|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
11423
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$762.44
|
| Rate for Payer: Aetna of WY Medicare |
$152.90
|
| Rate for Payer: Beech Street Commercial |
$739.10
|
| Rate for Payer: Cash Price |
$544.60
|
| Rate for Payer: Cash Price |
$544.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$754.66
|
| Rate for Payer: Cigna of WY Commercial |
$762.44
|
| Rate for Payer: First Choice Health Commercial |
$700.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$739.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.90
|
| Rate for Payer: HealthUtah PPO |
$778.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$754.66
|
| Rate for Payer: Multiplan Medicare/VA |
$129.96
|
| Rate for Payer: One Health Plan of WY PPO |
$762.44
|
| Rate for Payer: PacificSource Commercial |
$700.20
|
| Rate for Payer: PHCS PPO |
$739.10
|
| Rate for Payer: Three Rivers PPO |
$583.50
|
| Rate for Payer: TriWest Veterans Administration |
$152.90
|
| Rate for Payer: United Healthcare Commercial |
$676.86
|
| Rate for Payer: United Healthcare Medicare |
$152.90
|
| Rate for Payer: WINHealth Partners Commercial |
$661.30
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
11424
|
| Min. Negotiated Rate |
$149.28 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$692.86
|
| Rate for Payer: Aetna of WY Medicare |
$175.62
|
| Rate for Payer: Beech Street Commercial |
$671.65
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$685.79
|
| Rate for Payer: Cigna of WY Commercial |
$692.86
|
| Rate for Payer: First Choice Health Commercial |
$636.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$671.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.62
|
| Rate for Payer: HealthUtah PPO |
$707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$685.79
|
| Rate for Payer: Multiplan Medicare/VA |
$149.28
|
| Rate for Payer: One Health Plan of WY PPO |
$692.86
|
| Rate for Payer: PacificSource Commercial |
$636.30
|
| Rate for Payer: PHCS PPO |
$671.65
|
| Rate for Payer: Three Rivers PPO |
$530.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.62
|
| Rate for Payer: United Healthcare Commercial |
$615.09
|
| Rate for Payer: United Healthcare Medicare |
$175.62
|
| Rate for Payer: WINHealth Partners Commercial |
$600.95
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
11426
|
| Min. Negotiated Rate |
$219.75 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,344.56
|
| Rate for Payer: Aetna of WY Medicare |
$258.53
|
| Rate for Payer: Beech Street Commercial |
$1,303.40
|
| Rate for Payer: Cash Price |
$960.40
|
| Rate for Payer: Cash Price |
$960.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,330.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,344.56
|
| Rate for Payer: First Choice Health Commercial |
$1,234.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,303.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.53
|
| Rate for Payer: HealthUtah PPO |
$1,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,330.84
|
| Rate for Payer: Multiplan Medicare/VA |
$219.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,344.56
|
| Rate for Payer: PacificSource Commercial |
$1,234.80
|
| Rate for Payer: PHCS PPO |
$1,303.40
|
| Rate for Payer: Three Rivers PPO |
$1,029.00
|
| Rate for Payer: TriWest Veterans Administration |
$258.53
|
| Rate for Payer: United Healthcare Commercial |
$1,193.64
|
| Rate for Payer: United Healthcare Medicare |
$258.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,166.20
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
11400
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$82.47
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.47
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$70.10
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$82.47
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$82.47
|
| Rate for Payer: WINHealth Partners Commercial |
$345.10
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
11401
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$517.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$506.66
|
| Rate for Payer: Aetna of WY Medicare |
$103.09
|
| Rate for Payer: Beech Street Commercial |
$491.15
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$501.49
|
| Rate for Payer: Cigna of WY Commercial |
$506.66
|
| Rate for Payer: First Choice Health Commercial |
$465.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$491.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.09
|
| Rate for Payer: HealthUtah PPO |
$517.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$501.49
|
| Rate for Payer: Multiplan Medicare/VA |
$87.63
|
| Rate for Payer: One Health Plan of WY PPO |
$506.66
|
| Rate for Payer: PacificSource Commercial |
$465.30
|
| Rate for Payer: PHCS PPO |
$491.15
|
| Rate for Payer: Three Rivers PPO |
$387.75
|
| Rate for Payer: TriWest Veterans Administration |
$103.09
|
| Rate for Payer: United Healthcare Commercial |
$449.79
|
| Rate for Payer: United Healthcare Medicare |
$103.09
|
| Rate for Payer: WINHealth Partners Commercial |
$439.45
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$559.58
|
| Rate for Payer: Aetna of WY Medicare |
$112.65
|
| Rate for Payer: Beech Street Commercial |
$542.45
|
| Rate for Payer: Cash Price |
$399.70
|
| Rate for Payer: Cash Price |
$399.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$553.87
|
| Rate for Payer: Cigna of WY Commercial |
$559.58
|
| Rate for Payer: First Choice Health Commercial |
$513.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$542.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.65
|
| Rate for Payer: HealthUtah PPO |
$571.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$553.87
|
| Rate for Payer: Multiplan Medicare/VA |
$95.75
|
| Rate for Payer: One Health Plan of WY PPO |
$559.58
|
| Rate for Payer: PacificSource Commercial |
$513.90
|
| Rate for Payer: PHCS PPO |
$542.45
|
| Rate for Payer: Three Rivers PPO |
$428.25
|
| Rate for Payer: TriWest Veterans Administration |
$112.65
|
| Rate for Payer: United Healthcare Commercial |
$496.77
|
| Rate for Payer: United Healthcare Medicare |
$112.65
|
| Rate for Payer: WINHealth Partners Commercial |
$485.35
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$123.84 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$723.24
|
| Rate for Payer: Aetna of WY Medicare |
$145.70
|
| 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 |
$145.70
|
| Rate for Payer: HealthUtah PPO |
$738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$715.86
|
| Rate for Payer: Multiplan Medicare/VA |
$123.84
|
| 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 |
$145.70
|
| Rate for Payer: United Healthcare Commercial |
$642.06
|
| Rate for Payer: United Healthcare Medicare |
$145.70
|
| Rate for Payer: WINHealth Partners Commercial |
$627.30
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$135.79 |
| Max. Negotiated Rate |
$811.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$794.78
|
| Rate for Payer: Aetna of WY Medicare |
$159.75
|
| Rate for Payer: Beech Street Commercial |
$770.45
|
| Rate for Payer: Cash Price |
$567.70
|
| Rate for Payer: Cash Price |
$567.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$786.67
|
| Rate for Payer: Cigna of WY Commercial |
$794.78
|
| Rate for Payer: First Choice Health Commercial |
$729.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$770.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.75
|
| Rate for Payer: HealthUtah PPO |
$811.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$786.67
|
| Rate for Payer: Multiplan Medicare/VA |
$135.79
|
| Rate for Payer: One Health Plan of WY PPO |
$794.78
|
| Rate for Payer: PacificSource Commercial |
$729.90
|
| Rate for Payer: PHCS PPO |
$770.45
|
| Rate for Payer: Three Rivers PPO |
$608.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$705.57
|
| Rate for Payer: United Healthcare Medicare |
$159.75
|
| Rate for Payer: WINHealth Partners Commercial |
$689.35
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$203.67 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,206.38
|
| Rate for Payer: Aetna of WY Medicare |
$239.61
|
| Rate for Payer: Beech Street Commercial |
$1,169.45
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,194.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,206.38
|
| Rate for Payer: First Choice Health Commercial |
$1,107.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,169.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.61
|
| Rate for Payer: HealthUtah PPO |
$1,231.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,194.07
|
| Rate for Payer: Multiplan Medicare/VA |
$203.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,206.38
|
| Rate for Payer: PacificSource Commercial |
$1,107.90
|
| Rate for Payer: PHCS PPO |
$1,169.45
|
| Rate for Payer: Three Rivers PPO |
$923.25
|
| Rate for Payer: TriWest Veterans Administration |
$239.61
|
| Rate for Payer: United Healthcare Commercial |
$1,070.97
|
| Rate for Payer: United Healthcare Medicare |
$239.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,046.35
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$110.71 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$638.96
|
| Rate for Payer: Aetna of WY Medicare |
$130.25
|
| Rate for Payer: Beech Street Commercial |
$619.40
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$632.44
|
| Rate for Payer: Cigna of WY Commercial |
$638.96
|
| Rate for Payer: First Choice Health Commercial |
$586.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$619.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.25
|
| Rate for Payer: HealthUtah PPO |
$652.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$632.44
|
| Rate for Payer: Multiplan Medicare/VA |
$110.71
|
| Rate for Payer: One Health Plan of WY PPO |
$638.96
|
| Rate for Payer: PacificSource Commercial |
$586.80
|
| Rate for Payer: PHCS PPO |
$619.40
|
| Rate for Payer: Three Rivers PPO |
$489.00
|
| Rate for Payer: TriWest Veterans Administration |
$130.25
|
| Rate for Payer: United Healthcare Commercial |
$567.24
|
| Rate for Payer: United Healthcare Medicare |
$130.25
|
| Rate for Payer: WINHealth Partners Commercial |
$554.20
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$724.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$709.52
|
| Rate for Payer: Aetna of WY Medicare |
$143.33
|
| Rate for Payer: Beech Street Commercial |
$687.80
|
| Rate for Payer: Cash Price |
$506.80
|
| Rate for Payer: Cash Price |
$506.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$702.28
|
| Rate for Payer: Cigna of WY Commercial |
$709.52
|
| Rate for Payer: First Choice Health Commercial |
$651.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$687.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.33
|
| Rate for Payer: HealthUtah PPO |
$724.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$702.28
|
| Rate for Payer: Multiplan Medicare/VA |
$121.83
|
| Rate for Payer: One Health Plan of WY PPO |
$709.52
|
| Rate for Payer: PacificSource Commercial |
$651.60
|
| Rate for Payer: PHCS PPO |
$687.80
|
| Rate for Payer: Three Rivers PPO |
$543.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.33
|
| Rate for Payer: United Healthcare Commercial |
$629.88
|
| Rate for Payer: United Healthcare Medicare |
$143.33
|
| Rate for Payer: WINHealth Partners Commercial |
$615.40
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
11443
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$869.26
|
| Rate for Payer: Aetna of WY Medicare |
$174.08
|
| Rate for Payer: Beech Street Commercial |
$842.65
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$860.39
|
| Rate for Payer: Cigna of WY Commercial |
$869.26
|
| Rate for Payer: First Choice Health Commercial |
$798.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$842.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.08
|
| Rate for Payer: HealthUtah PPO |
$887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$860.39
|
| Rate for Payer: Multiplan Medicare/VA |
$147.97
|
| Rate for Payer: One Health Plan of WY PPO |
$869.26
|
| Rate for Payer: PacificSource Commercial |
$798.30
|
| Rate for Payer: PHCS PPO |
$842.65
|
| Rate for Payer: Three Rivers PPO |
$665.25
|
| Rate for Payer: TriWest Veterans Administration |
$174.08
|
| Rate for Payer: United Healthcare Commercial |
$771.69
|
| Rate for Payer: United Healthcare Medicare |
$174.08
|
| Rate for Payer: WINHealth Partners Commercial |
$753.95
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
11444
|
| Min. Negotiated Rate |
$185.78 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Medicare |
$218.57
|
| Rate for Payer: Beech Street Commercial |
$934.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
| Rate for Payer: Cigna of WY Commercial |
$964.32
|
| Rate for Payer: First Choice Health Commercial |
$885.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.57
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Multiplan Medicare/VA |
$185.78
|
| Rate for Payer: One Health Plan of WY PPO |
$964.32
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PHCS PPO |
$934.80
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$218.57
|
| Rate for Payer: United Healthcare Commercial |
$856.08
|
| Rate for Payer: United Healthcare Medicare |
$218.57
|
| Rate for Payer: WINHealth Partners Commercial |
$836.40
|
|
|
EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
HCPCS 42815
|
| Hospital Charge Code |
42815
|
| Min. Negotiated Rate |
$445.33 |
| Max. Negotiated Rate |
$2,804.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,747.92
|
| Rate for Payer: Aetna of WY Medicare |
$523.92
|
| Rate for Payer: Beech Street Commercial |
$2,663.80
|
| Rate for Payer: Cash Price |
$1,962.80
|
| Rate for Payer: Cash Price |
$1,962.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,719.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,747.92
|
| Rate for Payer: First Choice Health Commercial |
$2,523.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,663.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$523.92
|
| Rate for Payer: HealthUtah PPO |
$2,804.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,719.88
|
| Rate for Payer: Multiplan Medicare/VA |
$445.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,747.92
|
| Rate for Payer: PacificSource Commercial |
$2,523.60
|
| Rate for Payer: PHCS PPO |
$2,663.80
|
| Rate for Payer: Three Rivers PPO |
$2,103.00
|
| Rate for Payer: TriWest Veterans Administration |
$523.92
|
| Rate for Payer: United Healthcare Commercial |
$2,439.48
|
| Rate for Payer: United Healthcare Medicare |
$523.92
|
| Rate for Payer: WINHealth Partners Commercial |
$2,383.40
|
|
|
EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$2,355.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$377.38 |
| Max. Negotiated Rate |
$2,355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,307.90
|
| Rate for Payer: Aetna of WY Medicare |
$443.98
|
| Rate for Payer: Beech Street Commercial |
$2,237.25
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,284.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,307.90
|
| Rate for Payer: First Choice Health Commercial |
$2,119.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,237.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.98
|
| Rate for Payer: HealthUtah PPO |
$2,355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,284.35
|
| Rate for Payer: Multiplan Medicare/VA |
$377.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,307.90
|
| Rate for Payer: PacificSource Commercial |
$2,119.50
|
| Rate for Payer: PHCS PPO |
$2,237.25
|
| Rate for Payer: Three Rivers PPO |
$1,766.25
|
| Rate for Payer: TriWest Veterans Administration |
$443.98
|
| Rate for Payer: United Healthcare Commercial |
$2,048.85
|
| Rate for Payer: United Healthcare Medicare |
$443.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,001.75
|
|
|
EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$4,710.00
|
|
|
Service Code
|
HCPCS 19125 50
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$377.38 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,615.80
|
| Rate for Payer: Aetna of WY Medicare |
$443.98
|
| Rate for Payer: Beech Street Commercial |
$4,474.50
|
| Rate for Payer: Cash Price |
$3,297.00
|
| Rate for Payer: Cash Price |
$3,297.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,568.70
|
| Rate for Payer: Cigna of WY Commercial |
$4,615.80
|
| Rate for Payer: First Choice Health Commercial |
$4,239.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,474.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.98
|
| Rate for Payer: HealthUtah PPO |
$4,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,568.70
|
| Rate for Payer: Multiplan Medicare/VA |
$377.38
|
| Rate for Payer: One Health Plan of WY PPO |
$4,615.80
|
| Rate for Payer: PacificSource Commercial |
$4,239.00
|
| Rate for Payer: PHCS PPO |
$4,474.50
|
| Rate for Payer: Three Rivers PPO |
$3,532.50
|
| Rate for Payer: TriWest Veterans Administration |
$443.98
|
| Rate for Payer: United Healthcare Commercial |
$4,097.70
|
| Rate for Payer: United Healthcare Medicare |
$443.98
|
| Rate for Payer: WINHealth Partners Commercial |
$4,003.50
|
|
|
EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
28104
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,788.50
|
| Rate for Payer: Aetna of WY Medicare |
$346.70
|
| Rate for Payer: Beech Street Commercial |
$1,733.75
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,770.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,788.50
|
| Rate for Payer: First Choice Health Commercial |
$1,642.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,733.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.70
|
| Rate for Payer: HealthUtah PPO |
$1,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,770.25
|
| Rate for Payer: Multiplan Medicare/VA |
$294.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,788.50
|
| Rate for Payer: PacificSource Commercial |
$1,642.50
|
| Rate for Payer: PHCS PPO |
$1,733.75
|
| Rate for Payer: Three Rivers PPO |
$1,368.75
|
| Rate for Payer: TriWest Veterans Administration |
$346.70
|
| Rate for Payer: United Healthcare Commercial |
$1,587.75
|
| Rate for Payer: United Healthcare Medicare |
$346.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,551.25
|
|
|
EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$444.14 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$522.52
|
| Rate for Payer: Beech Street Commercial |
$1,771.75
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: First Choice Health Commercial |
$1,678.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.52
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$444.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,771.75
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$522.52
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$522.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,585.25
|
|
|
EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24120 80
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$444.14 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$522.52
|
| Rate for Payer: Beech Street Commercial |
$1,771.75
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: First Choice Health Commercial |
$1,678.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.52
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$444.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,771.75
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$522.52
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$522.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,585.25
|
|
|
EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24120 AS
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$444.14 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$522.52
|
| Rate for Payer: Beech Street Commercial |
$1,771.75
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: First Choice Health Commercial |
$1,678.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.52
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$444.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,771.75
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$522.52
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$522.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,585.25
|
|
|
EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$3,475.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
23156
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Aetna of WY Medicare |
$661.82
|
| Rate for Payer: Beech Street Commercial |
$3,301.25
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: First Choice Health Commercial |
$3,127.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.82
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$562.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,301.25
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$661.82
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$661.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,953.75
|
|
|
EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$3,475.00
|
|
|
Service Code
|
HCPCS 23156 80
|
| Hospital Charge Code |
23156
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Aetna of WY Medicare |
$661.82
|
| Rate for Payer: Beech Street Commercial |
$3,301.25
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: First Choice Health Commercial |
$3,127.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.82
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$562.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,301.25
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$661.82
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$661.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,953.75
|
|
|
EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$3,475.00
|
|
|
Service Code
|
HCPCS 23156 AS
|
| Hospital Charge Code |
23156
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$3,475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,405.50
|
| Rate for Payer: Aetna of WY Medicare |
$661.82
|
| Rate for Payer: Beech Street Commercial |
$3,301.25
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: Cash Price |
$2,432.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,370.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,405.50
|
| Rate for Payer: First Choice Health Commercial |
$3,127.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,301.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.82
|
| Rate for Payer: HealthUtah PPO |
$3,475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,370.75
|
| Rate for Payer: Multiplan Medicare/VA |
$562.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,405.50
|
| Rate for Payer: PacificSource Commercial |
$3,127.50
|
| Rate for Payer: PHCS PPO |
$3,301.25
|
| Rate for Payer: Three Rivers PPO |
$2,606.25
|
| Rate for Payer: TriWest Veterans Administration |
$661.82
|
| Rate for Payer: United Healthcare Commercial |
$3,023.25
|
| Rate for Payer: United Healthcare Medicare |
$661.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,953.75
|
|
|
EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$1,966.00
|
|
|
Service Code
|
HCPCS 25135 AS
|
| Hospital Charge Code |
25135
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$1,966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,926.68
|
| Rate for Payer: Aetna of WY Medicare |
$550.96
|
| Rate for Payer: Beech Street Commercial |
$1,867.70
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,907.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,926.68
|
| Rate for Payer: First Choice Health Commercial |
$1,769.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,867.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$550.96
|
| Rate for Payer: HealthUtah PPO |
$1,966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,907.02
|
| Rate for Payer: Multiplan Medicare/VA |
$468.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,926.68
|
| Rate for Payer: PacificSource Commercial |
$1,769.40
|
| Rate for Payer: PHCS PPO |
$1,867.70
|
| Rate for Payer: Three Rivers PPO |
$1,474.50
|
| Rate for Payer: TriWest Veterans Administration |
$550.96
|
| Rate for Payer: United Healthcare Commercial |
$1,710.42
|
| Rate for Payer: United Healthcare Medicare |
$550.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,671.10
|
|
|
EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$1,966.00
|
|
|
Service Code
|
HCPCS 25135
|
| Hospital Charge Code |
25135
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$1,966.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,926.68
|
| Rate for Payer: Aetna of WY Medicare |
$550.96
|
| Rate for Payer: Beech Street Commercial |
$1,867.70
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: Cash Price |
$1,376.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,907.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,926.68
|
| Rate for Payer: First Choice Health Commercial |
$1,769.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,867.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$550.96
|
| Rate for Payer: HealthUtah PPO |
$1,966.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,907.02
|
| Rate for Payer: Multiplan Medicare/VA |
$468.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,926.68
|
| Rate for Payer: PacificSource Commercial |
$1,769.40
|
| Rate for Payer: PHCS PPO |
$1,867.70
|
| Rate for Payer: Three Rivers PPO |
$1,474.50
|
| Rate for Payer: TriWest Veterans Administration |
$550.96
|
| Rate for Payer: United Healthcare Commercial |
$1,710.42
|
| Rate for Payer: United Healthcare Medicare |
$550.96
|
| Rate for Payer: WINHealth Partners Commercial |
$1,671.10
|
|
