|
HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW LEFT
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW LEFT
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW RIGHT
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Aetna of WY Medicare |
$178.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.60
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$148.77
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.60
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$156.60
|
| Rate for Payer: WINHealth Partners Commercial |
$264.60
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC X-RAY SHOULDER 1 VW - XR SHOULDER 1 VIEW RIGHT
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
3207302003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$264.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$259.20
|
| Rate for Payer: Altius Commercial |
$259.20
|
| Rate for Payer: Beech Street Commercial |
$264.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$221.67
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$261.90
|
| Rate for Payer: Cigna of WY Commercial |
$264.60
|
| Rate for Payer: Entrust Commercial |
$256.50
|
| Rate for Payer: First Choice Health Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$256.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.20
|
| Rate for Payer: HealthUtah PPO |
$270.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$261.90
|
| Rate for Payer: Multiplan Medicare/VA |
$169.29
|
| Rate for Payer: One Health Plan of WY PPO |
$264.60
|
| Rate for Payer: PacificSource Commercial |
$243.00
|
| Rate for Payer: PHCS PPO |
$264.60
|
| Rate for Payer: Three Rivers PPO |
$202.50
|
| Rate for Payer: TriWest Veterans Administration |
$178.20
|
| Rate for Payer: United Healthcare Commercial |
$234.90
|
| Rate for Payer: United Healthcare Medicare |
$178.20
|
| Rate for Payer: WINHealth Partners Commercial |
$256.50
|
| Rate for Payer: Wise Provider Network Commercial |
$256.50
|
|
|
HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS BILATERAL
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.26 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Aetna of WY Medicare |
$333.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$484.80
|
| Rate for Payer: Altius Commercial |
$484.80
|
| Rate for Payer: Beech Street Commercial |
$494.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: Entrust Commercial |
$479.75
|
| Rate for Payer: First Choice Health Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.90
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: Multiplan Medicare/VA |
$278.26
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$494.90
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: TriWest Veterans Administration |
$292.90
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: United Healthcare Medicare |
$292.90
|
| Rate for Payer: WINHealth Partners Commercial |
$494.90
|
| Rate for Payer: Wise Provider Network Commercial |
$479.75
|
|
|
HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS BILATERAL
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.64 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$484.80
|
| Rate for Payer: Altius Commercial |
$484.80
|
| Rate for Payer: Beech Street Commercial |
$494.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$414.60
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: Entrust Commercial |
$479.75
|
| Rate for Payer: First Choice Health Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$333.30
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: Multiplan Medicare/VA |
$316.64
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$494.90
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: TriWest Veterans Administration |
$333.30
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: United Healthcare Medicare |
$333.30
|
| Rate for Payer: WINHealth Partners Commercial |
$479.75
|
| Rate for Payer: Wise Provider Network Commercial |
$479.75
|
|
|
HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS LEFT
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS LEFT
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS RIGHT
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.88 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.40
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$275.88
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$290.40
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$290.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.00
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY SHOULDER 2+ VW - XR SHOULDER 2+ VIEWS RIGHT
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
3207303003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$431.20
|
| Rate for Payer: Aetna of WY Medicare |
$290.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$422.40
|
| Rate for Payer: Altius Commercial |
$422.40
|
| Rate for Payer: Beech Street Commercial |
$431.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$361.24
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$426.80
|
| Rate for Payer: Cigna of WY Commercial |
$431.20
|
| Rate for Payer: Entrust Commercial |
$418.00
|
| Rate for Payer: First Choice Health Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$426.80
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$431.20
|
| Rate for Payer: PacificSource Commercial |
$396.00
|
| Rate for Payer: PHCS PPO |
$431.20
|
| Rate for Payer: Three Rivers PPO |
$330.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$382.80
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$431.20
|
| Rate for Payer: Wise Provider Network Commercial |
$418.00
|
|
|
HC X-RAY SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
3207022001
|
|
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 SINUSES 3+ VW - XR PARANASAL SINUSES 3+ VIEWS
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
3207022001
|
|
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 SINUSES <3 VW - XR SINUSES WATERS VIEW ONLY
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
3207021001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.64 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Aetna of WY Medicare |
$260.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.10
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$217.64
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$229.10
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$229.10
|
| Rate for Payer: WINHealth Partners Commercial |
$387.10
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC X-RAY SINUSES <3 VW - XR SINUSES WATERS VIEW ONLY
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
3207021001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.66 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.20
|
| Rate for Payer: Altius Commercial |
$379.20
|
| Rate for Payer: Beech Street Commercial |
$387.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.30
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.15
|
| Rate for Payer: Cigna of WY Commercial |
$387.10
|
| Rate for Payer: Entrust Commercial |
$375.25
|
| Rate for Payer: First Choice Health Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.70
|
| Rate for Payer: HealthUtah PPO |
$395.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.15
|
| Rate for Payer: Multiplan Medicare/VA |
$247.66
|
| Rate for Payer: One Health Plan of WY PPO |
$387.10
|
| Rate for Payer: PacificSource Commercial |
$355.50
|
| Rate for Payer: PHCS PPO |
$387.10
|
| Rate for Payer: Three Rivers PPO |
$296.25
|
| Rate for Payer: TriWest Veterans Administration |
$260.70
|
| Rate for Payer: United Healthcare Commercial |
$343.65
|
| Rate for Payer: United Healthcare Medicare |
$260.70
|
| Rate for Payer: WINHealth Partners Commercial |
$375.25
|
| Rate for Payer: Wise Provider Network Commercial |
$375.25
|
|
|
HC X-RAY SKULL <4 VW - XR SKULL 1-3 VIEWS
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
3207025001
|
|
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 SKULL <4 VW - XR SKULL 1-3 VIEWS
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
3207025001
|
|
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 SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
3207026001
|
|
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 SKULL 4+ VW - XR SKULL COMPLETE 4+ VIEWS
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
3207026001
|
|
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 SPINE ONE VIEW - XR SPINE
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
3207202001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.46 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$303.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
| Rate for Payer: Altius Commercial |
$441.60
|
| Rate for Payer: Beech Street Commercial |
$450.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: Entrust Commercial |
$437.00
|
| Rate for Payer: First Choice Health Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.80
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$253.46
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$450.80
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$266.80
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$266.80
|
| Rate for Payer: WINHealth Partners Commercial |
$450.80
|
| Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
|
HC X-RAY SPINE ONE VIEW - XR SPINE
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
3207202001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.42 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$441.60
|
| Rate for Payer: Altius Commercial |
$441.60
|
| Rate for Payer: Beech Street Commercial |
$450.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$377.66
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: Entrust Commercial |
$437.00
|
| Rate for Payer: First Choice Health Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.60
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$288.42
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$450.80
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$303.60
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$303.60
|
| Rate for Payer: WINHealth Partners Commercial |
$437.00
|
| Rate for Payer: Wise Provider Network Commercial |
$437.00
|
|
|
HC X-RAY STERNO-CLAVICLUAR JT - XR STERNOCLAVICULAR JOINTS 3+ VIEWS
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
3207113001
|
|
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 STERNO-CLAVICLUAR JT - XR STERNOCLAVICULAR JOINTS 3+ VIEWS
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 71130
|
| Hospital Charge Code |
3207113001
|
|
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 STERNUM 2+ VW - XR STERNUM 2+ VIEWS
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
3207112001
|
|
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 STERNUM 2+ VW - XR STERNUM 2+ VIEWS
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 71120
|
| Hospital Charge Code |
3207112001
|
|
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 STRESS VIEW - XR ANKLE STRESS LEFT WO CONTRALATERAL JOINT
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
3207707123
|
|
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
|
|
