|
RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
71046
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$275.38
|
| Rate for Payer: Aetna of WY Medicare |
$22.84
|
| 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 |
$22.84
|
| Rate for Payer: HealthUtah PPO |
$281.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$272.57
|
| Rate for Payer: Multiplan Medicare/VA |
$19.41
|
| 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 |
$22.84
|
| Rate for Payer: United Healthcare Commercial |
$244.47
|
| Rate for Payer: United Healthcare Medicare |
$22.84
|
| Rate for Payer: WINHealth Partners Commercial |
$266.95
|
|
|
RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 71045 TC
|
| Hospital Charge Code |
71045
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$16.94
|
| 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 |
$16.94
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$14.40
|
| 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 |
$16.94
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$16.94
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
|
|
RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 74022 TC
|
| Hospital Charge Code |
74022
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$380.24
|
| Rate for Payer: Aetna of WY Medicare |
$34.30
|
| Rate for Payer: Beech Street Commercial |
$368.60
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$376.36
|
| Rate for Payer: Cigna of WY Commercial |
$380.24
|
| Rate for Payer: First Choice Health Commercial |
$349.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$368.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.30
|
| Rate for Payer: HealthUtah PPO |
$388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$376.36
|
| Rate for Payer: Multiplan Medicare/VA |
$29.16
|
| Rate for Payer: One Health Plan of WY PPO |
$380.24
|
| Rate for Payer: PacificSource Commercial |
$349.20
|
| Rate for Payer: PHCS PPO |
$368.60
|
| Rate for Payer: Three Rivers PPO |
$291.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$337.56
|
| Rate for Payer: United Healthcare Medicare |
$34.30
|
| Rate for Payer: WINHealth Partners Commercial |
$368.60
|
|
|
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 73600 26
|
| Hospital Charge Code |
73600
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.86
|
| Rate for Payer: Aetna of WY Medicare |
$7.45
|
| Rate for Payer: Beech Street Commercial |
$54.15
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.29
|
| Rate for Payer: Cigna of WY Commercial |
$55.86
|
| Rate for Payer: First Choice Health Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.45
|
| Rate for Payer: HealthUtah PPO |
$57.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.29
|
| Rate for Payer: Multiplan Medicare/VA |
$6.33
|
| Rate for Payer: One Health Plan of WY PPO |
$55.86
|
| Rate for Payer: PacificSource Commercial |
$51.30
|
| Rate for Payer: PHCS PPO |
$54.15
|
| Rate for Payer: Three Rivers PPO |
$42.75
|
| Rate for Payer: TriWest Veterans Administration |
$7.45
|
| Rate for Payer: United Healthcare Commercial |
$49.59
|
| Rate for Payer: United Healthcare Medicare |
$7.45
|
| Rate for Payer: WINHealth Partners Commercial |
$54.15
|
|
|
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
73600
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Aetna of WY Medicare |
$31.59
|
| Rate for Payer: Beech Street Commercial |
$197.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: First Choice Health Commercial |
$187.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.59
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: Multiplan Medicare/VA |
$26.85
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$197.60
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: TriWest Veterans Administration |
$31.59
|
| Rate for Payer: United Healthcare Commercial |
$180.96
|
| Rate for Payer: United Healthcare Medicare |
$31.59
|
| Rate for Payer: WINHealth Partners Commercial |
$197.60
|
|
|
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 73600 TC
|
| Hospital Charge Code |
73600
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Aetna of WY Medicare |
$24.15
|
| 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 |
$24.15
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$20.53
|
| 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 |
$24.15
|
| Rate for Payer: United Healthcare Commercial |
$249.69
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
| Rate for Payer: WINHealth Partners Commercial |
$272.65
|
|
|
RADIOLOGIC EXAMINATION FEMUR 1 VIEW
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73551 TC
|
| Hospital Charge Code |
73551
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$28.64
|
| Rate for Payer: Beech Street Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: First Choice Health Commercial |
$54.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.64
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$57.00
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.64
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$28.64
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
|
|
RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 73552 50,TC
|
| Hospital Charge Code |
73552
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$34.87
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.87
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$29.64
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$34.87
|
| Rate for Payer: United Healthcare Commercial |
$447.18
|
| Rate for Payer: United Healthcare Medicare |
$34.87
|
| Rate for Payer: WINHealth Partners Commercial |
$488.30
|
|
|
RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 73552 TC
|
| Hospital Charge Code |
73552
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$315.56
|
| Rate for Payer: Aetna of WY Medicare |
$26.44
|
| Rate for Payer: Beech Street Commercial |
$305.90
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$312.34
|
| Rate for Payer: Cigna of WY Commercial |
$315.56
|
| Rate for Payer: First Choice Health Commercial |
$289.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.44
|
| Rate for Payer: HealthUtah PPO |
$322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$312.34
|
| Rate for Payer: Multiplan Medicare/VA |
$22.47
|
| Rate for Payer: One Health Plan of WY PPO |
$315.56
|
| Rate for Payer: PacificSource Commercial |
$289.80
|
| Rate for Payer: PHCS PPO |
$305.90
|
| Rate for Payer: Three Rivers PPO |
$241.50
|
| Rate for Payer: TriWest Veterans Administration |
$26.44
|
| Rate for Payer: United Healthcare Commercial |
$280.14
|
| Rate for Payer: United Healthcare Medicare |
$26.44
|
| Rate for Payer: WINHealth Partners Commercial |
$305.90
|
|
|
RADIOLOGIC EXAMINATION FOOT 2 VIEWS
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 73620 50
|
| Hospital Charge Code |
73620
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$422.38
|
| Rate for Payer: Aetna of WY Medicare |
$27.99
|
| 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 |
$27.99
|
| Rate for Payer: HealthUtah PPO |
$431.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$418.07
|
| Rate for Payer: Multiplan Medicare/VA |
$23.79
|
| 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 |
$27.99
|
| Rate for Payer: United Healthcare Commercial |
$374.97
|
| Rate for Payer: United Healthcare Medicare |
$27.99
|
| Rate for Payer: WINHealth Partners Commercial |
$409.45
|
|
|
RADIOLOGIC EXAMINATION FOOT 2 VIEWS
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 73620 TC
|
| Hospital Charge Code |
73620
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$20.87
|
| 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 |
$20.87
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$17.74
|
| 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 |
$20.87
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$20.87
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
|
|
RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 73560 TC
|
| Hospital Charge Code |
73560
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$210.70
|
| Rate for Payer: Aetna of WY Medicare |
$25.78
|
| 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 |
$25.78
|
| Rate for Payer: HealthUtah PPO |
$215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$208.55
|
| Rate for Payer: Multiplan Medicare/VA |
$21.91
|
| 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 |
$25.78
|
| Rate for Payer: United Healthcare Commercial |
$187.05
|
| Rate for Payer: United Healthcare Medicare |
$25.78
|
| Rate for Payer: WINHealth Partners Commercial |
$204.25
|
|
|
RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
73560
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.70
|
| Rate for Payer: Aetna of WY Medicare |
$33.56
|
| Rate for Payer: Beech Street Commercial |
$156.75
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$160.05
|
| Rate for Payer: Cigna of WY Commercial |
$161.70
|
| Rate for Payer: First Choice Health Commercial |
$148.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.56
|
| Rate for Payer: HealthUtah PPO |
$165.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$160.05
|
| Rate for Payer: Multiplan Medicare/VA |
$28.53
|
| Rate for Payer: One Health Plan of WY PPO |
$161.70
|
| Rate for Payer: PacificSource Commercial |
$148.50
|
| Rate for Payer: PHCS PPO |
$156.75
|
| Rate for Payer: Three Rivers PPO |
$123.75
|
| Rate for Payer: TriWest Veterans Administration |
$33.56
|
| Rate for Payer: United Healthcare Commercial |
$143.55
|
| Rate for Payer: United Healthcare Medicare |
$33.56
|
| Rate for Payer: WINHealth Partners Commercial |
$156.75
|
|
|
RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$352.00
|
|
|
Service Code
|
HCPCS 73562 TC
|
| Hospital Charge Code |
73562
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$344.96
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Beech Street Commercial |
$334.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$341.44
|
| Rate for Payer: Cigna of WY Commercial |
$344.96
|
| Rate for Payer: First Choice Health Commercial |
$316.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$334.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$352.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$341.44
|
| Rate for Payer: Multiplan Medicare/VA |
$26.65
|
| Rate for Payer: One Health Plan of WY PPO |
$344.96
|
| Rate for Payer: PacificSource Commercial |
$316.80
|
| Rate for Payer: PHCS PPO |
$334.40
|
| Rate for Payer: Three Rivers PPO |
$264.00
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$306.24
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$334.40
|
|
|
RADIOLOGIC EXAMINATION NECK SOFT TISSUE
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 70360 TC
|
| Hospital Charge Code |
70360
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$22.18
|
| Rate for Payer: Beech Street Commercial |
$308.75
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: First Choice Health Commercial |
$292.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.18
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$18.85
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$308.75
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$22.18
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$22.18
|
| Rate for Payer: WINHealth Partners Commercial |
$308.75
|
|
|
RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 72170 TC
|
| Hospital Charge Code |
72170
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$432.18
|
| Rate for Payer: Aetna of WY Medicare |
$19.23
|
| 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 |
$19.23
|
| Rate for Payer: HealthUtah PPO |
$441.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$427.77
|
| Rate for Payer: Multiplan Medicare/VA |
$16.35
|
| 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 |
$19.23
|
| Rate for Payer: United Healthcare Commercial |
$383.67
|
| Rate for Payer: United Healthcare Medicare |
$19.23
|
| Rate for Payer: WINHealth Partners Commercial |
$418.95
|
|
|
RADIOLOGIC EXAMINATION SKULL 4< VIEWS
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 70250 TC
|
| Hospital Charge Code |
70250
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Aetna of WY Medicare |
$26.76
|
| Rate for Payer: Beech Street Commercial |
$163.40
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: First Choice Health Commercial |
$154.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.76
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$22.75
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$163.40
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$26.76
|
| Rate for Payer: United Healthcare Commercial |
$149.64
|
| Rate for Payer: United Healthcare Medicare |
$26.76
|
| Rate for Payer: WINHealth Partners Commercial |
$163.40
|
|
|
RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
73590
|
| Min. Negotiated Rate |
$26.30 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Aetna of WY Medicare |
$30.94
|
| Rate for Payer: Beech Street Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: First Choice Health Commercial |
$210.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.94
|
| Rate for Payer: HealthUtah PPO |
$234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$26.30
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$222.30
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$30.94
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$30.94
|
| Rate for Payer: WINHealth Partners Commercial |
$222.30
|
|
|
RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 73590 TC
|
| Hospital Charge Code |
73590
|
| 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
|
|
|
RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
HCPCS 73564 TC
|
| Hospital Charge Code |
73564
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$544.88
|
| Rate for Payer: Aetna of WY Medicare |
$35.61
|
| Rate for Payer: Beech Street Commercial |
$528.20
|
| Rate for Payer: Cash Price |
$389.20
|
| Rate for Payer: Cash Price |
$389.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$539.32
|
| Rate for Payer: Cigna of WY Commercial |
$544.88
|
| Rate for Payer: First Choice Health Commercial |
$500.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$528.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.61
|
| Rate for Payer: HealthUtah PPO |
$556.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$539.32
|
| Rate for Payer: Multiplan Medicare/VA |
$30.27
|
| Rate for Payer: One Health Plan of WY PPO |
$544.88
|
| Rate for Payer: PacificSource Commercial |
$500.40
|
| Rate for Payer: PHCS PPO |
$528.20
|
| Rate for Payer: Three Rivers PPO |
$417.00
|
| Rate for Payer: TriWest Veterans Administration |
$35.61
|
| Rate for Payer: United Healthcare Commercial |
$483.72
|
| Rate for Payer: United Healthcare Medicare |
$35.61
|
| Rate for Payer: WINHealth Partners Commercial |
$528.20
|
|
|
RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 72190 TC
|
| Hospital Charge Code |
72190
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$541.94
|
| Rate for Payer: Aetna of WY Medicare |
$29.71
|
| 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 |
$29.71
|
| Rate for Payer: HealthUtah PPO |
$553.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$536.41
|
| Rate for Payer: Multiplan Medicare/VA |
$25.25
|
| 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 |
$29.71
|
| Rate for Payer: United Healthcare Commercial |
$481.11
|
| Rate for Payer: United Healthcare Medicare |
$29.71
|
| Rate for Payer: WINHealth Partners Commercial |
$525.35
|
|
|
RADIOLUCENT 3M DOTS
|
Facility
|
OP
|
$1.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.70
|
| Rate for Payer: Aetna of WY Medicare |
$1.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.66
|
| Rate for Payer: Altius Commercial |
$1.66
|
| Rate for Payer: Beech Street Commercial |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.68
|
| Rate for Payer: Cigna of WY Commercial |
$1.70
|
| Rate for Payer: Entrust Commercial |
$1.64
|
| Rate for Payer: First Choice Health Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.00
|
| Rate for Payer: HealthUtah PPO |
$1.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.68
|
| Rate for Payer: Multiplan Medicare/VA |
$0.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1.70
|
| Rate for Payer: PacificSource Commercial |
$1.56
|
| Rate for Payer: PHCS PPO |
$1.70
|
| Rate for Payer: Three Rivers PPO |
$1.30
|
| Rate for Payer: TriWest Veterans Administration |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
| Rate for Payer: United Healthcare Medicare |
$1.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1.64
|
|
|
RADIOLUCENT 3M DOTS
|
Facility
|
IP
|
$1.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.66
|
| Rate for Payer: Altius Commercial |
$1.66
|
| Rate for Payer: Beech Street Commercial |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.68
|
| Rate for Payer: Cigna of WY Commercial |
$1.70
|
| Rate for Payer: Entrust Commercial |
$1.64
|
| Rate for Payer: First Choice Health Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.14
|
| Rate for Payer: HealthUtah PPO |
$1.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1.70
|
| Rate for Payer: PacificSource Commercial |
$1.56
|
| Rate for Payer: PHCS PPO |
$1.70
|
| Rate for Payer: Three Rivers PPO |
$1.30
|
| Rate for Payer: TriWest Veterans Administration |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1.64
|
| Rate for Payer: Wise Provider Network Commercial |
$1.64
|
|
|
RAD RESCJ CAPSL TISS&HTRTPC B1 ELBW CONTRCT RLS
|
Professional
|
Both
|
$4,083.00
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
24149
|
| Min. Negotiated Rate |
$972.67 |
| Max. Negotiated Rate |
$4,083.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,001.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,144.32
|
| Rate for Payer: Beech Street Commercial |
$3,878.85
|
| Rate for Payer: Cash Price |
$2,858.10
|
| Rate for Payer: Cash Price |
$2,858.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,960.51
|
| Rate for Payer: Cigna of WY Commercial |
$4,001.34
|
| Rate for Payer: First Choice Health Commercial |
$3,674.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,878.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,144.32
|
| Rate for Payer: HealthUtah PPO |
$4,083.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,960.51
|
| Rate for Payer: Multiplan Medicare/VA |
$972.67
|
| Rate for Payer: One Health Plan of WY PPO |
$4,001.34
|
| Rate for Payer: PacificSource Commercial |
$3,674.70
|
| Rate for Payer: PHCS PPO |
$3,878.85
|
| Rate for Payer: Three Rivers PPO |
$3,062.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,144.32
|
| Rate for Payer: United Healthcare Commercial |
$3,552.21
|
| Rate for Payer: United Healthcare Medicare |
$1,144.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3,470.55
|
|
|
RAD RESCJ CAPSL TISS&HTRTPC B1 ELBW CONTRCT RLS
|
Professional
|
Both
|
$4,083.00
|
|
|
Service Code
|
HCPCS 24149 AS
|
| Hospital Charge Code |
24149
|
| Min. Negotiated Rate |
$972.67 |
| Max. Negotiated Rate |
$4,083.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,001.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,144.32
|
| Rate for Payer: Beech Street Commercial |
$3,878.85
|
| Rate for Payer: Cash Price |
$2,858.10
|
| Rate for Payer: Cash Price |
$2,858.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,960.51
|
| Rate for Payer: Cigna of WY Commercial |
$4,001.34
|
| Rate for Payer: First Choice Health Commercial |
$3,674.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,878.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,144.32
|
| Rate for Payer: HealthUtah PPO |
$4,083.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,960.51
|
| Rate for Payer: Multiplan Medicare/VA |
$972.67
|
| Rate for Payer: One Health Plan of WY PPO |
$4,001.34
|
| Rate for Payer: PacificSource Commercial |
$3,674.70
|
| Rate for Payer: PHCS PPO |
$3,878.85
|
| Rate for Payer: Three Rivers PPO |
$3,062.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,144.32
|
| Rate for Payer: United Healthcare Commercial |
$3,552.21
|
| Rate for Payer: United Healthcare Medicare |
$1,144.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3,470.55
|
|
