|
HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
3207036001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$237.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.80
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$198.36
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$352.80
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
3207036001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.60
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$225.72
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$237.60
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$237.60
|
| Rate for Payer: WINHealth Partners Commercial |
$342.00
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE LATERAL
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
3207036002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$237.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.80
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$198.36
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$208.80
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$208.80
|
| Rate for Payer: WINHealth Partners Commercial |
$352.80
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC X-RAY NECK SOFT TISSUE - XR NECK SOFT TISSUE LATERAL
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
3207036002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$345.60
|
| Rate for Payer: Altius Commercial |
$345.60
|
| Rate for Payer: Beech Street Commercial |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$295.56
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: Entrust Commercial |
$342.00
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$237.60
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$225.72
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$352.80
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$237.60
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$237.60
|
| Rate for Payer: WINHealth Partners Commercial |
$342.00
|
| Rate for Payer: Wise Provider Network Commercial |
$342.00
|
|
|
HC X-RAY NOSE-RECTUM CHILD F.B. - XR ABDOMEN CHILD
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
3207601002
|
|
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 NOSE-RECTUM CHILD F.B. - XR ABDOMEN CHILD
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
3207601002
|
|
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 NOSE-RECTUM CHILD F.B. - XR NOSE TO RECTUM FOREIGN BODY PEDS
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
3207601001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$376.20 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$396.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$376.20
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$396.00
|
| Rate for Payer: WINHealth Partners Commercial |
$570.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC X-RAY NOSE-RECTUM CHILD F.B. - XR NOSE TO RECTUM FOREIGN BODY PEDS
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
3207601001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
| Rate for Payer: Aetna of WY Medicare |
$396.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
| Rate for Payer: Altius Commercial |
$576.00
|
| Rate for Payer: Beech Street Commercial |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
| Rate for Payer: Cigna of WY Commercial |
$588.00
|
| Rate for Payer: Entrust Commercial |
$570.00
|
| Rate for Payer: First Choice Health Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.00
|
| Rate for Payer: HealthUtah PPO |
$600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
| Rate for Payer: Multiplan Medicare/VA |
$330.60
|
| Rate for Payer: One Health Plan of WY PPO |
$588.00
|
| Rate for Payer: PacificSource Commercial |
$540.00
|
| Rate for Payer: PHCS PPO |
$588.00
|
| Rate for Payer: Three Rivers PPO |
$450.00
|
| Rate for Payer: TriWest Veterans Administration |
$348.00
|
| Rate for Payer: United Healthcare Commercial |
$522.00
|
| Rate for Payer: United Healthcare Medicare |
$348.00
|
| Rate for Payer: WINHealth Partners Commercial |
$588.00
|
| Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
|
HC X-RAY ORBITS - XR ORBITS COMPLETE 4+ VIEWS
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
3207020001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$386.10
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$366.80
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$386.10
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$386.10
|
| Rate for Payer: WINHealth Partners Commercial |
$555.75
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC X-RAY ORBITS - XR ORBITS COMPLETE 4+ VIEWS
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
3207020001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$573.30
|
| Rate for Payer: Aetna of WY Medicare |
$386.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$561.60
|
| Rate for Payer: Altius Commercial |
$561.60
|
| Rate for Payer: Beech Street Commercial |
$573.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$480.28
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$567.45
|
| Rate for Payer: Cigna of WY Commercial |
$573.30
|
| Rate for Payer: Entrust Commercial |
$555.75
|
| Rate for Payer: First Choice Health Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$555.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.30
|
| Rate for Payer: HealthUtah PPO |
$585.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$567.45
|
| Rate for Payer: Multiplan Medicare/VA |
$322.34
|
| Rate for Payer: One Health Plan of WY PPO |
$573.30
|
| Rate for Payer: PacificSource Commercial |
$526.50
|
| Rate for Payer: PHCS PPO |
$573.30
|
| Rate for Payer: Three Rivers PPO |
$438.75
|
| Rate for Payer: TriWest Veterans Administration |
$339.30
|
| Rate for Payer: United Healthcare Commercial |
$508.95
|
| Rate for Payer: United Healthcare Medicare |
$339.30
|
| Rate for Payer: WINHealth Partners Commercial |
$573.30
|
| Rate for Payer: Wise Provider Network Commercial |
$555.75
|
|
|
HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
3207217001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$360.90 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.90
|
| Rate for Payer: Aetna of WY Medicare |
$432.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$628.80
|
| Rate for Payer: Altius Commercial |
$628.80
|
| Rate for Payer: Beech Street Commercial |
$641.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.76
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$635.35
|
| Rate for Payer: Cigna of WY Commercial |
$641.90
|
| Rate for Payer: Entrust Commercial |
$622.25
|
| Rate for Payer: First Choice Health Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.90
|
| Rate for Payer: HealthUtah PPO |
$655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$635.35
|
| Rate for Payer: Multiplan Medicare/VA |
$360.90
|
| Rate for Payer: One Health Plan of WY PPO |
$641.90
|
| Rate for Payer: PacificSource Commercial |
$589.50
|
| Rate for Payer: PHCS PPO |
$641.90
|
| Rate for Payer: Three Rivers PPO |
$491.25
|
| Rate for Payer: TriWest Veterans Administration |
$379.90
|
| Rate for Payer: United Healthcare Commercial |
$569.85
|
| Rate for Payer: United Healthcare Medicare |
$379.90
|
| Rate for Payer: WINHealth Partners Commercial |
$641.90
|
| Rate for Payer: Wise Provider Network Commercial |
$622.25
|
|
|
HC X-RAY PELVIS 1/2 VW - XR PELVIS 1-2 VIEWS
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
3207217001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$410.68 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$641.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$628.80
|
| Rate for Payer: Altius Commercial |
$628.80
|
| Rate for Payer: Beech Street Commercial |
$641.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$537.76
|
| Rate for Payer: Cash Price |
$458.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$635.35
|
| Rate for Payer: Cigna of WY Commercial |
$641.90
|
| Rate for Payer: Entrust Commercial |
$622.25
|
| Rate for Payer: First Choice Health Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$622.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$432.30
|
| Rate for Payer: HealthUtah PPO |
$655.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$635.35
|
| Rate for Payer: Multiplan Medicare/VA |
$410.68
|
| Rate for Payer: One Health Plan of WY PPO |
$641.90
|
| Rate for Payer: PacificSource Commercial |
$589.50
|
| Rate for Payer: PHCS PPO |
$641.90
|
| Rate for Payer: Three Rivers PPO |
$491.25
|
| Rate for Payer: TriWest Veterans Administration |
$432.30
|
| Rate for Payer: United Healthcare Commercial |
$569.85
|
| Rate for Payer: United Healthcare Medicare |
$432.30
|
| Rate for Payer: WINHealth Partners Commercial |
$622.25
|
| Rate for Payer: Wise Provider Network Commercial |
$622.25
|
|
|
HC X-RAY PELVIS 3+ VW - XR PELVIS 3+ VIEWS
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 72190
|
| Hospital Charge Code |
3207219001
|
|
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 PELVIS 3+ VW - XR PELVIS 3+ VIEWS
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 72190
|
| Hospital Charge Code |
3207219001
|
|
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 RETROGRADE PYELOGRAM - FL PYELOGRAM RETROGRADE
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
3207442001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.60 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,188.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,128.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,188.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,710.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC X-RAY RETROGRADE PYELOGRAM - FL PYELOGRAM RETROGRADE
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
3207442001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$991.80 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,188.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.00
|
| Rate for Payer: Altius Commercial |
$1,728.00
|
| Rate for Payer: Beech Street Commercial |
$1,764.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.80
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.00
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.00
|
| Rate for Payer: Entrust Commercial |
$1,710.00
|
| Rate for Payer: First Choice Health Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,044.00
|
| Rate for Payer: HealthUtah PPO |
$1,800.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.00
|
| Rate for Payer: Multiplan Medicare/VA |
$991.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.00
|
| Rate for Payer: PacificSource Commercial |
$1,620.00
|
| Rate for Payer: PHCS PPO |
$1,764.00
|
| Rate for Payer: Three Rivers PPO |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,044.00
|
| Rate for Payer: United Healthcare Commercial |
$1,566.00
|
| Rate for Payer: United Healthcare Medicare |
$1,044.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,764.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.00
|
|
|
HC X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS LEFT
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
3207110001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$454.58 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$710.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$696.00
|
| Rate for Payer: Altius Commercial |
$696.00
|
| Rate for Payer: Beech Street Commercial |
$710.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$595.22
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$703.25
|
| Rate for Payer: Cigna of WY Commercial |
$710.50
|
| Rate for Payer: Entrust Commercial |
$688.75
|
| Rate for Payer: First Choice Health Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.50
|
| Rate for Payer: HealthUtah PPO |
$725.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$703.25
|
| Rate for Payer: Multiplan Medicare/VA |
$454.58
|
| Rate for Payer: One Health Plan of WY PPO |
$710.50
|
| Rate for Payer: PacificSource Commercial |
$652.50
|
| Rate for Payer: PHCS PPO |
$710.50
|
| Rate for Payer: Three Rivers PPO |
$543.75
|
| Rate for Payer: TriWest Veterans Administration |
$478.50
|
| Rate for Payer: United Healthcare Commercial |
$630.75
|
| Rate for Payer: United Healthcare Medicare |
$478.50
|
| Rate for Payer: WINHealth Partners Commercial |
$688.75
|
| Rate for Payer: Wise Provider Network Commercial |
$688.75
|
|
|
HC X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS LEFT
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
3207110001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.48 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$710.50
|
| Rate for Payer: Aetna of WY Medicare |
$478.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$696.00
|
| Rate for Payer: Altius Commercial |
$696.00
|
| Rate for Payer: Beech Street Commercial |
$710.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$595.22
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$703.25
|
| Rate for Payer: Cigna of WY Commercial |
$710.50
|
| Rate for Payer: Entrust Commercial |
$688.75
|
| Rate for Payer: First Choice Health Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$420.50
|
| Rate for Payer: HealthUtah PPO |
$725.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$703.25
|
| Rate for Payer: Multiplan Medicare/VA |
$399.48
|
| Rate for Payer: One Health Plan of WY PPO |
$710.50
|
| Rate for Payer: PacificSource Commercial |
$652.50
|
| Rate for Payer: PHCS PPO |
$710.50
|
| Rate for Payer: Three Rivers PPO |
$543.75
|
| Rate for Payer: TriWest Veterans Administration |
$420.50
|
| Rate for Payer: United Healthcare Commercial |
$630.75
|
| Rate for Payer: United Healthcare Medicare |
$420.50
|
| Rate for Payer: WINHealth Partners Commercial |
$710.50
|
| Rate for Payer: Wise Provider Network Commercial |
$688.75
|
|
|
HC X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS RIGHT
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
3207110002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.48 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$710.50
|
| Rate for Payer: Aetna of WY Medicare |
$478.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$696.00
|
| Rate for Payer: Altius Commercial |
$696.00
|
| Rate for Payer: Beech Street Commercial |
$710.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$595.22
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$703.25
|
| Rate for Payer: Cigna of WY Commercial |
$710.50
|
| Rate for Payer: Entrust Commercial |
$688.75
|
| Rate for Payer: First Choice Health Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$420.50
|
| Rate for Payer: HealthUtah PPO |
$725.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$703.25
|
| Rate for Payer: Multiplan Medicare/VA |
$399.48
|
| Rate for Payer: One Health Plan of WY PPO |
$710.50
|
| Rate for Payer: PacificSource Commercial |
$652.50
|
| Rate for Payer: PHCS PPO |
$710.50
|
| Rate for Payer: Three Rivers PPO |
$543.75
|
| Rate for Payer: TriWest Veterans Administration |
$420.50
|
| Rate for Payer: United Healthcare Commercial |
$630.75
|
| Rate for Payer: United Healthcare Medicare |
$420.50
|
| Rate for Payer: WINHealth Partners Commercial |
$710.50
|
| Rate for Payer: Wise Provider Network Commercial |
$688.75
|
|
|
HC X-RAY RIBS 2 VW UNILAT - XR RIBS 2 VIEWS RIGHT
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
3207110002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$454.58 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$710.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$696.00
|
| Rate for Payer: Altius Commercial |
$696.00
|
| Rate for Payer: Beech Street Commercial |
$710.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$595.22
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$703.25
|
| Rate for Payer: Cigna of WY Commercial |
$710.50
|
| Rate for Payer: Entrust Commercial |
$688.75
|
| Rate for Payer: First Choice Health Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$688.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.50
|
| Rate for Payer: HealthUtah PPO |
$725.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$703.25
|
| Rate for Payer: Multiplan Medicare/VA |
$454.58
|
| Rate for Payer: One Health Plan of WY PPO |
$710.50
|
| Rate for Payer: PacificSource Commercial |
$652.50
|
| Rate for Payer: PHCS PPO |
$710.50
|
| Rate for Payer: Three Rivers PPO |
$543.75
|
| Rate for Payer: TriWest Veterans Administration |
$478.50
|
| Rate for Payer: United Healthcare Commercial |
$630.75
|
| Rate for Payer: United Healthcare Medicare |
$478.50
|
| Rate for Payer: WINHealth Partners Commercial |
$688.75
|
| Rate for Payer: Wise Provider Network Commercial |
$688.75
|
|
|
HC X-RAY RIBS 3 VW BILAT - XR RIBS 3 VIEWS BILATERAL
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
3207111001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.89 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$226.20
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$214.89
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$226.20
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$226.20
|
| Rate for Payer: WINHealth Partners Commercial |
$382.20
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC X-RAY RIBS 3 VW BILAT - XR RIBS 3 VIEWS BILATERAL
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
3207111001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.53 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$374.40
|
| Rate for Payer: Altius Commercial |
$374.40
|
| Rate for Payer: Beech Street Commercial |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$320.19
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: Entrust Commercial |
$370.50
|
| Rate for Payer: First Choice Health Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.40
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$244.53
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$382.20
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$257.40
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$257.40
|
| Rate for Payer: WINHealth Partners Commercial |
$370.50
|
| Rate for Payer: Wise Provider Network Commercial |
$370.50
|
|
|
HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS LT W/ CHEST ANTEROPOSTERIOR
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
3247110101
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$681.60
|
| Rate for Payer: Altius Commercial |
$681.60
|
| Rate for Payer: Beech Street Commercial |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$582.91
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| Rate for Payer: Cigna of WY Commercial |
$695.80
|
| Rate for Payer: Entrust Commercial |
$674.50
|
| Rate for Payer: First Choice Health Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$468.60
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Multiplan Medicare/VA |
$445.17
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| Rate for Payer: PacificSource Commercial |
$639.00
|
| Rate for Payer: PHCS PPO |
$695.80
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: TriWest Veterans Administration |
$468.60
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$468.60
|
| Rate for Payer: WINHealth Partners Commercial |
$674.50
|
| Rate for Payer: Wise Provider Network Commercial |
$674.50
|
|
|
HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS LT W/ CHEST ANTEROPOSTERIOR
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
3247110101
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Aetna of WY Medicare |
$468.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$681.60
|
| Rate for Payer: Altius Commercial |
$681.60
|
| Rate for Payer: Beech Street Commercial |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$582.91
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| Rate for Payer: Cigna of WY Commercial |
$695.80
|
| Rate for Payer: Entrust Commercial |
$674.50
|
| Rate for Payer: First Choice Health Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.80
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Multiplan Medicare/VA |
$391.21
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| Rate for Payer: PacificSource Commercial |
$639.00
|
| Rate for Payer: PHCS PPO |
$695.80
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: TriWest Veterans Administration |
$411.80
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$411.80
|
| Rate for Payer: WINHealth Partners Commercial |
$695.80
|
| Rate for Payer: Wise Provider Network Commercial |
$674.50
|
|
|
HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS RT W/ CHEST ANTEROPOSTERIOR
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
3247110102
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Aetna of WY Medicare |
$468.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$681.60
|
| Rate for Payer: Altius Commercial |
$681.60
|
| Rate for Payer: Beech Street Commercial |
$695.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$582.91
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| Rate for Payer: Cigna of WY Commercial |
$695.80
|
| Rate for Payer: Entrust Commercial |
$674.50
|
| Rate for Payer: First Choice Health Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.80
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Multiplan Medicare/VA |
$391.21
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| Rate for Payer: PacificSource Commercial |
$639.00
|
| Rate for Payer: PHCS PPO |
$695.80
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: TriWest Veterans Administration |
$411.80
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$411.80
|
| Rate for Payer: WINHealth Partners Commercial |
$695.80
|
| Rate for Payer: Wise Provider Network Commercial |
$674.50
|
|
