|
EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
69140
|
| Min. Negotiated Rate |
$748.54 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,263.00
|
| Rate for Payer: Aetna of WY Medicare |
$880.63
|
| Rate for Payer: Beech Street Commercial |
$4,132.50
|
| Rate for Payer: Cash Price |
$3,045.00
|
| Rate for Payer: Cash Price |
$3,045.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,219.50
|
| Rate for Payer: Cigna of WY Commercial |
$4,263.00
|
| Rate for Payer: First Choice Health Commercial |
$3,915.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,132.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$880.63
|
| Rate for Payer: HealthUtah PPO |
$4,350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,219.50
|
| Rate for Payer: Multiplan Medicare/VA |
$748.54
|
| Rate for Payer: One Health Plan of WY PPO |
$4,263.00
|
| Rate for Payer: PacificSource Commercial |
$3,915.00
|
| Rate for Payer: PHCS PPO |
$4,132.50
|
| Rate for Payer: Three Rivers PPO |
$3,262.50
|
| Rate for Payer: TriWest Veterans Administration |
$880.63
|
| Rate for Payer: United Healthcare Commercial |
$3,784.50
|
| Rate for Payer: United Healthcare Medicare |
$880.63
|
| Rate for Payer: WINHealth Partners Commercial |
$3,697.50
|
|
|
EXCISION EXTERNAL EAR COMPLETE AMPUTATION
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 69120
|
| Hospital Charge Code |
69120
|
| Min. Negotiated Rate |
$321.71 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,967.84
|
| Rate for Payer: Aetna of WY Medicare |
$378.48
|
| Rate for Payer: Beech Street Commercial |
$1,907.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,947.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,967.84
|
| Rate for Payer: First Choice Health Commercial |
$1,807.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,907.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.48
|
| Rate for Payer: HealthUtah PPO |
$2,008.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,947.76
|
| Rate for Payer: Multiplan Medicare/VA |
$321.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1,967.84
|
| Rate for Payer: PacificSource Commercial |
$1,807.20
|
| Rate for Payer: PHCS PPO |
$1,907.60
|
| Rate for Payer: Three Rivers PPO |
$1,506.00
|
| Rate for Payer: TriWest Veterans Administration |
$378.48
|
| Rate for Payer: United Healthcare Commercial |
$1,746.96
|
| Rate for Payer: United Healthcare Medicare |
$378.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,706.80
|
|
|
EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
69110
|
| Min. Negotiated Rate |
$272.04 |
| Max. Negotiated Rate |
$1,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,634.64
|
| Rate for Payer: Aetna of WY Medicare |
$320.05
|
| Rate for Payer: Beech Street Commercial |
$1,584.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,617.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,634.64
|
| Rate for Payer: First Choice Health Commercial |
$1,501.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,584.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.05
|
| Rate for Payer: HealthUtah PPO |
$1,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,617.96
|
| Rate for Payer: Multiplan Medicare/VA |
$272.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,634.64
|
| Rate for Payer: PacificSource Commercial |
$1,501.20
|
| Rate for Payer: PHCS PPO |
$1,584.60
|
| Rate for Payer: Three Rivers PPO |
$1,251.00
|
| Rate for Payer: TriWest Veterans Administration |
$320.05
|
| Rate for Payer: United Healthcare Commercial |
$1,451.16
|
| Rate for Payer: United Healthcare Medicare |
$320.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,417.80
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
25111
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$1,659.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,625.82
|
| Rate for Payer: Aetna of WY Medicare |
$322.94
|
| Rate for Payer: Beech Street Commercial |
$1,576.05
|
| Rate for Payer: Cash Price |
$1,161.30
|
| Rate for Payer: Cash Price |
$1,161.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,609.23
|
| Rate for Payer: Cigna of WY Commercial |
$1,625.82
|
| Rate for Payer: First Choice Health Commercial |
$1,493.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,576.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$322.94
|
| Rate for Payer: HealthUtah PPO |
$1,659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,609.23
|
| Rate for Payer: Multiplan Medicare/VA |
$274.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,625.82
|
| Rate for Payer: PacificSource Commercial |
$1,493.10
|
| Rate for Payer: PHCS PPO |
$1,576.05
|
| Rate for Payer: Three Rivers PPO |
$1,244.25
|
| Rate for Payer: TriWest Veterans Administration |
$322.94
|
| Rate for Payer: United Healthcare Commercial |
$1,443.33
|
| Rate for Payer: United Healthcare Medicare |
$322.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1,410.15
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT
|
Professional
|
Both
|
$1,381.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
25112
|
| Min. Negotiated Rate |
$328.57 |
| Max. Negotiated Rate |
$1,381.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,353.38
|
| Rate for Payer: Aetna of WY Medicare |
$386.55
|
| Rate for Payer: Beech Street Commercial |
$1,311.95
|
| Rate for Payer: Cash Price |
$966.70
|
| Rate for Payer: Cash Price |
$966.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,339.57
|
| Rate for Payer: Cigna of WY Commercial |
$1,353.38
|
| Rate for Payer: First Choice Health Commercial |
$1,242.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,311.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$386.55
|
| Rate for Payer: HealthUtah PPO |
$1,381.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,339.57
|
| Rate for Payer: Multiplan Medicare/VA |
$328.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,353.38
|
| Rate for Payer: PacificSource Commercial |
$1,242.90
|
| Rate for Payer: PHCS PPO |
$1,311.95
|
| Rate for Payer: Three Rivers PPO |
$1,035.75
|
| Rate for Payer: TriWest Veterans Administration |
$386.55
|
| Rate for Payer: United Healthcare Commercial |
$1,201.47
|
| Rate for Payer: United Healthcare Medicare |
$386.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,173.85
|
|
|
EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
Both
|
$1,279.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
11450
|
| Min. Negotiated Rate |
$215.61 |
| Max. Negotiated Rate |
$1,279.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,253.42
|
| Rate for Payer: Aetna of WY Medicare |
$253.66
|
| Rate for Payer: Beech Street Commercial |
$1,215.05
|
| Rate for Payer: Cash Price |
$895.30
|
| Rate for Payer: Cash Price |
$895.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,240.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,253.42
|
| Rate for Payer: First Choice Health Commercial |
$1,151.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,215.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.66
|
| Rate for Payer: HealthUtah PPO |
$1,279.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,240.63
|
| Rate for Payer: Multiplan Medicare/VA |
$215.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,253.42
|
| Rate for Payer: PacificSource Commercial |
$1,151.10
|
| Rate for Payer: PHCS PPO |
$1,215.05
|
| Rate for Payer: Three Rivers PPO |
$959.25
|
| Rate for Payer: TriWest Veterans Administration |
$253.66
|
| Rate for Payer: United Healthcare Commercial |
$1,112.73
|
| Rate for Payer: United Healthcare Medicare |
$253.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,087.15
|
|
|
EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
11470
|
| Min. Negotiated Rate |
$235.92 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,381.80
|
| Rate for Payer: Aetna of WY Medicare |
$277.55
|
| Rate for Payer: Beech Street Commercial |
$1,339.50
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,367.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,381.80
|
| Rate for Payer: First Choice Health Commercial |
$1,269.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,339.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.55
|
| Rate for Payer: HealthUtah PPO |
$1,410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,367.70
|
| Rate for Payer: Multiplan Medicare/VA |
$235.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,381.80
|
| Rate for Payer: PacificSource Commercial |
$1,269.00
|
| Rate for Payer: PHCS PPO |
$1,339.50
|
| Rate for Payer: Three Rivers PPO |
$1,057.50
|
| Rate for Payer: TriWest Veterans Administration |
$277.55
|
| Rate for Payer: United Healthcare Commercial |
$1,226.70
|
| Rate for Payer: United Healthcare Medicare |
$277.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,198.50
|
|
|
EXCISION HYDROCELE UNILATERAL
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
55040
|
| Min. Negotiated Rate |
$279.09 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,600.34
|
| Rate for Payer: Aetna of WY Medicare |
$328.34
|
| Rate for Payer: Beech Street Commercial |
$1,551.35
|
| Rate for Payer: Cash Price |
$1,143.10
|
| Rate for Payer: Cash Price |
$1,143.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,584.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,600.34
|
| Rate for Payer: First Choice Health Commercial |
$1,469.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,551.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.34
|
| Rate for Payer: HealthUtah PPO |
$1,633.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,584.01
|
| Rate for Payer: Multiplan Medicare/VA |
$279.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,600.34
|
| Rate for Payer: PacificSource Commercial |
$1,469.70
|
| Rate for Payer: PHCS PPO |
$1,551.35
|
| Rate for Payer: Three Rivers PPO |
$1,224.75
|
| Rate for Payer: TriWest Veterans Administration |
$328.34
|
| Rate for Payer: United Healthcare Commercial |
$1,420.71
|
| Rate for Payer: United Healthcare Medicare |
$328.34
|
| Rate for Payer: WINHealth Partners Commercial |
$1,388.05
|
|
|
EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$1,458.00
|
|
|
Service Code
|
HCPCS 30130
|
| Hospital Charge Code |
30130
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,428.84
|
| Rate for Payer: Aetna of WY Medicare |
$408.39
|
| Rate for Payer: Beech Street Commercial |
$1,385.10
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,414.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,428.84
|
| Rate for Payer: First Choice Health Commercial |
$1,312.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,385.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.39
|
| Rate for Payer: HealthUtah PPO |
$1,458.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,414.26
|
| Rate for Payer: Multiplan Medicare/VA |
$347.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,428.84
|
| Rate for Payer: PacificSource Commercial |
$1,312.20
|
| Rate for Payer: PHCS PPO |
$1,385.10
|
| Rate for Payer: Three Rivers PPO |
$1,093.50
|
| Rate for Payer: TriWest Veterans Administration |
$408.39
|
| Rate for Payer: United Healthcare Commercial |
$1,268.46
|
| Rate for Payer: United Healthcare Medicare |
$408.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,239.30
|
|
|
EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
HCPCS 30130 50
|
| Hospital Charge Code |
30130
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$2,916.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,857.68
|
| Rate for Payer: Aetna of WY Medicare |
$408.39
|
| Rate for Payer: Beech Street Commercial |
$2,770.20
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,828.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,857.68
|
| Rate for Payer: First Choice Health Commercial |
$2,624.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,770.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.39
|
| Rate for Payer: HealthUtah PPO |
$2,916.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,828.52
|
| Rate for Payer: Multiplan Medicare/VA |
$347.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,857.68
|
| Rate for Payer: PacificSource Commercial |
$2,624.40
|
| Rate for Payer: PHCS PPO |
$2,770.20
|
| Rate for Payer: Three Rivers PPO |
$2,187.00
|
| Rate for Payer: TriWest Veterans Administration |
$408.39
|
| Rate for Payer: United Healthcare Commercial |
$2,536.92
|
| Rate for Payer: United Healthcare Medicare |
$408.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,478.60
|
|
|
EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
28080
|
| Min. Negotiated Rate |
$316.09 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,872.78
|
| Rate for Payer: Aetna of WY Medicare |
$371.87
|
| Rate for Payer: Beech Street Commercial |
$1,815.45
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,853.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,872.78
|
| Rate for Payer: First Choice Health Commercial |
$1,719.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,815.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.87
|
| Rate for Payer: HealthUtah PPO |
$1,911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,853.67
|
| Rate for Payer: Multiplan Medicare/VA |
$316.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,872.78
|
| Rate for Payer: PacificSource Commercial |
$1,719.90
|
| Rate for Payer: PHCS PPO |
$1,815.45
|
| Rate for Payer: Three Rivers PPO |
$1,433.25
|
| Rate for Payer: TriWest Veterans Administration |
$371.87
|
| Rate for Payer: United Healthcare Commercial |
$1,662.57
|
| Rate for Payer: United Healthcare Medicare |
$371.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.35
|
|
|
EXCISION LESION CONJUNCTIVA <1 CM
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 68110
|
| Hospital Charge Code |
68110
|
| Min. Negotiated Rate |
$903.00 |
| Max. Negotiated Rate |
$1,204.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,179.92
|
| Rate for Payer: Beech Street Commercial |
$1,143.80
|
| Rate for Payer: Cash Price |
$842.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,167.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,179.92
|
| Rate for Payer: First Choice Health Commercial |
$1,083.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,143.80
|
| Rate for Payer: HealthUtah PPO |
$1,204.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,167.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,179.92
|
| Rate for Payer: PacificSource Commercial |
$1,083.60
|
| Rate for Payer: PHCS PPO |
$1,143.80
|
| Rate for Payer: Three Rivers PPO |
$903.00
|
| Rate for Payer: United Healthcare Commercial |
$1,047.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,023.40
|
|
|
EXCISION LESION MENISCUS/CAPSULE KNEE
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 27347 AS
|
| Hospital Charge Code |
27347
|
| Min. Negotiated Rate |
$439.48 |
| Max. Negotiated Rate |
$2,162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,118.76
|
| Rate for Payer: Aetna of WY Medicare |
$517.04
|
| Rate for Payer: Beech Street Commercial |
$2,053.90
|
| Rate for Payer: Cash Price |
$1,513.40
|
| Rate for Payer: Cash Price |
$1,513.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,097.14
|
| Rate for Payer: Cigna of WY Commercial |
$2,118.76
|
| Rate for Payer: First Choice Health Commercial |
$1,945.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,053.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.04
|
| Rate for Payer: HealthUtah PPO |
$2,162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,097.14
|
| Rate for Payer: Multiplan Medicare/VA |
$439.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,118.76
|
| Rate for Payer: PacificSource Commercial |
$1,945.80
|
| Rate for Payer: PHCS PPO |
$2,053.90
|
| Rate for Payer: Three Rivers PPO |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration |
$517.04
|
| Rate for Payer: United Healthcare Commercial |
$1,880.94
|
| Rate for Payer: United Healthcare Medicare |
$517.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,837.70
|
|
|
EXCISION LESION MENISCUS/CAPSULE KNEE
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
27347
|
| Min. Negotiated Rate |
$439.48 |
| Max. Negotiated Rate |
$2,162.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,118.76
|
| Rate for Payer: Aetna of WY Medicare |
$517.04
|
| Rate for Payer: Beech Street Commercial |
$2,053.90
|
| Rate for Payer: Cash Price |
$1,513.40
|
| Rate for Payer: Cash Price |
$1,513.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,097.14
|
| Rate for Payer: Cigna of WY Commercial |
$2,118.76
|
| Rate for Payer: First Choice Health Commercial |
$1,945.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,053.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.04
|
| Rate for Payer: HealthUtah PPO |
$2,162.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,097.14
|
| Rate for Payer: Multiplan Medicare/VA |
$439.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,118.76
|
| Rate for Payer: PacificSource Commercial |
$1,945.80
|
| Rate for Payer: PHCS PPO |
$2,053.90
|
| Rate for Payer: Three Rivers PPO |
$1,621.50
|
| Rate for Payer: TriWest Veterans Administration |
$517.04
|
| Rate for Payer: United Healthcare Commercial |
$1,880.94
|
| Rate for Payer: United Healthcare Medicare |
$517.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,837.70
|
|
|
EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
27630
|
| Min. Negotiated Rate |
$297.66 |
| Max. Negotiated Rate |
$1,858.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,820.84
|
| Rate for Payer: Aetna of WY Medicare |
$350.19
|
| Rate for Payer: Beech Street Commercial |
$1,765.10
|
| Rate for Payer: Cash Price |
$1,300.60
|
| Rate for Payer: Cash Price |
$1,300.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,802.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,820.84
|
| Rate for Payer: First Choice Health Commercial |
$1,672.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,765.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.19
|
| Rate for Payer: HealthUtah PPO |
$1,858.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,802.26
|
| Rate for Payer: Multiplan Medicare/VA |
$297.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,820.84
|
| Rate for Payer: PacificSource Commercial |
$1,672.20
|
| Rate for Payer: PHCS PPO |
$1,765.10
|
| Rate for Payer: Three Rivers PPO |
$1,393.50
|
| Rate for Payer: TriWest Veterans Administration |
$350.19
|
| Rate for Payer: United Healthcare Commercial |
$1,616.46
|
| Rate for Payer: United Healthcare Medicare |
$350.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1,579.30
|
|
|
EXCISION LESION TENDON SHEATH FOREARM&/WRIST
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
25110
|
| Min. Negotiated Rate |
$291.10 |
| Max. Negotiated Rate |
$1,223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,198.54
|
| Rate for Payer: Aetna of WY Medicare |
$342.47
|
| Rate for Payer: Beech Street Commercial |
$1,161.85
|
| Rate for Payer: Cash Price |
$856.10
|
| Rate for Payer: Cash Price |
$856.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,186.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,198.54
|
| Rate for Payer: First Choice Health Commercial |
$1,100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,161.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$342.47
|
| Rate for Payer: HealthUtah PPO |
$1,223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,186.31
|
| Rate for Payer: Multiplan Medicare/VA |
$291.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,198.54
|
| Rate for Payer: PacificSource Commercial |
$1,100.70
|
| Rate for Payer: PHCS PPO |
$1,161.85
|
| Rate for Payer: Three Rivers PPO |
$917.25
|
| Rate for Payer: TriWest Veterans Administration |
$342.47
|
| Rate for Payer: United Healthcare Commercial |
$1,064.01
|
| Rate for Payer: United Healthcare Medicare |
$342.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,039.55
|
|
|
EXCISION LESION TONGUE W/O CLOSURE
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 41110
|
| Hospital Charge Code |
41110
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$787.92
|
| Rate for Payer: Aetna of WY Medicare |
$126.80
|
| Rate for Payer: Beech Street Commercial |
$763.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$779.88
|
| Rate for Payer: Cigna of WY Commercial |
$787.92
|
| Rate for Payer: First Choice Health Commercial |
$723.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$763.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.80
|
| Rate for Payer: HealthUtah PPO |
$804.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$779.88
|
| Rate for Payer: Multiplan Medicare/VA |
$107.78
|
| Rate for Payer: One Health Plan of WY PPO |
$787.92
|
| Rate for Payer: PacificSource Commercial |
$723.60
|
| Rate for Payer: PHCS PPO |
$763.80
|
| Rate for Payer: Three Rivers PPO |
$603.00
|
| Rate for Payer: TriWest Veterans Administration |
$126.80
|
| Rate for Payer: United Healthcare Commercial |
$699.48
|
| Rate for Payer: United Healthcare Medicare |
$126.80
|
| Rate for Payer: WINHealth Partners Commercial |
$683.40
|
|
|
EXCISION LINGUAL FRENUM FRENECTOMY
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
41115
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$894.74
|
| Rate for Payer: Aetna of WY Medicare |
$142.59
|
| Rate for Payer: Beech Street Commercial |
$867.35
|
| Rate for Payer: Cash Price |
$639.10
|
| Rate for Payer: Cash Price |
$639.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$885.61
|
| Rate for Payer: Cigna of WY Commercial |
$894.74
|
| Rate for Payer: First Choice Health Commercial |
$821.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$867.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.59
|
| Rate for Payer: HealthUtah PPO |
$913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$885.61
|
| Rate for Payer: Multiplan Medicare/VA |
$121.20
|
| Rate for Payer: One Health Plan of WY PPO |
$894.74
|
| Rate for Payer: PacificSource Commercial |
$821.70
|
| Rate for Payer: PHCS PPO |
$867.35
|
| Rate for Payer: Three Rivers PPO |
$684.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.59
|
| Rate for Payer: United Healthcare Commercial |
$794.31
|
| Rate for Payer: United Healthcare Medicare |
$142.59
|
| Rate for Payer: WINHealth Partners Commercial |
$776.05
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
11640
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$615.44
|
| Rate for Payer: Aetna of WY Medicare |
$122.96
|
| Rate for Payer: Beech Street Commercial |
$596.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.16
|
| Rate for Payer: Cigna of WY Commercial |
$615.44
|
| Rate for Payer: First Choice Health Commercial |
$565.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$596.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.96
|
| Rate for Payer: HealthUtah PPO |
$628.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.16
|
| Rate for Payer: Multiplan Medicare/VA |
$104.52
|
| Rate for Payer: One Health Plan of WY PPO |
$615.44
|
| Rate for Payer: PacificSource Commercial |
$565.20
|
| Rate for Payer: PHCS PPO |
$596.60
|
| Rate for Payer: Three Rivers PPO |
$471.00
|
| Rate for Payer: TriWest Veterans Administration |
$122.96
|
| Rate for Payer: United Healthcare Commercial |
$546.36
|
| Rate for Payer: United Healthcare Medicare |
$122.96
|
| Rate for Payer: WINHealth Partners Commercial |
$533.80
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
11641
|
| Min. Negotiated Rate |
$127.74 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$762.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.28
|
| 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 |
$150.28
|
| Rate for Payer: HealthUtah PPO |
$778.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$754.66
|
| Rate for Payer: Multiplan Medicare/VA |
$127.74
|
| 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 |
$150.28
|
| Rate for Payer: United Healthcare Commercial |
$676.86
|
| Rate for Payer: United Healthcare Medicare |
$150.28
|
| Rate for Payer: WINHealth Partners Commercial |
$661.30
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 11642
|
| Hospital Charge Code |
11642
|
| Min. Negotiated Rate |
$149.22 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$890.82
|
| Rate for Payer: Aetna of WY Medicare |
$175.55
|
| Rate for Payer: Beech Street Commercial |
$863.55
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$881.73
|
| Rate for Payer: Cigna of WY Commercial |
$890.82
|
| Rate for Payer: First Choice Health Commercial |
$818.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$863.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.55
|
| Rate for Payer: HealthUtah PPO |
$909.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$881.73
|
| Rate for Payer: Multiplan Medicare/VA |
$149.22
|
| Rate for Payer: One Health Plan of WY PPO |
$890.82
|
| Rate for Payer: PacificSource Commercial |
$818.10
|
| Rate for Payer: PHCS PPO |
$863.55
|
| Rate for Payer: Three Rivers PPO |
$681.75
|
| Rate for Payer: TriWest Veterans Administration |
$175.55
|
| Rate for Payer: United Healthcare Commercial |
$790.83
|
| Rate for Payer: United Healthcare Medicare |
$175.55
|
| Rate for Payer: WINHealth Partners Commercial |
$772.65
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
11643
|
| Min. Negotiated Rate |
$185.64 |
| Max. Negotiated Rate |
$1,141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,118.18
|
| Rate for Payer: Aetna of WY Medicare |
$218.40
|
| Rate for Payer: Beech Street Commercial |
$1,083.95
|
| Rate for Payer: Cash Price |
$798.70
|
| Rate for Payer: Cash Price |
$798.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,106.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,118.18
|
| Rate for Payer: First Choice Health Commercial |
$1,026.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.40
|
| Rate for Payer: HealthUtah PPO |
$1,141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,106.77
|
| Rate for Payer: Multiplan Medicare/VA |
$185.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,118.18
|
| Rate for Payer: PacificSource Commercial |
$1,026.90
|
| Rate for Payer: PHCS PPO |
$1,083.95
|
| Rate for Payer: Three Rivers PPO |
$855.75
|
| Rate for Payer: TriWest Veterans Administration |
$218.40
|
| Rate for Payer: United Healthcare Commercial |
$992.67
|
| Rate for Payer: United Healthcare Medicare |
$218.40
|
| Rate for Payer: WINHealth Partners Commercial |
$969.85
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
11644
|
| Min. Negotiated Rate |
$229.57 |
| Max. Negotiated Rate |
$1,417.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,388.66
|
| Rate for Payer: Aetna of WY Medicare |
$270.08
|
| Rate for Payer: Beech Street Commercial |
$1,346.15
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,374.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,388.66
|
| Rate for Payer: First Choice Health Commercial |
$1,275.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,346.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.08
|
| Rate for Payer: HealthUtah PPO |
$1,417.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,374.49
|
| Rate for Payer: Multiplan Medicare/VA |
$229.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,388.66
|
| Rate for Payer: PacificSource Commercial |
$1,275.30
|
| Rate for Payer: PHCS PPO |
$1,346.15
|
| Rate for Payer: Three Rivers PPO |
$1,062.75
|
| Rate for Payer: TriWest Veterans Administration |
$270.08
|
| Rate for Payer: United Healthcare Commercial |
$1,232.79
|
| Rate for Payer: United Healthcare Medicare |
$270.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,204.45
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$2,399.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
11646
|
| Min. Negotiated Rate |
$315.94 |
| Max. Negotiated Rate |
$2,399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,351.02
|
| Rate for Payer: Aetna of WY Medicare |
$371.70
|
| Rate for Payer: Beech Street Commercial |
$2,279.05
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,327.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,351.02
|
| Rate for Payer: First Choice Health Commercial |
$2,159.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,279.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.70
|
| Rate for Payer: HealthUtah PPO |
$2,399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,327.03
|
| Rate for Payer: Multiplan Medicare/VA |
$315.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,351.02
|
| Rate for Payer: PacificSource Commercial |
$2,159.10
|
| Rate for Payer: PHCS PPO |
$2,279.05
|
| Rate for Payer: Three Rivers PPO |
$1,799.25
|
| Rate for Payer: TriWest Veterans Administration |
$371.70
|
| Rate for Payer: United Healthcare Commercial |
$2,087.13
|
| Rate for Payer: United Healthcare Medicare |
$371.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,039.15
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
11620
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$599.76
|
| Rate for Payer: Aetna of WY Medicare |
$119.52
|
| Rate for Payer: Beech Street Commercial |
$581.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$593.64
|
| Rate for Payer: Cigna of WY Commercial |
$599.76
|
| Rate for Payer: First Choice Health Commercial |
$550.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.52
|
| Rate for Payer: HealthUtah PPO |
$612.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$593.64
|
| Rate for Payer: Multiplan Medicare/VA |
$101.59
|
| Rate for Payer: One Health Plan of WY PPO |
$599.76
|
| Rate for Payer: PacificSource Commercial |
$550.80
|
| Rate for Payer: PHCS PPO |
$581.40
|
| Rate for Payer: Three Rivers PPO |
$459.00
|
| Rate for Payer: TriWest Veterans Administration |
$119.52
|
| Rate for Payer: United Healthcare Commercial |
$532.44
|
| Rate for Payer: United Healthcare Medicare |
$119.52
|
| Rate for Payer: WINHealth Partners Commercial |
$520.20
|
|
