|
HC X-RAY STRESS VIEW - XR ANKLE STRESS LEFT WO CONTRALATERAL JOINT
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 77071
|
| Hospital Charge Code |
3207707123
|
|
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 THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
3207207001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.12 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$351.12
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$369.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
3207207001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$537.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$459.76
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$324.80
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$308.56
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$487.20
|
| Rate for Payer: United Healthcare Medicare |
$324.80
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
HC X-RAY THORACIC SPINE 4 VW - XR THORACIC SPINE COMPLETE 4+ VIEWS
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
3207207401
|
|
Hospital Revenue Code
|
320
|
| 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 THORACIC SPINE 4 VW - XR THORACIC SPINE COMPLETE 4+ VIEWS
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
3207207401
|
|
Hospital Revenue Code
|
320
|
| 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 THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
3207207201
|
|
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-RAY THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
3207207201
|
|
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 TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS BILATERAL
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
3207359003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$336.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.80
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$281.01
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$295.80
|
| Rate for Payer: WINHealth Partners Commercial |
$499.80
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS BILATERAL
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
3207359003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$319.77 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.60
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$319.77
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$336.60
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WINHealth Partners Commercial |
$484.50
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS LEFT
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
3207359001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$319.77 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.60
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$319.77
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$336.60
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WINHealth Partners Commercial |
$484.50
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS LEFT
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
3207359001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$336.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.80
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$281.01
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$295.80
|
| Rate for Payer: WINHealth Partners Commercial |
$499.80
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS RIGHT
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
3207359002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$319.77 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$336.60
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$319.77
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$336.60
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$336.60
|
| Rate for Payer: WINHealth Partners Commercial |
$484.50
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS RIGHT
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
3207359002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$499.80
|
| Rate for Payer: Aetna of WY Medicare |
$336.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$489.60
|
| Rate for Payer: Altius Commercial |
$489.60
|
| Rate for Payer: Beech Street Commercial |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$494.70
|
| Rate for Payer: Cigna of WY Commercial |
$499.80
|
| Rate for Payer: Entrust Commercial |
$484.50
|
| Rate for Payer: First Choice Health Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$484.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$295.80
|
| Rate for Payer: HealthUtah PPO |
$510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$494.70
|
| Rate for Payer: Multiplan Medicare/VA |
$281.01
|
| Rate for Payer: One Health Plan of WY PPO |
$499.80
|
| Rate for Payer: PacificSource Commercial |
$459.00
|
| Rate for Payer: PHCS PPO |
$499.80
|
| Rate for Payer: Three Rivers PPO |
$382.50
|
| Rate for Payer: TriWest Veterans Administration |
$295.80
|
| Rate for Payer: United Healthcare Commercial |
$443.70
|
| Rate for Payer: United Healthcare Medicare |
$295.80
|
| Rate for Payer: WINHealth Partners Commercial |
$499.80
|
| Rate for Payer: Wise Provider Network Commercial |
$484.50
|
|
|
HC X-RAY TMJ BILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED BIL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
3207033001
|
|
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 TMJ BILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED BIL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
3207033001
|
|
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 TMJ UNILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED LT
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 70328
|
| Hospital Charge Code |
3207032802
|
|
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 TMJ UNILAT - XR TEMPOROMANDIBULAR JOINT OPEN AND CLOSED LT
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 70328
|
| Hospital Charge Code |
3207032802
|
|
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 TOE(S) - XR TOES 2+ VIEWS BILATERAL
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$214.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$179.08
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$188.50
|
| Rate for Payer: WINHealth Partners Commercial |
$318.50
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC X-RAY TOE(S) - XR TOES 2+ VIEWS BILATERAL
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$312.00
|
| Rate for Payer: Altius Commercial |
$312.00
|
| Rate for Payer: Beech Street Commercial |
$318.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$266.82
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: Entrust Commercial |
$308.75
|
| Rate for Payer: First Choice Health Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$214.50
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$203.78
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$318.50
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$214.50
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$214.50
|
| Rate for Payer: WINHealth Partners Commercial |
$308.75
|
| Rate for Payer: Wise Provider Network Commercial |
$308.75
|
|
|
HC X-RAY TOE(S) - XR TOES 2+ VIEWS LEFT
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC X-RAY TOE(S) - XR TOES 2+ VIEWS LEFT
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC X-RAY TOE(S) - XR TOES 2+ VIEWS RIGHT
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.10
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$178.70
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$188.10
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$188.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.75
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC X-RAY TOE(S) - XR TOES 2+ VIEWS RIGHT
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$279.30
|
| Rate for Payer: Aetna of WY Medicare |
$188.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$273.60
|
| Rate for Payer: Altius Commercial |
$273.60
|
| Rate for Payer: Beech Street Commercial |
$279.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$276.45
|
| Rate for Payer: Cigna of WY Commercial |
$279.30
|
| Rate for Payer: Entrust Commercial |
$270.75
|
| Rate for Payer: First Choice Health Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$270.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.30
|
| Rate for Payer: HealthUtah PPO |
$285.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$276.45
|
| Rate for Payer: Multiplan Medicare/VA |
$157.04
|
| Rate for Payer: One Health Plan of WY PPO |
$279.30
|
| Rate for Payer: PacificSource Commercial |
$256.50
|
| Rate for Payer: PHCS PPO |
$279.30
|
| Rate for Payer: Three Rivers PPO |
$213.75
|
| Rate for Payer: TriWest Veterans Administration |
$165.30
|
| Rate for Payer: United Healthcare Commercial |
$247.95
|
| Rate for Payer: United Healthcare Medicare |
$165.30
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$270.75
|
|
|
HC X-RAY UPPER GI DELAY W/O KUB - FL UPPER GI WITHOUT KUB
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
3207424001
|
|
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-RAY UPPER GI DELAY W/O KUB - FL UPPER GI WITHOUT KUB
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
3207424001
|
|
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
|
|
