|
HC X-RAY RIBS, CHEST 3+ VW - XR RIBS 2 VWS RT W/ CHEST ANTEROPOSTERIOR
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
3247110102
|
|
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 4+ VW - XR RIBS 3 VWS BIL W/ CHEST POSTEROANTERIOR
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
3247111101
|
|
Hospital Revenue Code
|
324
|
| 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 RIBS, CHEST 4+ VW - XR RIBS 3 VWS BIL W/ CHEST POSTEROANTERIOR
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
3247111101
|
|
Hospital Revenue Code
|
324
|
| 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 SACROILIAC JTS <3 VW - XR SACROILIAC JOINTS 1-2 VIEWS
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 72200
|
| Hospital Charge Code |
3207220001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$250.80
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$264.00
|
| Rate for Payer: WINHealth Partners Commercial |
$380.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC X-RAY SACROILIAC JTS <3 VW - XR SACROILIAC JOINTS 1-2 VIEWS
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 72200
|
| Hospital Charge Code |
3207220001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Aetna of WY Medicare |
$264.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$384.00
|
| Rate for Payer: Altius Commercial |
$384.00
|
| Rate for Payer: Beech Street Commercial |
$392.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.40
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: Entrust Commercial |
$380.00
|
| Rate for Payer: First Choice Health Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$232.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: Multiplan Medicare/VA |
$220.40
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$392.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: TriWest Veterans Administration |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicare |
$232.00
|
| Rate for Payer: WINHealth Partners Commercial |
$392.00
|
| Rate for Payer: Wise Provider Network Commercial |
$380.00
|
|
|
HC X-RAY SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
3207220201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.68 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$426.30
|
| Rate for Payer: Aetna of WY Medicare |
$287.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$417.60
|
| Rate for Payer: Altius Commercial |
$417.60
|
| Rate for Payer: Beech Street Commercial |
$426.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.14
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$421.95
|
| Rate for Payer: Cigna of WY Commercial |
$426.30
|
| Rate for Payer: Entrust Commercial |
$413.25
|
| Rate for Payer: First Choice Health Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$252.30
|
| Rate for Payer: HealthUtah PPO |
$435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$421.95
|
| Rate for Payer: Multiplan Medicare/VA |
$239.68
|
| Rate for Payer: One Health Plan of WY PPO |
$426.30
|
| Rate for Payer: PacificSource Commercial |
$391.50
|
| Rate for Payer: PHCS PPO |
$426.30
|
| Rate for Payer: Three Rivers PPO |
$326.25
|
| Rate for Payer: TriWest Veterans Administration |
$252.30
|
| Rate for Payer: United Healthcare Commercial |
$378.45
|
| Rate for Payer: United Healthcare Medicare |
$252.30
|
| Rate for Payer: WINHealth Partners Commercial |
$426.30
|
| Rate for Payer: Wise Provider Network Commercial |
$413.25
|
|
|
HC X-RAY SACROILIAC JTS 3+ VW - XR SACROILIAC JOINTS 3+ VIEWS
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
3207220201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$426.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$417.60
|
| Rate for Payer: Altius Commercial |
$417.60
|
| Rate for Payer: Beech Street Commercial |
$426.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.14
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$421.95
|
| Rate for Payer: Cigna of WY Commercial |
$426.30
|
| Rate for Payer: Entrust Commercial |
$413.25
|
| Rate for Payer: First Choice Health Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.10
|
| Rate for Payer: HealthUtah PPO |
$435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$421.95
|
| Rate for Payer: Multiplan Medicare/VA |
$272.74
|
| Rate for Payer: One Health Plan of WY PPO |
$426.30
|
| Rate for Payer: PacificSource Commercial |
$391.50
|
| Rate for Payer: PHCS PPO |
$426.30
|
| Rate for Payer: Three Rivers PPO |
$326.25
|
| Rate for Payer: TriWest Veterans Administration |
$287.10
|
| Rate for Payer: United Healthcare Commercial |
$378.45
|
| Rate for Payer: United Healthcare Medicare |
$287.10
|
| Rate for Payer: WINHealth Partners Commercial |
$413.25
|
| Rate for Payer: Wise Provider Network Commercial |
$413.25
|
|
|
HC X-RAY SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
3207222001
|
|
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 SACRUM/COCCYX 2+ VW - XR SACRUM COCCYX 2+ VIEWS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
3207222001
|
|
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-RAYS, BONE LENGTH STUDIES - XR LOWER EXTREMITY LEG LENGTH EVAL
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
3207707301
|
|
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-RAYS, BONE LENGTH STUDIES - XR LOWER EXTREMITY LEG LENGTH EVAL
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
3207707301
|
|
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-RAYS, BONE SURVEY COMPLETE - XR BONE SURVEY COMPLETE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
3207707501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$551.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$980.00
|
| Rate for Payer: Aetna of WY Medicare |
$660.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$960.00
|
| Rate for Payer: Altius Commercial |
$960.00
|
| Rate for Payer: Beech Street Commercial |
$980.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$821.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$970.00
|
| Rate for Payer: Cigna of WY Commercial |
$980.00
|
| Rate for Payer: Entrust Commercial |
$950.00
|
| Rate for Payer: First Choice Health Commercial |
$950.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$950.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$580.00
|
| Rate for Payer: HealthUtah PPO |
$1,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$970.00
|
| Rate for Payer: Multiplan Medicare/VA |
$551.00
|
| Rate for Payer: One Health Plan of WY PPO |
$980.00
|
| Rate for Payer: PacificSource Commercial |
$900.00
|
| Rate for Payer: PHCS PPO |
$980.00
|
| Rate for Payer: Three Rivers PPO |
$750.00
|
| Rate for Payer: TriWest Veterans Administration |
$580.00
|
| Rate for Payer: United Healthcare Commercial |
$870.00
|
| Rate for Payer: United Healthcare Medicare |
$580.00
|
| Rate for Payer: WINHealth Partners Commercial |
$980.00
|
| Rate for Payer: Wise Provider Network Commercial |
$950.00
|
|
|
HC X-RAYS, BONE SURVEY COMPLETE - XR BONE SURVEY COMPLETE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
3207707501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$627.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$980.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$960.00
|
| Rate for Payer: Altius Commercial |
$960.00
|
| Rate for Payer: Beech Street Commercial |
$980.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$821.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$970.00
|
| Rate for Payer: Cigna of WY Commercial |
$980.00
|
| Rate for Payer: Entrust Commercial |
$950.00
|
| Rate for Payer: First Choice Health Commercial |
$950.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$950.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.00
|
| Rate for Payer: HealthUtah PPO |
$1,000.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$970.00
|
| Rate for Payer: Multiplan Medicare/VA |
$627.00
|
| Rate for Payer: One Health Plan of WY PPO |
$980.00
|
| Rate for Payer: PacificSource Commercial |
$900.00
|
| Rate for Payer: PHCS PPO |
$980.00
|
| Rate for Payer: Three Rivers PPO |
$750.00
|
| Rate for Payer: TriWest Veterans Administration |
$660.00
|
| Rate for Payer: United Healthcare Commercial |
$870.00
|
| Rate for Payer: United Healthcare Medicare |
$660.00
|
| Rate for Payer: WINHealth Partners Commercial |
$950.00
|
| Rate for Payer: Wise Provider Network Commercial |
$950.00
|
|
|
HC X-RAYS, BONE SURVEY, INFANT - XR BONE SURVEY INFANT
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 77076
|
| Hospital Charge Code |
3207707601
|
|
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-RAYS, BONE SURVEY, INFANT - XR BONE SURVEY INFANT
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 77076
|
| Hospital Charge Code |
3207707601
|
|
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 SCAPULA - XR SCAPULA BILATERAL
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301003
|
|
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 SCAPULA - XR SCAPULA BILATERAL
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301003
|
|
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 SCAPULA - XR SCAPULA LEFT
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Aetna of WY Medicare |
$313.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.50
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$261.72
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$275.50
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$275.50
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
|
HC X-RAY SCAPULA - XR SCAPULA LEFT
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.82 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.50
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$297.82
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$313.50
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$313.50
|
| Rate for Payer: WINHealth Partners Commercial |
$451.25
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
|
HC X-RAY SCAPULA - XR SCAPULA RIGHT
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Aetna of WY Medicare |
$313.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.50
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$261.72
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$275.50
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$275.50
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
|
HC X-RAY SCAPULA - XR SCAPULA RIGHT
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
3207301002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.82 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.50
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$297.82
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$313.50
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$313.50
|
| Rate for Payer: WINHealth Partners Commercial |
$451.25
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
|
HC X-RAYS FOR BONE AGE - XR BONE AGE HAND WRIST
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
3207707202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.88 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$622.30
|
| Rate for Payer: Aetna of WY Medicare |
$419.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$609.60
|
| Rate for Payer: Altius Commercial |
$609.60
|
| Rate for Payer: Beech Street Commercial |
$622.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$521.34
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$615.95
|
| Rate for Payer: Cigna of WY Commercial |
$622.30
|
| Rate for Payer: Entrust Commercial |
$603.25
|
| Rate for Payer: First Choice Health Commercial |
$603.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$603.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$368.30
|
| Rate for Payer: HealthUtah PPO |
$635.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$615.95
|
| Rate for Payer: Multiplan Medicare/VA |
$349.88
|
| Rate for Payer: One Health Plan of WY PPO |
$622.30
|
| Rate for Payer: PacificSource Commercial |
$571.50
|
| Rate for Payer: PHCS PPO |
$622.30
|
| Rate for Payer: Three Rivers PPO |
$476.25
|
| Rate for Payer: TriWest Veterans Administration |
$368.30
|
| Rate for Payer: United Healthcare Commercial |
$552.45
|
| Rate for Payer: United Healthcare Medicare |
$368.30
|
| Rate for Payer: WINHealth Partners Commercial |
$622.30
|
| Rate for Payer: Wise Provider Network Commercial |
$603.25
|
|
|
HC X-RAYS FOR BONE AGE - XR BONE AGE HAND WRIST
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
3207707202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$398.14 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$622.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$609.60
|
| Rate for Payer: Altius Commercial |
$609.60
|
| Rate for Payer: Beech Street Commercial |
$622.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$521.34
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$615.95
|
| Rate for Payer: Cigna of WY Commercial |
$622.30
|
| Rate for Payer: Entrust Commercial |
$603.25
|
| Rate for Payer: First Choice Health Commercial |
$603.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$603.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$419.10
|
| Rate for Payer: HealthUtah PPO |
$635.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$615.95
|
| Rate for Payer: Multiplan Medicare/VA |
$398.14
|
| Rate for Payer: One Health Plan of WY PPO |
$622.30
|
| Rate for Payer: PacificSource Commercial |
$571.50
|
| Rate for Payer: PHCS PPO |
$622.30
|
| Rate for Payer: Three Rivers PPO |
$476.25
|
| Rate for Payer: TriWest Veterans Administration |
$419.10
|
| Rate for Payer: United Healthcare Commercial |
$552.45
|
| Rate for Payer: United Healthcare Medicare |
$419.10
|
| Rate for Payer: WINHealth Partners Commercial |
$603.25
|
| Rate for Payer: Wise Provider Network Commercial |
$603.25
|
|
|
HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW BILATERAL
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Aetna of WY Medicare |
$234.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.90
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$195.60
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$205.90
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$205.90
|
| Rate for Payer: WINHealth Partners Commercial |
$347.90
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
|
HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW BILATERAL
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.58 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$347.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$340.80
|
| Rate for Payer: Altius Commercial |
$340.80
|
| Rate for Payer: Beech Street Commercial |
$347.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$291.46
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$344.35
|
| Rate for Payer: Cigna of WY Commercial |
$347.90
|
| Rate for Payer: Entrust Commercial |
$337.25
|
| Rate for Payer: First Choice Health Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$337.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.30
|
| Rate for Payer: HealthUtah PPO |
$355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$344.35
|
| Rate for Payer: Multiplan Medicare/VA |
$222.58
|
| Rate for Payer: One Health Plan of WY PPO |
$347.90
|
| Rate for Payer: PacificSource Commercial |
$319.50
|
| Rate for Payer: PHCS PPO |
$347.90
|
| Rate for Payer: Three Rivers PPO |
$266.25
|
| Rate for Payer: TriWest Veterans Administration |
$234.30
|
| Rate for Payer: United Healthcare Commercial |
$308.85
|
| Rate for Payer: United Healthcare Medicare |
$234.30
|
| Rate for Payer: WINHealth Partners Commercial |
$337.25
|
| Rate for Payer: Wise Provider Network Commercial |
$337.25
|
|
