|
RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 72072 TC
|
| Hospital Charge Code |
72072
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$541.94
|
| Rate for Payer: Aetna of WY Medicare |
$28.40
|
| Rate for Payer: Beech Street Commercial |
$525.35
|
| Rate for Payer: Cash Price |
$387.10
|
| Rate for Payer: Cash Price |
$387.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$536.41
|
| Rate for Payer: Cigna of WY Commercial |
$541.94
|
| Rate for Payer: First Choice Health Commercial |
$497.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$525.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.40
|
| Rate for Payer: HealthUtah PPO |
$553.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$536.41
|
| Rate for Payer: Multiplan Medicare/VA |
$24.14
|
| Rate for Payer: One Health Plan of WY PPO |
$541.94
|
| Rate for Payer: PacificSource Commercial |
$497.70
|
| Rate for Payer: PHCS PPO |
$525.35
|
| Rate for Payer: Three Rivers PPO |
$414.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.40
|
| Rate for Payer: United Healthcare Commercial |
$481.11
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WINHealth Partners Commercial |
$525.35
|
|
|
RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 72080 TC
|
| Hospital Charge Code |
72080
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$483.14
|
| Rate for Payer: Aetna of WY Medicare |
$24.15
|
| Rate for Payer: Beech Street Commercial |
$468.35
|
| Rate for Payer: Cash Price |
$345.10
|
| Rate for Payer: Cash Price |
$345.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$478.21
|
| Rate for Payer: Cigna of WY Commercial |
$483.14
|
| Rate for Payer: First Choice Health Commercial |
$443.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$468.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.15
|
| Rate for Payer: HealthUtah PPO |
$493.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$478.21
|
| Rate for Payer: Multiplan Medicare/VA |
$20.53
|
| Rate for Payer: One Health Plan of WY PPO |
$483.14
|
| Rate for Payer: PacificSource Commercial |
$443.70
|
| Rate for Payer: PHCS PPO |
$468.35
|
| Rate for Payer: Three Rivers PPO |
$369.75
|
| Rate for Payer: TriWest Veterans Administration |
$24.15
|
| Rate for Payer: United Healthcare Commercial |
$428.91
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
| Rate for Payer: WINHealth Partners Commercial |
$468.35
|
|
|
RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 71120 TC
|
| Hospital Charge Code |
71120
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$23.82
|
| Rate for Payer: Beech Street Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: First Choice Health Commercial |
$216.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.82
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$20.25
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$228.00
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$23.82
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$23.82
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
|
|
RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 73660 TC
|
| Hospital Charge Code |
73660
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$22.51
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.51
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$19.13
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$22.51
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$22.51
|
| Rate for Payer: WINHealth Partners Commercial |
$169.10
|
|
|
RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 73660 26
|
| Hospital Charge Code |
73660
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.14
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$5.22
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$6.14
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
73660
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$172.48
|
| Rate for Payer: Aetna of WY Medicare |
$28.64
|
| Rate for Payer: Beech Street Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$170.72
|
| Rate for Payer: Cigna of WY Commercial |
$172.48
|
| Rate for Payer: First Choice Health Commercial |
$158.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$167.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.64
|
| Rate for Payer: HealthUtah PPO |
$176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$170.72
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$172.48
|
| Rate for Payer: PacificSource Commercial |
$158.40
|
| Rate for Payer: PHCS PPO |
$167.20
|
| Rate for Payer: Three Rivers PPO |
$132.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.64
|
| Rate for Payer: United Healthcare Commercial |
$153.12
|
| Rate for Payer: United Healthcare Medicare |
$28.64
|
| Rate for Payer: WINHealth Partners Commercial |
$167.20
|
|
|
RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 73092 TC
|
| Hospital Charge Code |
73092
|
| 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 UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
73092
|
| 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 WRIST 2 VIEWS
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
73100
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$33.23
|
| Rate for Payer: Beech Street Commercial |
$233.70
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: First Choice Health Commercial |
$221.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.23
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$28.25
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$233.70
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.23
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$33.23
|
| Rate for Payer: WINHealth Partners Commercial |
$233.70
|
|
|
RADEX WRIST 2 VIEWS
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 73100 TC
|
| Hospital Charge Code |
73100
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$25.46
|
| Rate for Payer: Beech Street Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: First Choice Health Commercial |
$216.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.46
|
| Rate for Payer: HealthUtah PPO |
$240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$21.64
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$228.00
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$25.46
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$25.46
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
|
|
RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 73110 TC
|
| Hospital Charge Code |
73110
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$275.38
|
| Rate for Payer: Aetna of WY Medicare |
$32.33
|
| Rate for Payer: Beech Street Commercial |
$266.95
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$272.57
|
| Rate for Payer: Cigna of WY Commercial |
$275.38
|
| Rate for Payer: First Choice Health Commercial |
$252.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.33
|
| Rate for Payer: HealthUtah PPO |
$281.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$272.57
|
| Rate for Payer: Multiplan Medicare/VA |
$27.48
|
| Rate for Payer: One Health Plan of WY PPO |
$275.38
|
| Rate for Payer: PacificSource Commercial |
$252.90
|
| Rate for Payer: PHCS PPO |
$266.95
|
| Rate for Payer: Three Rivers PPO |
$210.75
|
| Rate for Payer: TriWest Veterans Administration |
$32.33
|
| Rate for Payer: United Healthcare Commercial |
$244.47
|
| Rate for Payer: United Healthcare Medicare |
$32.33
|
| Rate for Payer: WINHealth Partners Commercial |
$266.95
|
|
|
RADIAL ARTERY CATH 20G
|
Facility
|
OP
|
$35.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.64
|
| Rate for Payer: Aetna of WY Medicare |
$23.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.94
|
| Rate for Payer: Altius Commercial |
$33.94
|
| Rate for Payer: Beech Street Commercial |
$34.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.02
|
| Rate for Payer: Cash Price |
$24.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.29
|
| Rate for Payer: Cigna of WY Commercial |
$34.64
|
| Rate for Payer: Entrust Commercial |
$33.58
|
| Rate for Payer: First Choice Health Commercial |
$33.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.50
|
| Rate for Payer: HealthUtah PPO |
$35.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.29
|
| Rate for Payer: Multiplan Medicare/VA |
$19.48
|
| Rate for Payer: One Health Plan of WY PPO |
$34.64
|
| Rate for Payer: PacificSource Commercial |
$31.82
|
| Rate for Payer: PHCS PPO |
$34.64
|
| Rate for Payer: Three Rivers PPO |
$26.51
|
| Rate for Payer: TriWest Veterans Administration |
$20.50
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$20.50
|
| Rate for Payer: WINHealth Partners Commercial |
$34.64
|
| Rate for Payer: Wise Provider Network Commercial |
$33.58
|
|
|
RADIAL ARTERY CATH 20G
|
Facility
|
IP
|
$35.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.94
|
| Rate for Payer: Altius Commercial |
$33.94
|
| Rate for Payer: Beech Street Commercial |
$34.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.02
|
| Rate for Payer: Cash Price |
$24.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.29
|
| Rate for Payer: Cigna of WY Commercial |
$34.64
|
| Rate for Payer: Entrust Commercial |
$33.58
|
| Rate for Payer: First Choice Health Commercial |
$33.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.33
|
| Rate for Payer: HealthUtah PPO |
$35.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.29
|
| Rate for Payer: Multiplan Medicare/VA |
$22.16
|
| Rate for Payer: One Health Plan of WY PPO |
$34.64
|
| Rate for Payer: PacificSource Commercial |
$31.82
|
| Rate for Payer: PHCS PPO |
$34.64
|
| Rate for Payer: Three Rivers PPO |
$26.51
|
| Rate for Payer: TriWest Veterans Administration |
$23.33
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$23.33
|
| Rate for Payer: WINHealth Partners Commercial |
$33.58
|
| Rate for Payer: Wise Provider Network Commercial |
$33.58
|
|
|
RADIAL ARTERY CATH 22G
|
Facility
|
IP
|
$36.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.38
|
| Rate for Payer: Altius Commercial |
$35.38
|
| Rate for Payer: Beech Street Commercial |
$36.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.74
|
| Rate for Payer: Cigna of WY Commercial |
$36.11
|
| Rate for Payer: Entrust Commercial |
$35.01
|
| Rate for Payer: First Choice Health Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.32
|
| Rate for Payer: HealthUtah PPO |
$36.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.74
|
| Rate for Payer: Multiplan Medicare/VA |
$23.10
|
| Rate for Payer: One Health Plan of WY PPO |
$36.11
|
| Rate for Payer: PacificSource Commercial |
$33.16
|
| Rate for Payer: PHCS PPO |
$36.11
|
| Rate for Payer: Three Rivers PPO |
$27.64
|
| Rate for Payer: TriWest Veterans Administration |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$24.32
|
| Rate for Payer: WINHealth Partners Commercial |
$35.01
|
| Rate for Payer: Wise Provider Network Commercial |
$35.01
|
|
|
RADIAL ARTERY CATH 22G
|
Facility
|
OP
|
$36.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.11
|
| Rate for Payer: Aetna of WY Medicare |
$24.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.38
|
| Rate for Payer: Altius Commercial |
$35.38
|
| Rate for Payer: Beech Street Commercial |
$36.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.74
|
| Rate for Payer: Cigna of WY Commercial |
$36.11
|
| Rate for Payer: Entrust Commercial |
$35.01
|
| Rate for Payer: First Choice Health Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.37
|
| Rate for Payer: HealthUtah PPO |
$36.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.74
|
| Rate for Payer: Multiplan Medicare/VA |
$20.30
|
| Rate for Payer: One Health Plan of WY PPO |
$36.11
|
| Rate for Payer: PacificSource Commercial |
$33.16
|
| Rate for Payer: PHCS PPO |
$36.11
|
| Rate for Payer: Three Rivers PPO |
$27.64
|
| Rate for Payer: TriWest Veterans Administration |
$21.37
|
| Rate for Payer: United Healthcare Commercial |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$21.37
|
| Rate for Payer: WINHealth Partners Commercial |
$36.11
|
| Rate for Payer: Wise Provider Network Commercial |
$35.01
|
|
|
RADIAL SPRING-GUIDE WIRE
|
Facility
|
IP
|
$31.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.28
|
| Rate for Payer: Altius Commercial |
$30.28
|
| Rate for Payer: Beech Street Commercial |
$30.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$22.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.59
|
| Rate for Payer: Cigna of WY Commercial |
$30.91
|
| Rate for Payer: Entrust Commercial |
$29.96
|
| Rate for Payer: First Choice Health Commercial |
$29.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.82
|
| Rate for Payer: HealthUtah PPO |
$31.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.59
|
| Rate for Payer: Multiplan Medicare/VA |
$19.78
|
| Rate for Payer: One Health Plan of WY PPO |
$30.91
|
| Rate for Payer: PacificSource Commercial |
$28.39
|
| Rate for Payer: PHCS PPO |
$30.91
|
| Rate for Payer: Three Rivers PPO |
$23.66
|
| Rate for Payer: TriWest Veterans Administration |
$20.82
|
| Rate for Payer: United Healthcare Commercial |
$27.44
|
| Rate for Payer: United Healthcare Medicare |
$20.82
|
| Rate for Payer: WINHealth Partners Commercial |
$29.96
|
| Rate for Payer: Wise Provider Network Commercial |
$29.96
|
|
|
RADIAL SPRING-GUIDE WIRE
|
Facility
|
OP
|
$31.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.91
|
| Rate for Payer: Aetna of WY Medicare |
$20.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.28
|
| Rate for Payer: Altius Commercial |
$30.28
|
| Rate for Payer: Beech Street Commercial |
$30.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$22.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.59
|
| Rate for Payer: Cigna of WY Commercial |
$30.91
|
| Rate for Payer: Entrust Commercial |
$29.96
|
| Rate for Payer: First Choice Health Commercial |
$29.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.29
|
| Rate for Payer: HealthUtah PPO |
$31.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.59
|
| Rate for Payer: Multiplan Medicare/VA |
$17.38
|
| Rate for Payer: One Health Plan of WY PPO |
$30.91
|
| Rate for Payer: PacificSource Commercial |
$28.39
|
| Rate for Payer: PHCS PPO |
$30.91
|
| Rate for Payer: Three Rivers PPO |
$23.66
|
| Rate for Payer: TriWest Veterans Administration |
$18.29
|
| Rate for Payer: United Healthcare Commercial |
$27.44
|
| Rate for Payer: United Healthcare Medicare |
$18.29
|
| Rate for Payer: WINHealth Partners Commercial |
$30.91
|
| Rate for Payer: Wise Provider Network Commercial |
$29.96
|
|
|
RADICAL RESECTION TONSIL W/O CLOSURE
|
Professional
|
Both
|
$5,067.00
|
|
|
Service Code
|
HCPCS 42842
|
| Hospital Charge Code |
42842
|
| Min. Negotiated Rate |
$831.50 |
| Max. Negotiated Rate |
$5,067.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,965.66
|
| Rate for Payer: Aetna of WY Medicare |
$978.23
|
| Rate for Payer: Beech Street Commercial |
$4,813.65
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,914.99
|
| Rate for Payer: Cigna of WY Commercial |
$4,965.66
|
| Rate for Payer: First Choice Health Commercial |
$4,560.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,813.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$978.23
|
| Rate for Payer: HealthUtah PPO |
$5,067.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,914.99
|
| Rate for Payer: Multiplan Medicare/VA |
$831.50
|
| Rate for Payer: One Health Plan of WY PPO |
$4,965.66
|
| Rate for Payer: PacificSource Commercial |
$4,560.30
|
| Rate for Payer: PHCS PPO |
$4,813.65
|
| Rate for Payer: Three Rivers PPO |
$3,800.25
|
| Rate for Payer: TriWest Veterans Administration |
$978.23
|
| Rate for Payer: United Healthcare Commercial |
$4,408.29
|
| Rate for Payer: United Healthcare Medicare |
$978.23
|
| Rate for Payer: WINHealth Partners Commercial |
$4,306.95
|
|
|
RADICAL STYLOIDECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 25230
|
| Hospital Charge Code |
25230
|
| Min. Negotiated Rate |
$363.04 |
| Max. Negotiated Rate |
$3,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,303.58
|
| Rate for Payer: Aetna of WY Medicare |
$427.11
|
| Rate for Payer: Beech Street Commercial |
$3,202.45
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,269.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,303.58
|
| Rate for Payer: First Choice Health Commercial |
$3,033.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,202.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$427.11
|
| Rate for Payer: HealthUtah PPO |
$3,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,269.87
|
| Rate for Payer: Multiplan Medicare/VA |
$363.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3,303.58
|
| Rate for Payer: PacificSource Commercial |
$3,033.90
|
| Rate for Payer: PHCS PPO |
$3,202.45
|
| Rate for Payer: Three Rivers PPO |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration |
$427.11
|
| Rate for Payer: United Healthcare Commercial |
$2,932.77
|
| Rate for Payer: United Healthcare Medicare |
$427.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,865.35
|
|
|
RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$5,076.00
|
|
|
Service Code
|
HCPCS 64625 50
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$160.22 |
| Max. Negotiated Rate |
$5,076.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,974.48
|
| Rate for Payer: Aetna of WY Medicare |
$188.49
|
| Rate for Payer: Beech Street Commercial |
$4,822.20
|
| Rate for Payer: Cash Price |
$3,553.20
|
| Rate for Payer: Cash Price |
$3,553.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,923.72
|
| Rate for Payer: Cigna of WY Commercial |
$4,974.48
|
| Rate for Payer: First Choice Health Commercial |
$4,568.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,822.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.49
|
| Rate for Payer: HealthUtah PPO |
$5,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,923.72
|
| Rate for Payer: Multiplan Medicare/VA |
$160.22
|
| Rate for Payer: One Health Plan of WY PPO |
$4,974.48
|
| Rate for Payer: PacificSource Commercial |
$4,568.40
|
| Rate for Payer: PHCS PPO |
$4,822.20
|
| Rate for Payer: Three Rivers PPO |
$3,807.00
|
| Rate for Payer: TriWest Veterans Administration |
$188.49
|
| Rate for Payer: United Healthcare Commercial |
$4,416.12
|
| Rate for Payer: United Healthcare Medicare |
$188.49
|
| Rate for Payer: WINHealth Partners Commercial |
$4,314.60
|
|
|
RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$2,538.00
|
|
|
Service Code
|
HCPCS 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$160.22 |
| Max. Negotiated Rate |
$2,538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,487.24
|
| Rate for Payer: Aetna of WY Medicare |
$188.49
|
| Rate for Payer: Beech Street Commercial |
$2,411.10
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.86
|
| Rate for Payer: Cigna of WY Commercial |
$2,487.24
|
| Rate for Payer: First Choice Health Commercial |
$2,284.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,411.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.49
|
| Rate for Payer: HealthUtah PPO |
$2,538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.86
|
| Rate for Payer: Multiplan Medicare/VA |
$160.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,487.24
|
| Rate for Payer: PacificSource Commercial |
$2,284.20
|
| Rate for Payer: PHCS PPO |
$2,411.10
|
| Rate for Payer: Three Rivers PPO |
$1,903.50
|
| Rate for Payer: TriWest Veterans Administration |
$188.49
|
| Rate for Payer: United Healthcare Commercial |
$2,208.06
|
| Rate for Payer: United Healthcare Medicare |
$188.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,157.30
|
|
|
RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 70110 TC
|
| Hospital Charge Code |
70110
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.58
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Beech Street Commercial |
$257.45
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$262.87
|
| Rate for Payer: Cigna of WY Commercial |
$265.58
|
| Rate for Payer: First Choice Health Commercial |
$243.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$271.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$262.87
|
| Rate for Payer: Multiplan Medicare/VA |
$26.65
|
| Rate for Payer: One Health Plan of WY PPO |
$265.58
|
| Rate for Payer: PacificSource Commercial |
$243.90
|
| Rate for Payer: PHCS PPO |
$257.45
|
| Rate for Payer: Three Rivers PPO |
$203.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$235.77
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$257.45
|
|
|
RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 74018 TC
|
| Hospital Charge Code |
74018
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$21.20
|
| Rate for Payer: Beech Street Commercial |
$275.50
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: First Choice Health Commercial |
$261.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.20
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$18.02
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$275.50
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$21.20
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$21.20
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
|
|
RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 74019 TC
|
| Hospital Charge Code |
74019
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.20
|
| Rate for Payer: Aetna of WY Medicare |
$25.46
|
| Rate for Payer: Beech Street Commercial |
$275.50
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.30
|
| Rate for Payer: Cigna of WY Commercial |
$284.20
|
| Rate for Payer: First Choice Health Commercial |
$261.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.46
|
| Rate for Payer: HealthUtah PPO |
$290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.30
|
| Rate for Payer: Multiplan Medicare/VA |
$21.64
|
| Rate for Payer: One Health Plan of WY PPO |
$284.20
|
| Rate for Payer: PacificSource Commercial |
$261.00
|
| Rate for Payer: PHCS PPO |
$275.50
|
| Rate for Payer: Three Rivers PPO |
$217.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.46
|
| Rate for Payer: United Healthcare Commercial |
$252.30
|
| Rate for Payer: United Healthcare Medicare |
$25.46
|
| Rate for Payer: WINHealth Partners Commercial |
$275.50
|
|
|
RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 74021 TC
|
| Hospital Charge Code |
74021
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$336.14
|
| Rate for Payer: Aetna of WY Medicare |
$29.71
|
| Rate for Payer: Beech Street Commercial |
$325.85
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$332.71
|
| Rate for Payer: Cigna of WY Commercial |
$336.14
|
| Rate for Payer: First Choice Health Commercial |
$308.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.71
|
| Rate for Payer: HealthUtah PPO |
$343.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$332.71
|
| Rate for Payer: Multiplan Medicare/VA |
$25.25
|
| Rate for Payer: One Health Plan of WY PPO |
$336.14
|
| Rate for Payer: PacificSource Commercial |
$308.70
|
| Rate for Payer: PHCS PPO |
$325.85
|
| Rate for Payer: Three Rivers PPO |
$257.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.71
|
| Rate for Payer: United Healthcare Commercial |
$298.41
|
| Rate for Payer: United Healthcare Medicare |
$29.71
|
| Rate for Payer: WINHealth Partners Commercial |
$325.85
|
|
