|
RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 73522 TC
|
| Hospital Charge Code |
73522
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$330.26
|
| Rate for Payer: Aetna of WY Medicare |
$39.21
|
| Rate for Payer: Beech Street Commercial |
$320.15
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: Cash Price |
$235.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$326.89
|
| Rate for Payer: Cigna of WY Commercial |
$330.26
|
| Rate for Payer: First Choice Health Commercial |
$303.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$320.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.21
|
| Rate for Payer: HealthUtah PPO |
$337.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$326.89
|
| Rate for Payer: Multiplan Medicare/VA |
$33.33
|
| Rate for Payer: One Health Plan of WY PPO |
$330.26
|
| Rate for Payer: PacificSource Commercial |
$303.30
|
| Rate for Payer: PHCS PPO |
$320.15
|
| Rate for Payer: Three Rivers PPO |
$252.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.21
|
| Rate for Payer: United Healthcare Commercial |
$293.19
|
| Rate for Payer: United Healthcare Medicare |
$39.21
|
| Rate for Payer: WINHealth Partners Commercial |
$320.15
|
|
|
RADEX HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
73501
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$432.18
|
| Rate for Payer: Aetna of WY Medicare |
$32.25
|
| Rate for Payer: Beech Street Commercial |
$418.95
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$427.77
|
| Rate for Payer: Cigna of WY Commercial |
$432.18
|
| Rate for Payer: First Choice Health Commercial |
$396.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$418.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.25
|
| Rate for Payer: HealthUtah PPO |
$441.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$427.77
|
| Rate for Payer: Multiplan Medicare/VA |
$27.41
|
| Rate for Payer: One Health Plan of WY PPO |
$432.18
|
| Rate for Payer: PacificSource Commercial |
$396.90
|
| Rate for Payer: PHCS PPO |
$418.95
|
| Rate for Payer: Three Rivers PPO |
$330.75
|
| Rate for Payer: TriWest Veterans Administration |
$32.25
|
| Rate for Payer: United Healthcare Commercial |
$383.67
|
| Rate for Payer: United Healthcare Medicare |
$32.25
|
| Rate for Payer: WINHealth Partners Commercial |
$418.95
|
|
|
RADEX HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 73501 TC
|
| Hospital Charge Code |
73501
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$23.49
|
| Rate for Payer: Beech Street Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: First Choice Health Commercial |
$73.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$19.97
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$77.90
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$77.90
|
|
|
RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 73502 TC
|
| Hospital Charge Code |
73502
|
| Min. Negotiated Rate |
$30.82 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Aetna of WY Medicare |
$36.26
|
| 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 |
$36.26
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$30.82
|
| 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 |
$36.26
|
| Rate for Payer: United Healthcare Commercial |
$249.69
|
| Rate for Payer: United Healthcare Medicare |
$36.26
|
| Rate for Payer: WINHealth Partners Commercial |
$272.65
|
|
|
RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Hospital Charge Code |
73060
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.82
|
| Rate for Payer: Beech Street Commercial |
$223.25
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: First Choice Health Commercial |
$211.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.82
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$20.25
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$223.25
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.82
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$23.82
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
|
|
RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 73592 TC
|
| Hospital Charge Code |
73592
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$224.42
|
| Rate for Payer: Aetna of WY Medicare |
$23.49
|
| Rate for Payer: Beech Street Commercial |
$217.55
|
| Rate for Payer: Cash Price |
$160.30
|
| Rate for Payer: Cash Price |
$160.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$222.13
|
| Rate for Payer: Cigna of WY Commercial |
$224.42
|
| Rate for Payer: First Choice Health Commercial |
$206.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$217.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$222.13
|
| Rate for Payer: Multiplan Medicare/VA |
$19.97
|
| Rate for Payer: One Health Plan of WY PPO |
$224.42
|
| Rate for Payer: PacificSource Commercial |
$206.10
|
| Rate for Payer: PHCS PPO |
$217.55
|
| Rate for Payer: Three Rivers PPO |
$171.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Commercial |
$199.23
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$217.55
|
|
|
RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
73592
|
| Min. Negotiated Rate |
$26.30 |
| Max. Negotiated Rate |
$467.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$457.66
|
| Rate for Payer: Aetna of WY Medicare |
$30.94
|
| Rate for Payer: Beech Street Commercial |
$443.65
|
| Rate for Payer: Cash Price |
$326.90
|
| Rate for Payer: Cash Price |
$326.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.99
|
| Rate for Payer: Cigna of WY Commercial |
$457.66
|
| Rate for Payer: First Choice Health Commercial |
$420.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$443.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.94
|
| Rate for Payer: HealthUtah PPO |
$467.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.99
|
| Rate for Payer: Multiplan Medicare/VA |
$26.30
|
| Rate for Payer: One Health Plan of WY PPO |
$457.66
|
| Rate for Payer: PacificSource Commercial |
$420.30
|
| Rate for Payer: PHCS PPO |
$443.65
|
| Rate for Payer: Three Rivers PPO |
$350.25
|
| Rate for Payer: TriWest Veterans Administration |
$30.94
|
| Rate for Payer: United Healthcare Commercial |
$406.29
|
| Rate for Payer: United Healthcare Medicare |
$30.94
|
| Rate for Payer: WINHealth Partners Commercial |
$443.65
|
|
|
RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 70160 TC
|
| Hospital Charge Code |
70160
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$29.06
|
| 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 |
$29.06
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$24.70
|
| 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 |
$29.06
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$29.06
|
| Rate for Payer: WINHealth Partners Commercial |
$187.15
|
|
|
RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 71100 TC
|
| Hospital Charge Code |
71100
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.62
|
| Rate for Payer: Aetna of WY Medicare |
$25.78
|
| Rate for Payer: Beech Street Commercial |
$255.55
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.93
|
| Rate for Payer: Cigna of WY Commercial |
$263.62
|
| Rate for Payer: First Choice Health Commercial |
$242.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.78
|
| Rate for Payer: HealthUtah PPO |
$269.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.93
|
| Rate for Payer: Multiplan Medicare/VA |
$21.91
|
| Rate for Payer: One Health Plan of WY PPO |
$263.62
|
| Rate for Payer: PacificSource Commercial |
$242.10
|
| Rate for Payer: PHCS PPO |
$255.55
|
| Rate for Payer: Three Rivers PPO |
$201.75
|
| Rate for Payer: TriWest Veterans Administration |
$25.78
|
| Rate for Payer: United Healthcare Commercial |
$234.03
|
| Rate for Payer: United Healthcare Medicare |
$25.78
|
| Rate for Payer: WINHealth Partners Commercial |
$255.55
|
|
|
RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 71101 TC
|
| Hospital Charge Code |
71101
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$29.06
|
| Rate for Payer: Beech Street Commercial |
$294.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: First Choice Health Commercial |
$279.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.06
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$24.70
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$294.50
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$29.06
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$29.06
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
|
|
RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 72220 TC
|
| Hospital Charge Code |
72220
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$440.02
|
| Rate for Payer: Aetna of WY Medicare |
$23.82
|
| Rate for Payer: Beech Street Commercial |
$426.55
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$435.53
|
| Rate for Payer: Cigna of WY Commercial |
$440.02
|
| Rate for Payer: First Choice Health Commercial |
$404.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$426.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.82
|
| Rate for Payer: HealthUtah PPO |
$449.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$435.53
|
| Rate for Payer: Multiplan Medicare/VA |
$20.25
|
| Rate for Payer: One Health Plan of WY PPO |
$440.02
|
| Rate for Payer: PacificSource Commercial |
$404.10
|
| Rate for Payer: PHCS PPO |
$426.55
|
| Rate for Payer: Three Rivers PPO |
$336.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.82
|
| Rate for Payer: United Healthcare Commercial |
$390.63
|
| Rate for Payer: United Healthcare Medicare |
$23.82
|
| Rate for Payer: WINHealth Partners Commercial |
$426.55
|
|
|
RADEX SCAPULA COMPLETE
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 73010
|
| Hospital Charge Code |
73010
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$247.94
|
| Rate for Payer: Aetna of WY Medicare |
$23.40
|
| Rate for Payer: Beech Street Commercial |
$240.35
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: Cash Price |
$177.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$245.41
|
| Rate for Payer: Cigna of WY Commercial |
$247.94
|
| Rate for Payer: First Choice Health Commercial |
$227.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$240.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.40
|
| Rate for Payer: HealthUtah PPO |
$253.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$245.41
|
| Rate for Payer: Multiplan Medicare/VA |
$19.89
|
| Rate for Payer: One Health Plan of WY PPO |
$247.94
|
| Rate for Payer: PacificSource Commercial |
$227.70
|
| Rate for Payer: PHCS PPO |
$240.35
|
| Rate for Payer: Three Rivers PPO |
$189.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$220.11
|
| Rate for Payer: United Healthcare Medicare |
$23.40
|
| Rate for Payer: WINHealth Partners Commercial |
$240.35
|
|
|
RADEX SCAPULA COMPLETE
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 73010 TC
|
| Hospital Charge Code |
73010
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.04
|
| Rate for Payer: Aetna of WY Medicare |
$14.98
|
| Rate for Payer: Beech Street Commercial |
$235.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$240.56
|
| Rate for Payer: Cigna of WY Commercial |
$243.04
|
| Rate for Payer: First Choice Health Commercial |
$223.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$235.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.98
|
| Rate for Payer: HealthUtah PPO |
$248.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$240.56
|
| Rate for Payer: Multiplan Medicare/VA |
$12.73
|
| Rate for Payer: One Health Plan of WY PPO |
$243.04
|
| Rate for Payer: PacificSource Commercial |
$223.20
|
| Rate for Payer: PHCS PPO |
$235.60
|
| Rate for Payer: Three Rivers PPO |
$186.00
|
| Rate for Payer: TriWest Veterans Administration |
$14.98
|
| Rate for Payer: United Healthcare Commercial |
$215.76
|
| Rate for Payer: United Healthcare Medicare |
$14.98
|
| Rate for Payer: WINHealth Partners Commercial |
$235.60
|
|
|
RADEX SHOULDER 1 VIEW
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 73020 TC
|
| Hospital Charge Code |
73020
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$13.99
|
| 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 |
$13.99
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.89
|
| 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 |
$13.99
|
| Rate for Payer: United Healthcare Commercial |
$192.27
|
| Rate for Payer: United Healthcare Medicare |
$13.99
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
|
|
RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
HCPCS 73030 50
|
| Hospital Charge Code |
73030
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$580.16
|
| Rate for Payer: Aetna of WY Medicare |
$34.21
|
| Rate for Payer: Beech Street Commercial |
$562.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$574.24
|
| Rate for Payer: Cigna of WY Commercial |
$580.16
|
| Rate for Payer: First Choice Health Commercial |
$532.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$562.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.21
|
| Rate for Payer: HealthUtah PPO |
$592.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$574.24
|
| Rate for Payer: Multiplan Medicare/VA |
$29.08
|
| Rate for Payer: One Health Plan of WY PPO |
$580.16
|
| Rate for Payer: PacificSource Commercial |
$532.80
|
| Rate for Payer: PHCS PPO |
$562.40
|
| Rate for Payer: Three Rivers PPO |
$444.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.21
|
| Rate for Payer: United Healthcare Commercial |
$515.04
|
| Rate for Payer: United Healthcare Medicare |
$34.21
|
| Rate for Payer: WINHealth Partners Commercial |
$562.40
|
|
|
RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 73030 TC
|
| Hospital Charge Code |
73030
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Aetna of WY Medicare |
$25.46
|
| Rate for Payer: Beech Street Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: First Choice Health Commercial |
$266.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.46
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: Multiplan Medicare/VA |
$21.64
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$281.20
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: TriWest Veterans Administration |
$25.46
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: United Healthcare Medicare |
$25.46
|
| Rate for Payer: WINHealth Partners Commercial |
$281.20
|
|
|
RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 70220 TC
|
| Hospital Charge Code |
70220
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.72
|
| Rate for Payer: Aetna of WY Medicare |
$26.76
|
| Rate for Payer: Beech Street Commercial |
$535.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$547.08
|
| Rate for Payer: Cigna of WY Commercial |
$552.72
|
| Rate for Payer: First Choice Health Commercial |
$507.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.76
|
| Rate for Payer: HealthUtah PPO |
$564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$547.08
|
| Rate for Payer: Multiplan Medicare/VA |
$22.75
|
| Rate for Payer: One Health Plan of WY PPO |
$552.72
|
| Rate for Payer: PacificSource Commercial |
$507.60
|
| Rate for Payer: PHCS PPO |
$535.80
|
| Rate for Payer: Three Rivers PPO |
$423.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.76
|
| Rate for Payer: United Healthcare Commercial |
$490.68
|
| Rate for Payer: United Healthcare Medicare |
$26.76
|
| Rate for Payer: WINHealth Partners Commercial |
$535.80
|
|
|
RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 72020 TC
|
| Hospital Charge Code |
72020
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Aetna of WY Medicare |
$16.29
|
| Rate for Payer: Beech Street Commercial |
$168.15
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: First Choice Health Commercial |
$159.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.29
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: Multiplan Medicare/VA |
$13.85
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$168.15
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: TriWest Veterans Administration |
$16.29
|
| Rate for Payer: United Healthcare Commercial |
$153.99
|
| Rate for Payer: United Healthcare Medicare |
$16.29
|
| Rate for Payer: WINHealth Partners Commercial |
$168.15
|
|
|
RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 72040 TC
|
| Hospital Charge Code |
72040
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Medicare |
$28.40
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.40
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$24.14
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.40
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WINHealth Partners Commercial |
$263.15
|
|
|
RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 72050 TC
|
| Hospital Charge Code |
72050
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$332.22
|
| Rate for Payer: Aetna of WY Medicare |
$40.19
|
| Rate for Payer: Beech Street Commercial |
$322.05
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.83
|
| Rate for Payer: Cigna of WY Commercial |
$332.22
|
| Rate for Payer: First Choice Health Commercial |
$305.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$322.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.19
|
| Rate for Payer: HealthUtah PPO |
$339.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.83
|
| Rate for Payer: Multiplan Medicare/VA |
$34.16
|
| Rate for Payer: One Health Plan of WY PPO |
$332.22
|
| Rate for Payer: PacificSource Commercial |
$305.10
|
| Rate for Payer: PHCS PPO |
$322.05
|
| Rate for Payer: Three Rivers PPO |
$254.25
|
| Rate for Payer: TriWest Veterans Administration |
$40.19
|
| Rate for Payer: United Healthcare Commercial |
$294.93
|
| Rate for Payer: United Healthcare Medicare |
$40.19
|
| Rate for Payer: WINHealth Partners Commercial |
$322.05
|
|
|
RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 72100 TC
|
| Hospital Charge Code |
72100
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$305.76
|
| Rate for Payer: Aetna of WY Medicare |
$28.73
|
| Rate for Payer: Beech Street Commercial |
$296.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$302.64
|
| Rate for Payer: Cigna of WY Commercial |
$305.76
|
| Rate for Payer: First Choice Health Commercial |
$280.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.73
|
| Rate for Payer: HealthUtah PPO |
$312.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$302.64
|
| Rate for Payer: Multiplan Medicare/VA |
$24.42
|
| Rate for Payer: One Health Plan of WY PPO |
$305.76
|
| Rate for Payer: PacificSource Commercial |
$280.80
|
| Rate for Payer: PHCS PPO |
$296.40
|
| Rate for Payer: Three Rivers PPO |
$234.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.73
|
| Rate for Payer: United Healthcare Commercial |
$271.44
|
| Rate for Payer: United Healthcare Medicare |
$28.73
|
| Rate for Payer: WINHealth Partners Commercial |
$296.40
|
|
|
RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 72110 TC
|
| Hospital Charge Code |
72110
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$723.24
|
| Rate for Payer: Aetna of WY Medicare |
$38.88
|
| Rate for Payer: Beech Street Commercial |
$701.10
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$715.86
|
| Rate for Payer: Cigna of WY Commercial |
$723.24
|
| Rate for Payer: First Choice Health Commercial |
$664.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$701.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.88
|
| Rate for Payer: HealthUtah PPO |
$738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$715.86
|
| Rate for Payer: Multiplan Medicare/VA |
$33.05
|
| Rate for Payer: One Health Plan of WY PPO |
$723.24
|
| Rate for Payer: PacificSource Commercial |
$664.20
|
| Rate for Payer: PHCS PPO |
$701.10
|
| Rate for Payer: Three Rivers PPO |
$553.50
|
| Rate for Payer: TriWest Veterans Administration |
$38.88
|
| Rate for Payer: United Healthcare Commercial |
$642.06
|
| Rate for Payer: United Healthcare Medicare |
$38.88
|
| Rate for Payer: WINHealth Partners Commercial |
$701.10
|
|
|
RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 72120 TC
|
| Hospital Charge Code |
72120
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.86
|
| Rate for Payer: Aetna of WY Medicare |
$29.38
|
| 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 |
$29.38
|
| Rate for Payer: HealthUtah PPO |
$307.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.79
|
| Rate for Payer: Multiplan Medicare/VA |
$24.97
|
| 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 |
$29.38
|
| Rate for Payer: United Healthcare Commercial |
$267.09
|
| Rate for Payer: United Healthcare Medicare |
$29.38
|
| Rate for Payer: WINHealth Partners Commercial |
$291.65
|
|
|
RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$709.00
|
|
|
Service Code
|
HCPCS 72114 TC
|
| Hospital Charge Code |
72114
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$709.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$694.82
|
| Rate for Payer: Aetna of WY Medicare |
$46.08
|
| Rate for Payer: Beech Street Commercial |
$673.55
|
| Rate for Payer: Cash Price |
$496.30
|
| Rate for Payer: Cash Price |
$496.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$687.73
|
| Rate for Payer: Cigna of WY Commercial |
$694.82
|
| Rate for Payer: First Choice Health Commercial |
$638.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$673.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.08
|
| Rate for Payer: HealthUtah PPO |
$709.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$687.73
|
| Rate for Payer: Multiplan Medicare/VA |
$39.17
|
| Rate for Payer: One Health Plan of WY PPO |
$694.82
|
| Rate for Payer: PacificSource Commercial |
$638.10
|
| Rate for Payer: PHCS PPO |
$673.55
|
| Rate for Payer: Three Rivers PPO |
$531.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.08
|
| Rate for Payer: United Healthcare Commercial |
$616.83
|
| Rate for Payer: United Healthcare Medicare |
$46.08
|
| Rate for Payer: WINHealth Partners Commercial |
$673.55
|
|
|
RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 72070 TC
|
| Hospital Charge Code |
72070
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$493.92
|
| Rate for Payer: Aetna of WY Medicare |
$22.84
|
| Rate for Payer: Beech Street Commercial |
$478.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$488.88
|
| Rate for Payer: Cigna of WY Commercial |
$493.92
|
| Rate for Payer: First Choice Health Commercial |
$453.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$478.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.84
|
| Rate for Payer: HealthUtah PPO |
$504.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$488.88
|
| Rate for Payer: Multiplan Medicare/VA |
$19.41
|
| Rate for Payer: One Health Plan of WY PPO |
$493.92
|
| Rate for Payer: PacificSource Commercial |
$453.60
|
| Rate for Payer: PHCS PPO |
$478.80
|
| Rate for Payer: Three Rivers PPO |
$378.00
|
| Rate for Payer: TriWest Veterans Administration |
$22.84
|
| Rate for Payer: United Healthcare Commercial |
$438.48
|
| Rate for Payer: United Healthcare Medicare |
$22.84
|
| Rate for Payer: WINHealth Partners Commercial |
$478.80
|
|
