Healthcare Medicare |
$171.60
|
| Rate for Payer: WINHealth Partners Commercial |
$247.00
|
| Rate for Payer: Wise Provider Network Commercial |
$247.00
|
|
|
HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS BILAT
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
3207356003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.42 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.60
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$231.42
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$243.60
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$243.60
|
| Rate for Payer: WINHealth Partners Commercial |
$411.60
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS BILAT
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
3207356003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.34 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$411.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$403.20
|
| Rate for Payer: Altius Commercial |
$403.20
|
| Rate for Payer: Beech Street Commercial |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$344.82
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$407.40
|
| Rate for Payer: Cigna of WY Commercial |
$411.60
|
| Rate for Payer: Entrust Commercial |
$399.00
|
| Rate for Payer: First Choice Health Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$399.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.20
|
| Rate for Payer: HealthUtah PPO |
$420.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$407.40
|
| Rate for Payer: Multiplan Medicare/VA |
$263.34
|
| Rate for Payer: One Health Plan of WY PPO |
$411.60
|
| Rate for Payer: PacificSource Commercial |
$378.00
|
| Rate for Payer: PHCS PPO |
$411.60
|
| Rate for Payer: Three Rivers PPO |
$315.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Medicare |
$277.20
|
| Rate for Payer: WINHealth Partners Commercial |
$399.00
|
| Rate for Payer: Wise Provider Network Commercial |
$399.00
|
|
|
HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS LEFT
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
3207356001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS LEFT
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
3207356001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS RIGHT
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
3207356002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$323.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$284.20
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$269.99
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$284.20
|
| Rate for Payer: WINHealth Partners Commercial |
$480.20
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC X-RAY KNEE 1 OR 2 VIEW - XR KNEE 1-2 VIEWS RIGHT
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
3207356002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$470.40
|
| Rate for Payer: Altius Commercial |
$470.40
|
| Rate for Payer: Beech Street Commercial |
$480.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$402.29
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: Entrust Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.40
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$307.23
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$480.20
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$323.40
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$323.40
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$465.50
|
|
|
HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS BILATERAL
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
3207356203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.03 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Medicare |
$349.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.40
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$292.03
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$307.40
|
| Rate for Payer: WINHealth Partners Commercial |
$519.40
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS BILATERAL
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
3207356203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$508.80
|
| Rate for Payer: Altius Commercial |
$508.80
|
| Rate for Payer: Beech Street Commercial |
$519.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$435.13
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: Entrust Commercial |
$503.50
|
| Rate for Payer: First Choice Health Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.80
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Multiplan Medicare/VA |
$332.31
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$519.40
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: TriWest Veterans Administration |
$349.80
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$349.80
|
| Rate for Payer: WINHealth Partners Commercial |
$503.50
|
| Rate for Payer: Wise Provider Network Commercial |
$503.50
|
|
|
HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS LEFT
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
3207356201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS LEFT
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
3207356201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS RIGHT
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
3207356202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY KNEE 3 VIEW - XR KNEE 3 VIEWS RIGHT
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
3207356202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY KNEE 4+ VIEW - HIP TO ANKLE BILATERAL
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356406
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$583.11 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$911.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$892.80
|
| Rate for Payer: Altius Commercial |
$892.80
|
| Rate for Payer: Beech Street Commercial |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$763.53
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$902.10
|
| Rate for Payer: Cigna of WY Commercial |
$911.40
|
| Rate for Payer: Entrust Commercial |
$883.50
|
| Rate for Payer: First Choice Health Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$613.80
|
| Rate for Payer: HealthUtah PPO |
$930.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$902.10
|
| Rate for Payer: Multiplan Medicare/VA |
$583.11
|
| Rate for Payer: One Health Plan of WY PPO |
$911.40
|
| Rate for Payer: PacificSource Commercial |
$837.00
|
| Rate for Payer: PHCS PPO |
$911.40
|
| Rate for Payer: Three Rivers PPO |
$697.50
|
| Rate for Payer: TriWest Veterans Administration |
$613.80
|
| Rate for Payer: United Healthcare Commercial |
$809.10
|
| Rate for Payer: United Healthcare Medicare |
$613.80
|
| Rate for Payer: WINHealth Partners Commercial |
$883.50
|
| Rate for Payer: Wise Provider Network Commercial |
$883.50
|
|
|
HC X-RAY KNEE 4+ VIEW - HIP TO ANKLE BILATERAL
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356406
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$512.43 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$911.40
|
| Rate for Payer: Aetna of WY Medicare |
$613.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$892.80
|
| Rate for Payer: Altius Commercial |
$892.80
|
| Rate for Payer: Beech Street Commercial |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$763.53
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$902.10
|
| Rate for Payer: Cigna of WY Commercial |
$911.40
|
| Rate for Payer: Entrust Commercial |
$883.50
|
| Rate for Payer: First Choice Health Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.40
|
| Rate for Payer: HealthUtah PPO |
$930.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$902.10
|
| Rate for Payer: Multiplan Medicare/VA |
$512.43
|
| Rate for Payer: One Health Plan of WY PPO |
$911.40
|
| Rate for Payer: PacificSource Commercial |
$837.00
|
| Rate for Payer: PHCS PPO |
$911.40
|
| Rate for Payer: Three Rivers PPO |
$697.50
|
| Rate for Payer: TriWest Veterans Administration |
$539.40
|
| Rate for Payer: United Healthcare Commercial |
$809.10
|
| Rate for Payer: United Healthcare Medicare |
$539.40
|
| Rate for Payer: WINHealth Partners Commercial |
$911.40
|
| Rate for Payer: Wise Provider Network Commercial |
$883.50
|
|
|
HC X-RAY KNEE 4+ VIEW - HIP TO ANKLE LEFT
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356405
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$512.43 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$911.40
|
| Rate for Payer: Aetna of WY Medicare |
$613.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$892.80
|
| Rate for Payer: Altius Commercial |
$892.80
|
| Rate for Payer: Beech Street Commercial |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$763.53
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$902.10
|
| Rate for Payer: Cigna of WY Commercial |
$911.40
|
| Rate for Payer: Entrust Commercial |
$883.50
|
| Rate for Payer: First Choice Health Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.40
|
| Rate for Payer: HealthUtah PPO |
$930.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$902.10
|
| Rate for Payer: Multiplan Medicare/VA |
$512.43
|
| Rate for Payer: One Health Plan of WY PPO |
$911.40
|
| Rate for Payer: PacificSource Commercial |
$837.00
|
| Rate for Payer: PHCS PPO |
$911.40
|
| Rate for Payer: Three Rivers PPO |
$697.50
|
| Rate for Payer: TriWest Veterans Administration |
$539.40
|
| Rate for Payer: United Healthcare Commercial |
$809.10
|
| Rate for Payer: United Healthcare Medicare |
$539.40
|
| Rate for Payer: WINHealth Partners Commercial |
$911.40
|
| Rate for Payer: Wise Provider Network Commercial |
$883.50
|
|
|
HC X-RAY KNEE 4+ VIEW - HIP TO ANKLE LEFT
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356405
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$583.11 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$911.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$892.80
|
| Rate for Payer: Altius Commercial |
$892.80
|
| Rate for Payer: Beech Street Commercial |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$763.53
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$902.10
|
| Rate for Payer: Cigna of WY Commercial |
$911.40
|
| Rate for Payer: Entrust Commercial |
$883.50
|
| Rate for Payer: First Choice Health Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$613.80
|
| Rate for Payer: HealthUtah PPO |
$930.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$902.10
|
| Rate for Payer: Multiplan Medicare/VA |
$583.11
|
| Rate for Payer: One Health Plan of WY PPO |
$911.40
|
| Rate for Payer: PacificSource Commercial |
$837.00
|
| Rate for Payer: PHCS PPO |
$911.40
|
| Rate for Payer: Three Rivers PPO |
$697.50
|
| Rate for Payer: TriWest Veterans Administration |
$613.80
|
| Rate for Payer: United Healthcare Commercial |
$809.10
|
| Rate for Payer: United Healthcare Medicare |
$613.80
|
| Rate for Payer: WINHealth Partners Commercial |
$883.50
|
| Rate for Payer: Wise Provider Network Commercial |
$883.50
|
|
|
HC X-RAY KNEE 4+ VIEW - HIP TO ANKLE RIGHT
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356404
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$512.43 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$911.40
|
| Rate for Payer: Aetna of WY Medicare |
$613.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$892.80
|
| Rate for Payer: Altius Commercial |
$892.80
|
| Rate for Payer: Beech Street Commercial |
$911.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$763.53
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$902.10
|
| Rate for Payer: Cigna of WY Commercial |
$911.40
|
| Rate for Payer: Entrust Commercial |
$883.50
|
| Rate for Payer: First Choice Health Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$883.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.40
|
| Rate for Payer: HealthUtah PPO |
$930.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$902.10
|
| Rate for Payer: Multiplan Medicare/VA |
$512.43
|
| Rate for Payer: One Health Plan of WY PPO |
$911.40
|
| Rate for Payer: PacificSource Commercial |
$837.00
|
| Rate for Payer: PHCS PPO |
$911.40
|
| Rate for Payer: Three Rivers PPO |
$697.50
|
| Rate for Payer: TriWest Veterans Administration |
$539.40
|
| Rate for Payer: United Healthcare Commercial |
$809.10
|
| Rate for Payer: United Healthcare Medicare |
$539.40
|
| Rate for Payer: WINHealth Partners Commercial |
$911.40
|
| Rate for Payer: Wise Provider Network Commercial |
$883.50
|
|
