|
EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$4,247.00
|
|
|
Service Code
|
HCPCS 19120 50
|
| Hospital Charge Code |
19120
|
| Min. Negotiated Rate |
$341.68 |
| Max. Negotiated Rate |
$4,247.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,162.06
|
| Rate for Payer: Aetna of WY Medicare |
$401.98
|
| Rate for Payer: Beech Street Commercial |
$4,034.65
|
| Rate for Payer: Cash Price |
$2,972.90
|
| Rate for Payer: Cash Price |
$2,972.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,119.59
|
| Rate for Payer: Cigna of WY Commercial |
$4,162.06
|
| Rate for Payer: First Choice Health Commercial |
$3,822.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,034.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.98
|
| Rate for Payer: HealthUtah PPO |
$4,247.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,119.59
|
| Rate for Payer: Multiplan Medicare/VA |
$341.68
|
| Rate for Payer: One Health Plan of WY PPO |
$4,162.06
|
| Rate for Payer: PacificSource Commercial |
$3,822.30
|
| Rate for Payer: PHCS PPO |
$4,034.65
|
| Rate for Payer: Three Rivers PPO |
$3,185.25
|
| Rate for Payer: TriWest Veterans Administration |
$401.98
|
| Rate for Payer: United Healthcare Commercial |
$3,694.89
|
| Rate for Payer: United Healthcare Medicare |
$401.98
|
| Rate for Payer: WINHealth Partners Commercial |
$3,609.95
|
|
|
EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
19120
|
| Min. Negotiated Rate |
$341.68 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,081.52
|
| Rate for Payer: Aetna of WY Medicare |
$401.98
|
| Rate for Payer: Beech Street Commercial |
$2,017.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,060.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,081.52
|
| Rate for Payer: First Choice Health Commercial |
$1,911.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,017.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.98
|
| Rate for Payer: HealthUtah PPO |
$2,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,060.28
|
| Rate for Payer: Multiplan Medicare/VA |
$341.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,081.52
|
| Rate for Payer: PacificSource Commercial |
$1,911.60
|
| Rate for Payer: PHCS PPO |
$2,017.80
|
| Rate for Payer: Three Rivers PPO |
$1,593.00
|
| Rate for Payer: TriWest Veterans Administration |
$401.98
|
| Rate for Payer: United Healthcare Commercial |
$1,847.88
|
| Rate for Payer: United Healthcare Medicare |
$401.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.40
|
|
|
EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$3,054.00
|
|
|
Service Code
|
HCPCS 26390
|
| Hospital Charge Code |
26390
|
| Min. Negotiated Rate |
$727.29 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,992.92
|
| Rate for Payer: Aetna of WY Medicare |
$855.64
|
| Rate for Payer: Beech Street Commercial |
$2,901.30
|
| Rate for Payer: Cash Price |
$2,137.80
|
| Rate for Payer: Cash Price |
$2,137.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,962.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,992.92
|
| Rate for Payer: First Choice Health Commercial |
$2,748.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,901.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$855.64
|
| Rate for Payer: HealthUtah PPO |
$3,054.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,962.38
|
| Rate for Payer: Multiplan Medicare/VA |
$727.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,992.92
|
| Rate for Payer: PacificSource Commercial |
$2,748.60
|
| Rate for Payer: PHCS PPO |
$2,901.30
|
| Rate for Payer: Three Rivers PPO |
$2,290.50
|
| Rate for Payer: TriWest Veterans Administration |
$855.64
|
| Rate for Payer: United Healthcare Commercial |
$2,656.98
|
| Rate for Payer: United Healthcare Medicare |
$855.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2,595.90
|
|
|
EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$3,054.00
|
|
|
Service Code
|
HCPCS 26390 AS
|
| Hospital Charge Code |
26390
|
| Min. Negotiated Rate |
$727.29 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,992.92
|
| Rate for Payer: Aetna of WY Medicare |
$855.64
|
| Rate for Payer: Beech Street Commercial |
$2,901.30
|
| Rate for Payer: Cash Price |
$2,137.80
|
| Rate for Payer: Cash Price |
$2,137.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,962.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,992.92
|
| Rate for Payer: First Choice Health Commercial |
$2,748.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,901.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$855.64
|
| Rate for Payer: HealthUtah PPO |
$3,054.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,962.38
|
| Rate for Payer: Multiplan Medicare/VA |
$727.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,992.92
|
| Rate for Payer: PacificSource Commercial |
$2,748.60
|
| Rate for Payer: PHCS PPO |
$2,901.30
|
| Rate for Payer: Three Rivers PPO |
$2,290.50
|
| Rate for Payer: TriWest Veterans Administration |
$855.64
|
| Rate for Payer: United Healthcare Commercial |
$2,656.98
|
| Rate for Payer: United Healthcare Medicare |
$855.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2,595.90
|
|
|
EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$1,094.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
40819
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$1,094.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,072.12
|
| Rate for Payer: Aetna of WY Medicare |
$194.74
|
| Rate for Payer: Beech Street Commercial |
$1,039.30
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,061.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,072.12
|
| Rate for Payer: First Choice Health Commercial |
$984.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,039.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.74
|
| Rate for Payer: HealthUtah PPO |
$1,094.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,061.18
|
| Rate for Payer: Multiplan Medicare/VA |
$165.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,072.12
|
| Rate for Payer: PacificSource Commercial |
$984.60
|
| Rate for Payer: PHCS PPO |
$1,039.30
|
| Rate for Payer: Three Rivers PPO |
$820.50
|
| Rate for Payer: TriWest Veterans Administration |
$194.74
|
| Rate for Payer: United Healthcare Commercial |
$951.78
|
| Rate for Payer: United Healthcare Medicare |
$194.74
|
| Rate for Payer: WINHealth Partners Commercial |
$929.90
|
|
|
EXCIS CHEST WALL TUMOR/RIBS
|
Professional
|
Both
|
$4,026.00
|
|
|
Service Code
|
HCPCS 19260
|
| Hospital Charge Code |
19260
|
| Min. Negotiated Rate |
$3,019.50 |
| Max. Negotiated Rate |
$4,026.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,945.48
|
| Rate for Payer: Beech Street Commercial |
$3,824.70
|
| Rate for Payer: Cash Price |
$2,818.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,905.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,945.48
|
| Rate for Payer: First Choice Health Commercial |
$3,623.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,824.70
|
| Rate for Payer: HealthUtah PPO |
$4,026.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,905.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3,945.48
|
| Rate for Payer: PacificSource Commercial |
$3,623.40
|
| Rate for Payer: PHCS PPO |
$3,824.70
|
| Rate for Payer: Three Rivers PPO |
$3,019.50
|
| Rate for Payer: United Healthcare Commercial |
$3,502.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,422.10
|
|
|
EXCISION AURAL GLOMUS TUMOR TRANSCANAL
|
Professional
|
Both
|
$3,632.00
|
|
|
Service Code
|
HCPCS 69550
|
| Hospital Charge Code |
69550
|
| Min. Negotiated Rate |
$879.43 |
| Max. Negotiated Rate |
$3,632.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,559.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,034.62
|
| Rate for Payer: Beech Street Commercial |
$3,450.40
|
| Rate for Payer: Cash Price |
$2,542.40
|
| Rate for Payer: Cash Price |
$2,542.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,523.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,559.36
|
| Rate for Payer: First Choice Health Commercial |
$3,268.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,450.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,034.62
|
| Rate for Payer: HealthUtah PPO |
$3,632.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,523.04
|
| Rate for Payer: Multiplan Medicare/VA |
$879.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,559.36
|
| Rate for Payer: PacificSource Commercial |
$3,268.80
|
| Rate for Payer: PHCS PPO |
$3,450.40
|
| Rate for Payer: Three Rivers PPO |
$2,724.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,034.62
|
| Rate for Payer: United Healthcare Commercial |
$3,159.84
|
| Rate for Payer: United Healthcare Medicare |
$1,034.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,087.20
|
|
|
EXCISION AURAL POLYP
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
69540
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$726.18
|
| Rate for Payer: Aetna of WY Medicare |
$127.72
|
| Rate for Payer: Beech Street Commercial |
$703.95
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$718.77
|
| Rate for Payer: Cigna of WY Commercial |
$726.18
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$703.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.72
|
| Rate for Payer: HealthUtah PPO |
$741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$718.77
|
| Rate for Payer: Multiplan Medicare/VA |
$108.56
|
| Rate for Payer: One Health Plan of WY PPO |
$726.18
|
| Rate for Payer: PacificSource Commercial |
$666.90
|
| Rate for Payer: PHCS PPO |
$703.95
|
| Rate for Payer: Three Rivers PPO |
$555.75
|
| Rate for Payer: TriWest Veterans Administration |
$127.72
|
| Rate for Payer: United Healthcare Commercial |
$644.67
|
| Rate for Payer: United Healthcare Medicare |
$127.72
|
| Rate for Payer: WINHealth Partners Commercial |
$629.85
|
|
|
EXCISION BARTHOLINS GLAND OR CYST
|
Professional
|
Both
|
$1,096.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
56740
|
| Min. Negotiated Rate |
$258.94 |
| Max. Negotiated Rate |
$1,096.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,074.08
|
| Rate for Payer: Aetna of WY Medicare |
$304.63
|
| Rate for Payer: Beech Street Commercial |
$1,041.20
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,063.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,074.08
|
| Rate for Payer: First Choice Health Commercial |
$986.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,041.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.63
|
| Rate for Payer: HealthUtah PPO |
$1,096.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,063.12
|
| Rate for Payer: Multiplan Medicare/VA |
$258.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,074.08
|
| Rate for Payer: PacificSource Commercial |
$986.40
|
| Rate for Payer: PHCS PPO |
$1,041.20
|
| Rate for Payer: Three Rivers PPO |
$822.00
|
| Rate for Payer: TriWest Veterans Administration |
$304.63
|
| Rate for Payer: United Healthcare Commercial |
$953.52
|
| Rate for Payer: United Healthcare Medicare |
$304.63
|
| Rate for Payer: WINHealth Partners Commercial |
$931.60
|
|
|
EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 27635 80
|
| Hospital Charge Code |
27635
|
| Min. Negotiated Rate |
$479.82 |
| Max. Negotiated Rate |
$2,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,974.70
|
| Rate for Payer: Aetna of WY Medicare |
$564.49
|
| Rate for Payer: Beech Street Commercial |
$1,914.25
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,954.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,974.70
|
| Rate for Payer: First Choice Health Commercial |
$1,813.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,914.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.49
|
| Rate for Payer: HealthUtah PPO |
$2,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,954.55
|
| Rate for Payer: Multiplan Medicare/VA |
$479.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,974.70
|
| Rate for Payer: PacificSource Commercial |
$1,813.50
|
| Rate for Payer: PHCS PPO |
$1,914.25
|
| Rate for Payer: Three Rivers PPO |
$1,511.25
|
| Rate for Payer: TriWest Veterans Administration |
$564.49
|
| Rate for Payer: United Healthcare Commercial |
$1,753.05
|
| Rate for Payer: United Healthcare Medicare |
$564.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,712.75
|
|
|
EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA
|
Professional
|
Both
|
$2,015.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
27635
|
| Min. Negotiated Rate |
$479.82 |
| Max. Negotiated Rate |
$2,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,974.70
|
| Rate for Payer: Aetna of WY Medicare |
$564.49
|
| Rate for Payer: Beech Street Commercial |
$1,914.25
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: Cash Price |
$1,410.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,954.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,974.70
|
| Rate for Payer: First Choice Health Commercial |
$1,813.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,914.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.49
|
| Rate for Payer: HealthUtah PPO |
$2,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,954.55
|
| Rate for Payer: Multiplan Medicare/VA |
$479.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,974.70
|
| Rate for Payer: PacificSource Commercial |
$1,813.50
|
| Rate for Payer: PHCS PPO |
$1,914.25
|
| Rate for Payer: Three Rivers PPO |
$1,511.25
|
| Rate for Payer: TriWest Veterans Administration |
$564.49
|
| Rate for Payer: United Healthcare Commercial |
$1,753.05
|
| Rate for Payer: United Healthcare Medicare |
$564.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,712.75
|
|
|
EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 25130
|
| Hospital Charge Code |
25130
|
| Min. Negotiated Rate |
$378.62 |
| Max. Negotiated Rate |
$1,590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,558.20
|
| Rate for Payer: Aetna of WY Medicare |
$445.44
|
| Rate for Payer: Beech Street Commercial |
$1,510.50
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,542.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,558.20
|
| Rate for Payer: First Choice Health Commercial |
$1,431.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,510.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.44
|
| Rate for Payer: HealthUtah PPO |
$1,590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,542.30
|
| Rate for Payer: Multiplan Medicare/VA |
$378.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,558.20
|
| Rate for Payer: PacificSource Commercial |
$1,431.00
|
| Rate for Payer: PHCS PPO |
$1,510.50
|
| Rate for Payer: Three Rivers PPO |
$1,192.50
|
| Rate for Payer: TriWest Veterans Administration |
$445.44
|
| Rate for Payer: United Healthcare Commercial |
$1,383.30
|
| Rate for Payer: United Healthcare Medicare |
$445.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,351.50
|
|
|
EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$5,788.00
|
|
|
Service Code
|
HCPCS 27355 AS
|
| Hospital Charge Code |
27355
|
| Min. Negotiated Rate |
$504.38 |
| Max. Negotiated Rate |
$5,788.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,672.24
|
| Rate for Payer: Aetna of WY Medicare |
$593.39
|
| Rate for Payer: Beech Street Commercial |
$5,498.60
|
| Rate for Payer: Cash Price |
$4,051.60
|
| Rate for Payer: Cash Price |
$4,051.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,614.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,672.24
|
| Rate for Payer: First Choice Health Commercial |
$5,209.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,498.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.39
|
| Rate for Payer: HealthUtah PPO |
$5,788.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,614.36
|
| Rate for Payer: Multiplan Medicare/VA |
$504.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5,672.24
|
| Rate for Payer: PacificSource Commercial |
$5,209.20
|
| Rate for Payer: PHCS PPO |
$5,498.60
|
| Rate for Payer: Three Rivers PPO |
$4,341.00
|
| Rate for Payer: TriWest Veterans Administration |
$593.39
|
| Rate for Payer: United Healthcare Commercial |
$5,035.56
|
| Rate for Payer: United Healthcare Medicare |
$593.39
|
| Rate for Payer: WINHealth Partners Commercial |
$4,919.80
|
|
|
EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$5,788.00
|
|
|
Service Code
|
HCPCS 27355 80
|
| Hospital Charge Code |
27355
|
| Min. Negotiated Rate |
$504.38 |
| Max. Negotiated Rate |
$5,788.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,672.24
|
| Rate for Payer: Aetna of WY Medicare |
$593.39
|
| Rate for Payer: Beech Street Commercial |
$5,498.60
|
| Rate for Payer: Cash Price |
$4,051.60
|
| Rate for Payer: Cash Price |
$4,051.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,614.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,672.24
|
| Rate for Payer: First Choice Health Commercial |
$5,209.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,498.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.39
|
| Rate for Payer: HealthUtah PPO |
$5,788.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,614.36
|
| Rate for Payer: Multiplan Medicare/VA |
$504.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5,672.24
|
| Rate for Payer: PacificSource Commercial |
$5,209.20
|
| Rate for Payer: PHCS PPO |
$5,498.60
|
| Rate for Payer: Three Rivers PPO |
$4,341.00
|
| Rate for Payer: TriWest Veterans Administration |
$593.39
|
| Rate for Payer: United Healthcare Commercial |
$5,035.56
|
| Rate for Payer: United Healthcare Medicare |
$593.39
|
| Rate for Payer: WINHealth Partners Commercial |
$4,919.80
|
|
|
EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$5,788.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
27355
|
| Min. Negotiated Rate |
$504.38 |
| Max. Negotiated Rate |
$5,788.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,672.24
|
| Rate for Payer: Aetna of WY Medicare |
$593.39
|
| Rate for Payer: Beech Street Commercial |
$5,498.60
|
| Rate for Payer: Cash Price |
$4,051.60
|
| Rate for Payer: Cash Price |
$4,051.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,614.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,672.24
|
| Rate for Payer: First Choice Health Commercial |
$5,209.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,498.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.39
|
| Rate for Payer: HealthUtah PPO |
$5,788.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,614.36
|
| Rate for Payer: Multiplan Medicare/VA |
$504.38
|
| Rate for Payer: One Health Plan of WY PPO |
$5,672.24
|
| Rate for Payer: PacificSource Commercial |
$5,209.20
|
| Rate for Payer: PHCS PPO |
$5,498.60
|
| Rate for Payer: Three Rivers PPO |
$4,341.00
|
| Rate for Payer: TriWest Veterans Administration |
$593.39
|
| Rate for Payer: United Healthcare Commercial |
$5,035.56
|
| Rate for Payer: United Healthcare Medicare |
$593.39
|
| Rate for Payer: WINHealth Partners Commercial |
$4,919.80
|
|
|
EXCISION/CURETTAGE CYST/TUMOR METACARPAL
|
Professional
|
Both
|
$5,625.00
|
|
|
Service Code
|
HCPCS 26200
|
| Hospital Charge Code |
26200
|
| Min. Negotiated Rate |
$377.36 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,512.50
|
| Rate for Payer: Aetna of WY Medicare |
$443.95
|
| Rate for Payer: Beech Street Commercial |
$5,343.75
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,456.25
|
| Rate for Payer: Cigna of WY Commercial |
$5,512.50
|
| Rate for Payer: First Choice Health Commercial |
$5,062.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,343.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.95
|
| Rate for Payer: HealthUtah PPO |
$5,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,456.25
|
| Rate for Payer: Multiplan Medicare/VA |
$377.36
|
| Rate for Payer: One Health Plan of WY PPO |
$5,512.50
|
| Rate for Payer: PacificSource Commercial |
$5,062.50
|
| Rate for Payer: PHCS PPO |
$5,343.75
|
| Rate for Payer: Three Rivers PPO |
$4,218.75
|
| Rate for Payer: TriWest Veterans Administration |
$443.95
|
| Rate for Payer: United Healthcare Commercial |
$4,893.75
|
| Rate for Payer: United Healthcare Medicare |
$443.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4,781.25
|
|
|
EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER
|
Professional
|
Both
|
$5,068.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
26210
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$5,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,966.64
|
| Rate for Payer: Aetna of WY Medicare |
$442.58
|
| Rate for Payer: Beech Street Commercial |
$4,814.60
|
| Rate for Payer: Cash Price |
$3,547.60
|
| Rate for Payer: Cash Price |
$3,547.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,915.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,966.64
|
| Rate for Payer: First Choice Health Commercial |
$4,561.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,814.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$442.58
|
| Rate for Payer: HealthUtah PPO |
$5,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,915.96
|
| Rate for Payer: Multiplan Medicare/VA |
$376.19
|
| Rate for Payer: One Health Plan of WY PPO |
$4,966.64
|
| Rate for Payer: PacificSource Commercial |
$4,561.20
|
| Rate for Payer: PHCS PPO |
$4,814.60
|
| Rate for Payer: Three Rivers PPO |
$3,801.00
|
| Rate for Payer: TriWest Veterans Administration |
$442.58
|
| Rate for Payer: United Healthcare Commercial |
$4,409.16
|
| Rate for Payer: United Healthcare Medicare |
$442.58
|
| Rate for Payer: WINHealth Partners Commercial |
$4,307.80
|
|
|
EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA
|
Professional
|
Both
|
$1,762.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
25120
|
| Min. Negotiated Rate |
$419.55 |
| Max. Negotiated Rate |
$1,762.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,726.76
|
| Rate for Payer: Aetna of WY Medicare |
$493.59
|
| Rate for Payer: Beech Street Commercial |
$1,673.90
|
| Rate for Payer: Cash Price |
$1,233.40
|
| Rate for Payer: Cash Price |
$1,233.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,709.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,726.76
|
| Rate for Payer: First Choice Health Commercial |
$1,585.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,673.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$493.59
|
| Rate for Payer: HealthUtah PPO |
$1,762.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,709.14
|
| Rate for Payer: Multiplan Medicare/VA |
$419.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,726.76
|
| Rate for Payer: PacificSource Commercial |
$1,585.80
|
| Rate for Payer: PHCS PPO |
$1,673.90
|
| Rate for Payer: Three Rivers PPO |
$1,321.50
|
| Rate for Payer: TriWest Veterans Administration |
$493.59
|
| Rate for Payer: United Healthcare Commercial |
$1,532.94
|
| Rate for Payer: United Healthcare Medicare |
$493.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,497.70
|
|
|
EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA
|
Professional
|
Both
|
$1,762.00
|
|
|
Service Code
|
HCPCS 25120 AS
|
| Hospital Charge Code |
25120
|
| Min. Negotiated Rate |
$419.55 |
| Max. Negotiated Rate |
$1,762.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,726.76
|
| Rate for Payer: Aetna of WY Medicare |
$493.59
|
| Rate for Payer: Beech Street Commercial |
$1,673.90
|
| Rate for Payer: Cash Price |
$1,233.40
|
| Rate for Payer: Cash Price |
$1,233.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,709.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,726.76
|
| Rate for Payer: First Choice Health Commercial |
$1,585.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,673.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$493.59
|
| Rate for Payer: HealthUtah PPO |
$1,762.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,709.14
|
| Rate for Payer: Multiplan Medicare/VA |
$419.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,726.76
|
| Rate for Payer: PacificSource Commercial |
$1,585.80
|
| Rate for Payer: PHCS PPO |
$1,673.90
|
| Rate for Payer: Three Rivers PPO |
$1,321.50
|
| Rate for Payer: TriWest Veterans Administration |
$493.59
|
| Rate for Payer: United Healthcare Commercial |
$1,532.94
|
| Rate for Payer: United Healthcare Medicare |
$493.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,497.70
|
|
|
EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
28100
|
| Min. Negotiated Rate |
$346.68 |
| Max. Negotiated Rate |
$2,537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,486.26
|
| Rate for Payer: Aetna of WY Medicare |
$407.86
|
| Rate for Payer: Beech Street Commercial |
$2,410.15
|
| Rate for Payer: Cash Price |
$1,775.90
|
| Rate for Payer: Cash Price |
$1,775.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,460.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,486.26
|
| Rate for Payer: First Choice Health Commercial |
$2,283.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,410.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.86
|
| Rate for Payer: HealthUtah PPO |
$2,537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,460.89
|
| Rate for Payer: Multiplan Medicare/VA |
$346.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,486.26
|
| Rate for Payer: PacificSource Commercial |
$2,283.30
|
| Rate for Payer: PHCS PPO |
$2,410.15
|
| Rate for Payer: Three Rivers PPO |
$1,902.75
|
| Rate for Payer: TriWest Veterans Administration |
$407.86
|
| Rate for Payer: United Healthcare Commercial |
$2,207.19
|
| Rate for Payer: United Healthcare Medicare |
$407.86
|
| Rate for Payer: WINHealth Partners Commercial |
$2,156.45
|
|
|
EXCISION/DESTRUCTION INTRANASAL LESION INT APPR
|
Professional
|
Both
|
$3,456.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
30117
|
| Min. Negotiated Rate |
$343.84 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,386.88
|
| Rate for Payer: Aetna of WY Medicare |
$404.52
|
| Rate for Payer: Beech Street Commercial |
$3,283.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,352.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,386.88
|
| Rate for Payer: First Choice Health Commercial |
$3,110.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,283.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$404.52
|
| Rate for Payer: HealthUtah PPO |
$3,456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,352.32
|
| Rate for Payer: Multiplan Medicare/VA |
$343.84
|
| Rate for Payer: One Health Plan of WY PPO |
$3,386.88
|
| Rate for Payer: PacificSource Commercial |
$3,110.40
|
| Rate for Payer: PHCS PPO |
$3,283.20
|
| Rate for Payer: Three Rivers PPO |
$2,592.00
|
| Rate for Payer: TriWest Veterans Administration |
$404.52
|
| Rate for Payer: United Healthcare Commercial |
$3,006.72
|
| Rate for Payer: United Healthcare Medicare |
$404.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,937.60
|
|
|
EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$6,178.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
49203
|
| Min. Negotiated Rate |
$965.47 |
| Max. Negotiated Rate |
$6,178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,054.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.85
|
| Rate for Payer: Beech Street Commercial |
$5,869.10
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,992.66
|
| Rate for Payer: Cigna of WY Commercial |
$6,054.44
|
| Rate for Payer: First Choice Health Commercial |
$5,560.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,869.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.85
|
| Rate for Payer: HealthUtah PPO |
$6,178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,992.66
|
| Rate for Payer: Multiplan Medicare/VA |
$965.47
|
| Rate for Payer: One Health Plan of WY PPO |
$6,054.44
|
| Rate for Payer: PacificSource Commercial |
$5,560.20
|
| Rate for Payer: PHCS PPO |
$5,869.10
|
| Rate for Payer: Three Rivers PPO |
$4,633.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.85
|
| Rate for Payer: United Healthcare Commercial |
$5,374.86
|
| Rate for Payer: United Healthcare Medicare |
$1,135.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,251.30
|
|
|
EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$6,178.00
|
|
|
Service Code
|
HCPCS 49203 AS
|
| Hospital Charge Code |
49203
|
| Min. Negotiated Rate |
$965.47 |
| Max. Negotiated Rate |
$6,178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,054.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.85
|
| Rate for Payer: Beech Street Commercial |
$5,869.10
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,992.66
|
| Rate for Payer: Cigna of WY Commercial |
$6,054.44
|
| Rate for Payer: First Choice Health Commercial |
$5,560.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,869.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.85
|
| Rate for Payer: HealthUtah PPO |
$6,178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,992.66
|
| Rate for Payer: Multiplan Medicare/VA |
$965.47
|
| Rate for Payer: One Health Plan of WY PPO |
$6,054.44
|
| Rate for Payer: PacificSource Commercial |
$5,560.20
|
| Rate for Payer: PHCS PPO |
$5,869.10
|
| Rate for Payer: Three Rivers PPO |
$4,633.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.85
|
| Rate for Payer: United Healthcare Commercial |
$5,374.86
|
| Rate for Payer: United Healthcare Medicare |
$1,135.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,251.30
|
|
|
EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$6,178.00
|
|
|
Service Code
|
HCPCS 49203 80
|
| Hospital Charge Code |
49203
|
| Min. Negotiated Rate |
$965.47 |
| Max. Negotiated Rate |
$6,178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,054.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.85
|
| Rate for Payer: Beech Street Commercial |
$5,869.10
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,992.66
|
| Rate for Payer: Cigna of WY Commercial |
$6,054.44
|
| Rate for Payer: First Choice Health Commercial |
$5,560.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,869.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.85
|
| Rate for Payer: HealthUtah PPO |
$6,178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,992.66
|
| Rate for Payer: Multiplan Medicare/VA |
$965.47
|
| Rate for Payer: One Health Plan of WY PPO |
$6,054.44
|
| Rate for Payer: PacificSource Commercial |
$5,560.20
|
| Rate for Payer: PHCS PPO |
$5,869.10
|
| Rate for Payer: Three Rivers PPO |
$4,633.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.85
|
| Rate for Payer: United Healthcare Commercial |
$5,374.86
|
| Rate for Payer: United Healthcare Medicare |
$1,135.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,251.30
|
|
|
EXCISION DISTAL ULNA PARTIAL/COMPLETE
|
Professional
|
Both
|
$3,549.00
|
|
|
Service Code
|
HCPCS 25240
|
| Hospital Charge Code |
25240
|
| Min. Negotiated Rate |
$360.82 |
| Max. Negotiated Rate |
$3,549.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,478.02
|
| Rate for Payer: Aetna of WY Medicare |
$424.49
|
| Rate for Payer: Beech Street Commercial |
$3,371.55
|
| Rate for Payer: Cash Price |
$2,484.30
|
| Rate for Payer: Cash Price |
$2,484.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,442.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,478.02
|
| Rate for Payer: First Choice Health Commercial |
$3,194.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,371.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.49
|
| Rate for Payer: HealthUtah PPO |
$3,549.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,442.53
|
| Rate for Payer: Multiplan Medicare/VA |
$360.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3,478.02
|
| Rate for Payer: PacificSource Commercial |
$3,194.10
|
| Rate for Payer: PHCS PPO |
$3,371.55
|
| Rate for Payer: Three Rivers PPO |
$2,661.75
|
| Rate for Payer: TriWest Veterans Administration |
$424.49
|
| Rate for Payer: United Healthcare Commercial |
$3,087.63
|
| Rate for Payer: United Healthcare Medicare |
$424.49
|
| Rate for Payer: WINHealth Partners Commercial |
$3,016.65
|
|
