|
HC X-RAY KNEE 4+ VIEW - HIP TO ANKLE RIGHT
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356404
|
|
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 - XR KNEE 4+ VIEWS BILATERAL
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356403
|
|
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 - XR KNEE 4+ VIEWS BILATERAL
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356403
|
|
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 - XR KNEE 4+ VIEWS LEFT
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356401
|
|
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 - XR KNEE 4+ VIEWS LEFT
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356401
|
|
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 - XR KNEE 4+ VIEWS RIGHT
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356402
|
|
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 - XR KNEE 4+ VIEWS RIGHT
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
3207356402
|
|
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 BILAT STANDING - XR KNEES ANTEROPOSTERIOR STANDING BILAT
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
3207356501
|
|
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 KNEE BILAT STANDING - XR KNEES ANTEROPOSTERIOR STANDING BILAT
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
3207356501
|
|
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 LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
3207359203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Aetna of WY Medicare |
$343.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$286.52
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.60
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$301.60
|
| Rate for Payer: WINHealth Partners Commercial |
$509.60
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
3207359203
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.04 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.20
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$326.04
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$343.20
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$343.20
|
| Rate for Payer: WINHealth Partners Commercial |
$494.00
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT BILATERAL
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
3207359204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$746.13 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,166.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,142.40
|
| Rate for Payer: Altius Commercial |
$1,142.40
|
| Rate for Payer: Beech Street Commercial |
$1,166.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$976.99
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,154.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,166.20
|
| Rate for Payer: Entrust Commercial |
$1,130.50
|
| Rate for Payer: First Choice Health Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$785.40
|
| Rate for Payer: HealthUtah PPO |
$1,190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,154.30
|
| Rate for Payer: Multiplan Medicare/VA |
$746.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,166.20
|
| Rate for Payer: PacificSource Commercial |
$1,071.00
|
| Rate for Payer: PHCS PPO |
$1,166.20
|
| Rate for Payer: Three Rivers PPO |
$892.50
|
| Rate for Payer: TriWest Veterans Administration |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$1,035.30
|
| Rate for Payer: United Healthcare Medicare |
$785.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,130.50
|
|
|
HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT BILATERAL
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
3207359204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$655.69 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,166.20
|
| Rate for Payer: Aetna of WY Medicare |
$785.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,142.40
|
| Rate for Payer: Altius Commercial |
$1,142.40
|
| Rate for Payer: Beech Street Commercial |
$1,166.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$976.99
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,154.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,166.20
|
| Rate for Payer: Entrust Commercial |
$1,130.50
|
| Rate for Payer: First Choice Health Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$690.20
|
| Rate for Payer: HealthUtah PPO |
$1,190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,154.30
|
| Rate for Payer: Multiplan Medicare/VA |
$655.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,166.20
|
| Rate for Payer: PacificSource Commercial |
$1,071.00
|
| Rate for Payer: PHCS PPO |
$1,166.20
|
| Rate for Payer: Three Rivers PPO |
$892.50
|
| Rate for Payer: TriWest Veterans Administration |
$690.20
|
| Rate for Payer: United Healthcare Commercial |
$1,035.30
|
| Rate for Payer: United Healthcare Medicare |
$690.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,166.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,130.50
|
|
|
HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT LEFT
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
3207359201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Aetna of WY Medicare |
$330.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$275.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$290.00
|
| Rate for Payer: WINHealth Partners Commercial |
$490.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC X-RAY LEG, INFANT - XR LOWER EXTREMITY 2+ VIEWS INFANT LEFT
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
3207359201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$490.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$480.00
|
| Rate for Payer: Altius Commercial |
$480.00
|
| Rate for Payer: Beech Street Commercial |
$490.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.50
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$485.00
|
| Rate for Payer: Cigna of WY Commercial |
$490.00
|
| Rate for Payer: Entrust Commercial |
$475.00
|
| Rate for Payer: First Choice Health Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$475.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.00
|
| Rate for Payer: HealthUtah PPO |
$500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$485.00
|
| Rate for Payer: Multiplan Medicare/VA |
$313.50
|
| Rate for Payer: One Health Plan of WY PPO |
$490.00
|
| Rate for Payer: PacificSource Commercial |
$450.00
|
| Rate for Payer: PHCS PPO |
$490.00
|
| Rate for Payer: Three Rivers PPO |
$375.00
|
| Rate for Payer: TriWest Veterans Administration |
$330.00
|
| Rate for Payer: United Healthcare Commercial |
$435.00
|
| Rate for Payer: United Healthcare Medicare |
$330.00
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
| Rate for Payer: Wise Provider Network Commercial |
$475.00
|
|
|
HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
3207210001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$286.52 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Aetna of WY Medicare |
$343.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$301.60
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$286.52
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$301.60
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$301.60
|
| Rate for Payer: WINHealth Partners Commercial |
$509.60
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC X-RAY LUMBAR SPINE 2/3 VW - XR LUMBAR SPINE 2-3 VIEWS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
3207210001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.04 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$509.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$499.20
|
| Rate for Payer: Altius Commercial |
$499.20
|
| Rate for Payer: Beech Street Commercial |
$509.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$426.92
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$504.40
|
| Rate for Payer: Cigna of WY Commercial |
$509.60
|
| Rate for Payer: Entrust Commercial |
$494.00
|
| Rate for Payer: First Choice Health Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$494.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.20
|
| Rate for Payer: HealthUtah PPO |
$520.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$504.40
|
| Rate for Payer: Multiplan Medicare/VA |
$326.04
|
| Rate for Payer: One Health Plan of WY PPO |
$509.60
|
| Rate for Payer: PacificSource Commercial |
$468.00
|
| Rate for Payer: PHCS PPO |
$509.60
|
| Rate for Payer: Three Rivers PPO |
$390.00
|
| Rate for Payer: TriWest Veterans Administration |
$343.20
|
| Rate for Payer: United Healthcare Commercial |
$452.40
|
| Rate for Payer: United Healthcare Medicare |
$343.20
|
| Rate for Payer: WINHealth Partners Commercial |
$494.00
|
| Rate for Payer: Wise Provider Network Commercial |
$494.00
|
|
|
HC X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
3207211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$432.54 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$769.30
|
| Rate for Payer: Aetna of WY Medicare |
$518.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$753.60
|
| Rate for Payer: Altius Commercial |
$753.60
|
| Rate for Payer: Beech Street Commercial |
$769.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$549.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$761.45
|
| Rate for Payer: Cigna of WY Commercial |
$769.30
|
| Rate for Payer: Entrust Commercial |
$745.75
|
| Rate for Payer: First Choice Health Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$455.30
|
| Rate for Payer: HealthUtah PPO |
$785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$761.45
|
| Rate for Payer: Multiplan Medicare/VA |
$432.54
|
| Rate for Payer: One Health Plan of WY PPO |
$769.30
|
| Rate for Payer: PacificSource Commercial |
$706.50
|
| Rate for Payer: PHCS PPO |
$769.30
|
| Rate for Payer: Three Rivers PPO |
$588.75
|
| Rate for Payer: TriWest Veterans Administration |
$455.30
|
| Rate for Payer: United Healthcare Commercial |
$682.95
|
| Rate for Payer: United Healthcare Medicare |
$455.30
|
| Rate for Payer: WINHealth Partners Commercial |
$769.30
|
| Rate for Payer: Wise Provider Network Commercial |
$745.75
|
|
|
HC X-RAY LUMBAR SPINE 4 VW - XR LUMBAR SPINE COMPLETE 4+ VIEWS
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
3207211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$492.20 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$769.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$753.60
|
| Rate for Payer: Altius Commercial |
$753.60
|
| Rate for Payer: Beech Street Commercial |
$769.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$644.48
|
| Rate for Payer: Cash Price |
$549.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$761.45
|
| Rate for Payer: Cigna of WY Commercial |
$769.30
|
| Rate for Payer: Entrust Commercial |
$745.75
|
| Rate for Payer: First Choice Health Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$745.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$518.10
|
| Rate for Payer: HealthUtah PPO |
$785.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$761.45
|
| Rate for Payer: Multiplan Medicare/VA |
$492.20
|
| Rate for Payer: One Health Plan of WY PPO |
$769.30
|
| Rate for Payer: PacificSource Commercial |
$706.50
|
| Rate for Payer: PHCS PPO |
$769.30
|
| Rate for Payer: Three Rivers PPO |
$588.75
|
| Rate for Payer: TriWest Veterans Administration |
$518.10
|
| Rate for Payer: United Healthcare Commercial |
$682.95
|
| Rate for Payer: United Healthcare Medicare |
$518.10
|
| Rate for Payer: WINHealth Partners Commercial |
$745.75
|
| Rate for Payer: Wise Provider Network Commercial |
$745.75
|
|
|
HC X-RAY LUMBAR SPINE 6+ VW - XR LUMBAR SPINE 6+ VWS INCLUDING BENDING
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
3207211401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.07 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Aetna of WY Medicare |
$376.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.60
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$314.07
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$330.60
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$330.60
|
| Rate for Payer: WINHealth Partners Commercial |
$558.60
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC X-RAY LUMBAR SPINE 6+ VW - XR LUMBAR SPINE 6+ VWS INCLUDING BENDING
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
3207211401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.39 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$558.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$547.20
|
| Rate for Payer: Altius Commercial |
$547.20
|
| Rate for Payer: Beech Street Commercial |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$467.97
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$552.90
|
| Rate for Payer: Cigna of WY Commercial |
$558.60
|
| Rate for Payer: Entrust Commercial |
$541.50
|
| Rate for Payer: First Choice Health Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$541.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$376.20
|
| Rate for Payer: HealthUtah PPO |
$570.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$552.90
|
| Rate for Payer: Multiplan Medicare/VA |
$357.39
|
| Rate for Payer: One Health Plan of WY PPO |
$558.60
|
| Rate for Payer: PacificSource Commercial |
$513.00
|
| Rate for Payer: PHCS PPO |
$558.60
|
| Rate for Payer: Three Rivers PPO |
$427.50
|
| Rate for Payer: TriWest Veterans Administration |
$376.20
|
| Rate for Payer: United Healthcare Commercial |
$495.90
|
| Rate for Payer: United Healthcare Medicare |
$376.20
|
| Rate for Payer: WINHealth Partners Commercial |
$541.50
|
| Rate for Payer: Wise Provider Network Commercial |
$541.50
|
|
|
HC X-RAY LUMBAR SPINE FLEX/EXTEN - XR LUMBAR SPINE 4+ VIEWS W/ FLEX EXT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
3207212001
|
|
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 LUMBAR SPINE FLEX/EXTEN - XR LUMBAR SPINE 4+ VIEWS W/ FLEX EXT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
3207212001
|
|
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 NASAL BONES - XR NASAL BONES
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
3207016001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$148.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$123.98
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$130.50
|
| Rate for Payer: WINHealth Partners Commercial |
$220.50
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
|
HC X-RAY NASAL BONES - XR NASAL BONES
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
3207016001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$216.00
|
| Rate for Payer: Altius Commercial |
$216.00
|
| Rate for Payer: Beech Street Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: Entrust Commercial |
$213.75
|
| Rate for Payer: First Choice Health Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.50
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$141.08
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$220.50
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$148.50
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
| Rate for Payer: Wise Provider Network Commercial |
$213.75
|
|
