|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [35924]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 0487590199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.68
|
| Rate for Payer: Altius Commercial |
$7.68
|
| Rate for Payer: Beech Street Commercial |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: Entrust Commercial |
$7.60
|
| Rate for Payer: First Choice Health Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.28
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: Multiplan Medicare/VA |
$5.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.84
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.28
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
| Rate for Payer: Wise Provider Network Commercial |
$7.60
|
|
|
RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 73050 TC
|
| Hospital Charge Code |
73050
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Aetna of WY Medicare |
$19.56
|
| Rate for Payer: Beech Street Commercial |
$239.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: First Choice Health Commercial |
$226.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.56
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$16.63
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$239.40
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$19.56
|
| Rate for Payer: United Healthcare Commercial |
$219.24
|
| Rate for Payer: United Healthcare Medicare |
$19.56
|
| Rate for Payer: WINHealth Partners Commercial |
$239.40
|
|
|
RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 73610 TC
|
| Hospital Charge Code |
73610
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Aetna of WY Medicare |
$27.75
|
| Rate for Payer: Beech Street Commercial |
$272.65
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$278.39
|
| Rate for Payer: Cigna of WY Commercial |
$281.26
|
| Rate for Payer: First Choice Health Commercial |
$258.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.75
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$23.59
|
| Rate for Payer: One Health Plan of WY PPO |
$281.26
|
| Rate for Payer: PacificSource Commercial |
$258.30
|
| Rate for Payer: PHCS PPO |
$272.65
|
| Rate for Payer: Three Rivers PPO |
$215.25
|
| Rate for Payer: TriWest Veterans Administration |
$27.75
|
| Rate for Payer: United Healthcare Commercial |
$249.69
|
| Rate for Payer: United Healthcare Medicare |
$27.75
|
| Rate for Payer: WINHealth Partners Commercial |
$272.65
|
|
|
RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 73650 TC
|
| Hospital Charge Code |
73650
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$20.54
|
| Rate for Payer: Beech Street Commercial |
$187.15
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: First Choice Health Commercial |
$177.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.54
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$17.46
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$187.15
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.54
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$20.54
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
|
|
RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 25115
|
| Hospital Charge Code |
25115
|
| Min. Negotiated Rate |
$628.01 |
| Max. Negotiated Rate |
$2,637.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,584.26
|
| Rate for Payer: Aetna of WY Medicare |
$738.84
|
| Rate for Payer: Beech Street Commercial |
$2,505.15
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,557.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,584.26
|
| Rate for Payer: First Choice Health Commercial |
$2,373.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,505.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.84
|
| Rate for Payer: HealthUtah PPO |
$2,637.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,557.89
|
| Rate for Payer: Multiplan Medicare/VA |
$628.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,584.26
|
| Rate for Payer: PacificSource Commercial |
$2,373.30
|
| Rate for Payer: PHCS PPO |
$2,505.15
|
| Rate for Payer: Three Rivers PPO |
$1,977.75
|
| Rate for Payer: TriWest Veterans Administration |
$738.84
|
| Rate for Payer: United Healthcare Commercial |
$2,294.19
|
| Rate for Payer: United Healthcare Medicare |
$738.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,241.45
|
|
|
RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS
|
Professional
|
Both
|
$2,119.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
25116
|
| Min. Negotiated Rate |
$504.79 |
| Max. Negotiated Rate |
$2,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,076.62
|
| Rate for Payer: Aetna of WY Medicare |
$593.87
|
| Rate for Payer: Beech Street Commercial |
$2,013.05
|
| Rate for Payer: Cash Price |
$1,483.30
|
| Rate for Payer: Cash Price |
$1,483.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,055.43
|
| Rate for Payer: Cigna of WY Commercial |
$2,076.62
|
| Rate for Payer: First Choice Health Commercial |
$1,907.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,013.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.87
|
| Rate for Payer: HealthUtah PPO |
$2,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,055.43
|
| Rate for Payer: Multiplan Medicare/VA |
$504.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,076.62
|
| Rate for Payer: PacificSource Commercial |
$1,907.10
|
| Rate for Payer: PHCS PPO |
$2,013.05
|
| Rate for Payer: Three Rivers PPO |
$1,589.25
|
| Rate for Payer: TriWest Veterans Administration |
$593.87
|
| Rate for Payer: United Healthcare Commercial |
$1,843.53
|
| Rate for Payer: United Healthcare Medicare |
$593.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,801.15
|
|
|
RADEX CLAVICLE COMPLETE
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 73000 TC
|
| Hospital Charge Code |
73000
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$24.15
|
| Rate for Payer: Beech Street Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: First Choice Health Commercial |
$363.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.15
|
| Rate for Payer: HealthUtah PPO |
$404.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$20.53
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$383.80
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.15
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
| Rate for Payer: WINHealth Partners Commercial |
$383.80
|
|
|
RADEX CLAVICLE COMPLETE
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 73000 50,TC
|
| Hospital Charge Code |
73000
|
| Min. Negotiated Rate |
$27.13 |
| Max. Negotiated Rate |
$538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$527.24
|
| Rate for Payer: Aetna of WY Medicare |
$31.92
|
| Rate for Payer: Beech Street Commercial |
$511.10
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$521.86
|
| Rate for Payer: Cigna of WY Commercial |
$527.24
|
| Rate for Payer: First Choice Health Commercial |
$484.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.92
|
| Rate for Payer: HealthUtah PPO |
$538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$521.86
|
| Rate for Payer: Multiplan Medicare/VA |
$27.13
|
| Rate for Payer: One Health Plan of WY PPO |
$527.24
|
| Rate for Payer: PacificSource Commercial |
$484.20
|
| Rate for Payer: PHCS PPO |
$511.10
|
| Rate for Payer: Three Rivers PPO |
$403.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.92
|
| Rate for Payer: United Healthcare Commercial |
$468.06
|
| Rate for Payer: United Healthcare Medicare |
$31.92
|
| Rate for Payer: WINHealth Partners Commercial |
$511.10
|
|
|
RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 73070 TC
|
| Hospital Charge Code |
73070
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$464.52
|
| Rate for Payer: Aetna of WY Medicare |
$20.87
|
| Rate for Payer: Beech Street Commercial |
$450.30
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$459.78
|
| Rate for Payer: Cigna of WY Commercial |
$464.52
|
| Rate for Payer: First Choice Health Commercial |
$426.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$450.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.87
|
| Rate for Payer: HealthUtah PPO |
$474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$459.78
|
| Rate for Payer: Multiplan Medicare/VA |
$17.74
|
| Rate for Payer: One Health Plan of WY PPO |
$464.52
|
| Rate for Payer: PacificSource Commercial |
$426.60
|
| Rate for Payer: PHCS PPO |
$450.30
|
| Rate for Payer: Three Rivers PPO |
$355.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.87
|
| Rate for Payer: United Healthcare Commercial |
$412.38
|
| Rate for Payer: United Healthcare Medicare |
$20.87
|
| Rate for Payer: WINHealth Partners Commercial |
$450.30
|
|
|
RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 73080 TC
|
| Hospital Charge Code |
73080
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$478.24
|
| Rate for Payer: Aetna of WY Medicare |
$24.15
|
| Rate for Payer: Beech Street Commercial |
$463.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$473.36
|
| Rate for Payer: Cigna of WY Commercial |
$478.24
|
| Rate for Payer: First Choice Health Commercial |
$439.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$463.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.15
|
| Rate for Payer: HealthUtah PPO |
$488.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$473.36
|
| Rate for Payer: Multiplan Medicare/VA |
$20.53
|
| Rate for Payer: One Health Plan of WY PPO |
$478.24
|
| Rate for Payer: PacificSource Commercial |
$439.20
|
| Rate for Payer: PHCS PPO |
$463.60
|
| Rate for Payer: Three Rivers PPO |
$366.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.15
|
| Rate for Payer: United Healthcare Commercial |
$424.56
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
| Rate for Payer: WINHealth Partners Commercial |
$463.60
|
|
|
RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 73080 50,TC
|
| Hospital Charge Code |
73080
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$527.24
|
| Rate for Payer: Aetna of WY Medicare |
$32.25
|
| Rate for Payer: Beech Street Commercial |
$511.10
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$521.86
|
| Rate for Payer: Cigna of WY Commercial |
$527.24
|
| Rate for Payer: First Choice Health Commercial |
$484.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.25
|
| Rate for Payer: HealthUtah PPO |
$538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$521.86
|
| Rate for Payer: Multiplan Medicare/VA |
$27.41
|
| Rate for Payer: One Health Plan of WY PPO |
$527.24
|
| Rate for Payer: PacificSource Commercial |
$484.20
|
| Rate for Payer: PHCS PPO |
$511.10
|
| Rate for Payer: Three Rivers PPO |
$403.50
|
| Rate for Payer: TriWest Veterans Administration |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$468.06
|
| Rate for Payer: United Healthcare Medicare |
$32.25
|
| Rate for Payer: WINHealth Partners Commercial |
$511.10
|
|
|
RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 72082 TC
|
| Hospital Charge Code |
72082
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$54.27
|
| Rate for Payer: Beech Street Commercial |
$261.25
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: First Choice Health Commercial |
$247.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.27
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$46.13
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$261.25
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$54.27
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$54.27
|
| Rate for Payer: WINHealth Partners Commercial |
$261.25
|
|
|
RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Hospital Charge Code |
70140
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Aetna of WY Medicare |
$22.18
|
| Rate for Payer: Beech Street Commercial |
$154.85
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: First Choice Health Commercial |
$146.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.18
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: Multiplan Medicare/VA |
$18.85
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$154.85
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: TriWest Veterans Administration |
$22.18
|
| Rate for Payer: United Healthcare Commercial |
$141.81
|
| Rate for Payer: United Healthcare Medicare |
$22.18
|
| Rate for Payer: WINHealth Partners Commercial |
$154.85
|
|
|
RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 70150 TC
|
| Hospital Charge Code |
70150
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$289.10
|
| Rate for Payer: Aetna of WY Medicare |
$34.30
|
| Rate for Payer: Beech Street Commercial |
$280.25
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$286.15
|
| Rate for Payer: Cigna of WY Commercial |
$289.10
|
| Rate for Payer: First Choice Health Commercial |
$265.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$280.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.30
|
| Rate for Payer: HealthUtah PPO |
$295.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$286.15
|
| Rate for Payer: Multiplan Medicare/VA |
$29.16
|
| Rate for Payer: One Health Plan of WY PPO |
$289.10
|
| Rate for Payer: PacificSource Commercial |
$265.50
|
| Rate for Payer: PHCS PPO |
$280.25
|
| Rate for Payer: Three Rivers PPO |
$221.25
|
| Rate for Payer: TriWest Veterans Administration |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$256.65
|
| Rate for Payer: United Healthcare Medicare |
$34.30
|
| Rate for Payer: WINHealth Partners Commercial |
$280.25
|
|
|
RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 73140 TC
|
| Hospital Charge Code |
73140
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$167.58
|
| Rate for Payer: Aetna of WY Medicare |
$31.02
|
| Rate for Payer: Beech Street Commercial |
$162.45
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$165.87
|
| Rate for Payer: Cigna of WY Commercial |
$167.58
|
| Rate for Payer: First Choice Health Commercial |
$153.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$162.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.02
|
| Rate for Payer: HealthUtah PPO |
$171.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$165.87
|
| Rate for Payer: Multiplan Medicare/VA |
$26.37
|
| Rate for Payer: One Health Plan of WY PPO |
$167.58
|
| Rate for Payer: PacificSource Commercial |
$153.90
|
| Rate for Payer: PHCS PPO |
$162.45
|
| Rate for Payer: Three Rivers PPO |
$128.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.02
|
| Rate for Payer: United Healthcare Commercial |
$148.77
|
| Rate for Payer: United Healthcare Medicare |
$31.02
|
| Rate for Payer: WINHealth Partners Commercial |
$162.45
|
|
|
RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
73630
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$33.56
|
| Rate for Payer: Beech Street Commercial |
$211.85
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: First Choice Health Commercial |
$200.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.56
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$28.53
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$211.85
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.56
|
| Rate for Payer: United Healthcare Commercial |
$194.01
|
| Rate for Payer: United Healthcare Medicare |
$33.56
|
| Rate for Payer: WINHealth Partners Commercial |
$211.85
|
|
|
RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 73630 TC
|
| Hospital Charge Code |
73630
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$25.78
|
| Rate for Payer: Beech Street Commercial |
$209.95
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: First Choice Health Commercial |
$198.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.78
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$21.91
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$209.95
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$25.78
|
| Rate for Payer: United Healthcare Commercial |
$192.27
|
| Rate for Payer: United Healthcare Medicare |
$25.78
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
|
|
RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 73630 26
|
| Hospital Charge Code |
73630
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
|
|
RADEX FOREARM 2 VIEWS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 73090 TC
|
| Hospital Charge Code |
73090
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$21.20
|
| Rate for Payer: Beech Street Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: First Choice Health Commercial |
$186.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.20
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$18.02
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$196.65
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$21.20
|
| Rate for Payer: United Healthcare Commercial |
$180.09
|
| Rate for Payer: United Healthcare Medicare |
$21.20
|
| Rate for Payer: WINHealth Partners Commercial |
$196.65
|
|
|
RADEX FOREARM 2 VIEWS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
73090
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$199.92
|
| Rate for Payer: Aetna of WY Medicare |
$28.64
|
| Rate for Payer: Beech Street Commercial |
$193.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$197.88
|
| Rate for Payer: Cigna of WY Commercial |
$199.92
|
| Rate for Payer: First Choice Health Commercial |
$183.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$193.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.64
|
| Rate for Payer: HealthUtah PPO |
$204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$197.88
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$199.92
|
| Rate for Payer: PacificSource Commercial |
$183.60
|
| Rate for Payer: PHCS PPO |
$193.80
|
| Rate for Payer: Three Rivers PPO |
$153.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.64
|
| Rate for Payer: United Healthcare Commercial |
$177.48
|
| Rate for Payer: United Healthcare Medicare |
$28.64
|
| Rate for Payer: WINHealth Partners Commercial |
$193.80
|
|
|
RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
76010
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$218.54
|
| Rate for Payer: Aetna of WY Medicare |
$28.64
|
| Rate for Payer: Beech Street Commercial |
$211.85
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$216.31
|
| Rate for Payer: Cigna of WY Commercial |
$218.54
|
| Rate for Payer: First Choice Health Commercial |
$200.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$211.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.64
|
| Rate for Payer: HealthUtah PPO |
$223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$216.31
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$218.54
|
| Rate for Payer: PacificSource Commercial |
$200.70
|
| Rate for Payer: PHCS PPO |
$211.85
|
| Rate for Payer: Three Rivers PPO |
$167.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.64
|
| Rate for Payer: United Healthcare Commercial |
$194.01
|
| Rate for Payer: United Healthcare Medicare |
$28.64
|
| Rate for Payer: WINHealth Partners Commercial |
$211.85
|
|
|
RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 73120 TC
|
| Hospital Charge Code |
73120
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$23.16
|
| Rate for Payer: Beech Street Commercial |
$187.15
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: First Choice Health Commercial |
$177.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.16
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$19.69
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$187.15
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.16
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$23.16
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
|
|
RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 73130 TC
|
| Hospital Charge Code |
73130
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$28.40
|
| Rate for Payer: Beech Street Commercial |
$204.25
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: Cash Price |
$150.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$208.55
|
| Rate for Payer: Cigna of WY Commercial |
$210.70
|
| Rate for Payer: First Choice Health Commercial |
$193.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$204.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.40
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$24.14
|
| Rate for Payer: One Health Plan of WY PPO |
$210.70
|
| Rate for Payer: PacificSource Commercial |
$193.50
|
| Rate for Payer: PHCS PPO |
$204.25
|
| Rate for Payer: Three Rivers PPO |
$161.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.40
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
|
|
RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 73130 50
|
| Hospital Charge Code |
73130
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Aetna of WY Medicare |
$36.50
|
| Rate for Payer: Beech Street Commercial |
$409.45
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: Cash Price |
$301.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$418.07
|
| Rate for Payer: Cigna of WY Commercial |
$422.38
|
| Rate for Payer: First Choice Health Commercial |
$387.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$409.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.50
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$31.02
|
| Rate for Payer: One Health Plan of WY PPO |
$422.38
|
| Rate for Payer: PacificSource Commercial |
$387.90
|
| Rate for Payer: PHCS PPO |
$409.45
|
| Rate for Payer: Three Rivers PPO |
$323.25
|
| Rate for Payer: TriWest Veterans Administration |
$36.50
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$36.50
|
| Rate for Payer: WINHealth Partners Commercial |
$409.45
|
|
|
RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 73521 TC
|
| Hospital Charge Code |
73521
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.86
|
| Rate for Payer: Aetna of WY Medicare |
$30.04
|
| Rate for Payer: Beech Street Commercial |
$291.65
|
| Rate for Payer: Cash Price |
$214.90
|
| Rate for Payer: Cash Price |
$214.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.79
|
| Rate for Payer: Cigna of WY Commercial |
$300.86
|
| Rate for Payer: First Choice Health Commercial |
$276.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.04
|
| Rate for Payer: HealthUtah PPO |
$307.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.79
|
| Rate for Payer: Multiplan Medicare/VA |
$25.53
|
| Rate for Payer: One Health Plan of WY PPO |
$300.86
|
| Rate for Payer: PacificSource Commercial |
$276.30
|
| Rate for Payer: PHCS PPO |
$291.65
|
| Rate for Payer: Three Rivers PPO |
$230.25
|
| Rate for Payer: TriWest Veterans Administration |
$30.04
|
| Rate for Payer: United Healthcare Commercial |
$267.09
|
| Rate for Payer: United Healthcare Medicare |
$30.04
|
| Rate for Payer: WINHealth Partners Commercial |
$291.65
|
|
