|
EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Professional
|
Both
|
$3,908.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
46220
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$3,908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,829.84
|
| Rate for Payer: Aetna of WY Medicare |
$117.93
|
| Rate for Payer: Beech Street Commercial |
$3,712.60
|
| Rate for Payer: Cash Price |
$2,735.60
|
| Rate for Payer: Cash Price |
$2,735.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,790.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,829.84
|
| Rate for Payer: First Choice Health Commercial |
$3,517.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,712.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.93
|
| Rate for Payer: HealthUtah PPO |
$3,908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,790.76
|
| Rate for Payer: Multiplan Medicare/VA |
$100.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3,829.84
|
| Rate for Payer: PacificSource Commercial |
$3,517.20
|
| Rate for Payer: PHCS PPO |
$3,712.60
|
| Rate for Payer: Three Rivers PPO |
$2,931.00
|
| Rate for Payer: TriWest Veterans Administration |
$117.93
|
| Rate for Payer: United Healthcare Commercial |
$3,399.96
|
| Rate for Payer: United Healthcare Medicare |
$117.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3,321.80
|
|
|
EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 69145
|
| Hospital Charge Code |
69145
|
| Min. Negotiated Rate |
$214.46 |
| Max. Negotiated Rate |
$1,282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,256.36
|
| Rate for Payer: Aetna of WY Medicare |
$252.31
|
| Rate for Payer: Beech Street Commercial |
$1,217.90
|
| Rate for Payer: Cash Price |
$897.40
|
| Rate for Payer: Cash Price |
$897.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,243.54
|
| Rate for Payer: Cigna of WY Commercial |
$1,256.36
|
| Rate for Payer: First Choice Health Commercial |
$1,153.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,217.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$252.31
|
| Rate for Payer: HealthUtah PPO |
$1,282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,243.54
|
| Rate for Payer: Multiplan Medicare/VA |
$214.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,256.36
|
| Rate for Payer: PacificSource Commercial |
$1,153.80
|
| Rate for Payer: PHCS PPO |
$1,217.90
|
| Rate for Payer: Three Rivers PPO |
$961.50
|
| Rate for Payer: TriWest Veterans Administration |
$252.31
|
| Rate for Payer: United Healthcare Commercial |
$1,115.34
|
| Rate for Payer: United Healthcare Medicare |
$252.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,089.70
|
|
|
EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Professional
|
Both
|
$6,311.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
54840
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$6,311.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,184.78
|
| Rate for Payer: Aetna of WY Medicare |
$312.15
|
| Rate for Payer: Beech Street Commercial |
$5,995.45
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,121.67
|
| Rate for Payer: Cigna of WY Commercial |
$6,184.78
|
| Rate for Payer: First Choice Health Commercial |
$5,679.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,995.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$312.15
|
| Rate for Payer: HealthUtah PPO |
$6,311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,121.67
|
| Rate for Payer: Multiplan Medicare/VA |
$265.33
|
| Rate for Payer: One Health Plan of WY PPO |
$6,184.78
|
| Rate for Payer: PacificSource Commercial |
$5,679.90
|
| Rate for Payer: PHCS PPO |
$5,995.45
|
| Rate for Payer: Three Rivers PPO |
$4,733.25
|
| Rate for Payer: TriWest Veterans Administration |
$312.15
|
| Rate for Payer: United Healthcare Commercial |
$5,490.57
|
| Rate for Payer: United Healthcare Medicare |
$312.15
|
| Rate for Payer: WINHealth Partners Commercial |
$5,364.35
|
|
|
EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
42440
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$1,445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,416.10
|
| Rate for Payer: Aetna of WY Medicare |
$405.04
|
| Rate for Payer: Beech Street Commercial |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,401.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,416.10
|
| Rate for Payer: First Choice Health Commercial |
$1,300.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,372.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.04
|
| Rate for Payer: HealthUtah PPO |
$1,445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,401.65
|
| Rate for Payer: Multiplan Medicare/VA |
$344.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,416.10
|
| Rate for Payer: PacificSource Commercial |
$1,300.50
|
| Rate for Payer: PHCS PPO |
$1,372.75
|
| Rate for Payer: Three Rivers PPO |
$1,083.75
|
| Rate for Payer: TriWest Veterans Administration |
$405.04
|
| Rate for Payer: United Healthcare Commercial |
$1,257.15
|
| Rate for Payer: United Healthcare Medicare |
$405.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,228.25
|
|
|
EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 42440 80
|
| Hospital Charge Code |
42440
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$1,445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,416.10
|
| Rate for Payer: Aetna of WY Medicare |
$405.04
|
| Rate for Payer: Beech Street Commercial |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,401.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,416.10
|
| Rate for Payer: First Choice Health Commercial |
$1,300.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,372.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.04
|
| Rate for Payer: HealthUtah PPO |
$1,445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,401.65
|
| Rate for Payer: Multiplan Medicare/VA |
$344.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,416.10
|
| Rate for Payer: PacificSource Commercial |
$1,300.50
|
| Rate for Payer: PHCS PPO |
$1,372.75
|
| Rate for Payer: Three Rivers PPO |
$1,083.75
|
| Rate for Payer: TriWest Veterans Administration |
$405.04
|
| Rate for Payer: United Healthcare Commercial |
$1,257.15
|
| Rate for Payer: United Healthcare Medicare |
$405.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,228.25
|
|
|
EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
30120
|
| Min. Negotiated Rate |
$347.17 |
| Max. Negotiated Rate |
$1,777.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,741.46
|
| Rate for Payer: Aetna of WY Medicare |
$408.44
|
| Rate for Payer: Beech Street Commercial |
$1,688.15
|
| Rate for Payer: Cash Price |
$1,243.90
|
| Rate for Payer: Cash Price |
$1,243.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,723.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,741.46
|
| Rate for Payer: First Choice Health Commercial |
$1,599.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,688.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.44
|
| Rate for Payer: HealthUtah PPO |
$1,777.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,723.69
|
| Rate for Payer: Multiplan Medicare/VA |
$347.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,741.46
|
| Rate for Payer: PacificSource Commercial |
$1,599.30
|
| Rate for Payer: PHCS PPO |
$1,688.15
|
| Rate for Payer: Three Rivers PPO |
$1,332.75
|
| Rate for Payer: TriWest Veterans Administration |
$408.44
|
| Rate for Payer: United Healthcare Commercial |
$1,545.99
|
| Rate for Payer: United Healthcare Medicare |
$408.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,510.45
|
|
|
EXCISION SYNOVIAL CYST POPLITEAL SPACE
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 27345 80
|
| Hospital Charge Code |
27345
|
| Min. Negotiated Rate |
$405.84 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,641.28
|
| Rate for Payer: Aetna of WY Medicare |
$477.46
|
| Rate for Payer: Beech Street Commercial |
$4,499.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,593.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,641.28
|
| Rate for Payer: First Choice Health Commercial |
$4,262.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,499.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.46
|
| Rate for Payer: HealthUtah PPO |
$4,736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,593.92
|
| Rate for Payer: Multiplan Medicare/VA |
$405.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,641.28
|
| Rate for Payer: PacificSource Commercial |
$4,262.40
|
| Rate for Payer: PHCS PPO |
$4,499.20
|
| Rate for Payer: Three Rivers PPO |
$3,552.00
|
| Rate for Payer: TriWest Veterans Administration |
$477.46
|
| Rate for Payer: United Healthcare Commercial |
$4,120.32
|
| Rate for Payer: United Healthcare Medicare |
$477.46
|
| Rate for Payer: WINHealth Partners Commercial |
$4,025.60
|
|
|
EXCISION SYNOVIAL CYST POPLITEAL SPACE
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 27345
|
| Hospital Charge Code |
27345
|
| Min. Negotiated Rate |
$405.84 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,641.28
|
| Rate for Payer: Aetna of WY Medicare |
$477.46
|
| Rate for Payer: Beech Street Commercial |
$4,499.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,593.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,641.28
|
| Rate for Payer: First Choice Health Commercial |
$4,262.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,499.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.46
|
| Rate for Payer: HealthUtah PPO |
$4,736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,593.92
|
| Rate for Payer: Multiplan Medicare/VA |
$405.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,641.28
|
| Rate for Payer: PacificSource Commercial |
$4,262.40
|
| Rate for Payer: PHCS PPO |
$4,499.20
|
| Rate for Payer: Three Rivers PPO |
$3,552.00
|
| Rate for Payer: TriWest Veterans Administration |
$477.46
|
| Rate for Payer: United Healthcare Commercial |
$4,120.32
|
| Rate for Payer: United Healthcare Medicare |
$477.46
|
| Rate for Payer: WINHealth Partners Commercial |
$4,025.60
|
|
|
EXCISION SYNOVIAL CYST POPLITEAL SPACE
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 27345 AS
|
| Hospital Charge Code |
27345
|
| Min. Negotiated Rate |
$405.84 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,641.28
|
| Rate for Payer: Aetna of WY Medicare |
$477.46
|
| Rate for Payer: Beech Street Commercial |
$4,499.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,593.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,641.28
|
| Rate for Payer: First Choice Health Commercial |
$4,262.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,499.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$477.46
|
| Rate for Payer: HealthUtah PPO |
$4,736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,593.92
|
| Rate for Payer: Multiplan Medicare/VA |
$405.84
|
| Rate for Payer: One Health Plan of WY PPO |
$4,641.28
|
| Rate for Payer: PacificSource Commercial |
$4,262.40
|
| Rate for Payer: PHCS PPO |
$4,499.20
|
| Rate for Payer: Three Rivers PPO |
$3,552.00
|
| Rate for Payer: TriWest Veterans Administration |
$477.46
|
| Rate for Payer: United Healthcare Commercial |
$4,120.32
|
| Rate for Payer: United Healthcare Medicare |
$477.46
|
| Rate for Payer: WINHealth Partners Commercial |
$4,025.60
|
|
|
EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 26180
|
| Hospital Charge Code |
26180
|
| Min. Negotiated Rate |
$377.87 |
| Max. Negotiated Rate |
$4,213.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,128.74
|
| Rate for Payer: Aetna of WY Medicare |
$444.55
|
| Rate for Payer: Beech Street Commercial |
$4,002.35
|
| Rate for Payer: Cash Price |
$2,949.10
|
| Rate for Payer: Cash Price |
$2,949.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,086.61
|
| Rate for Payer: Cigna of WY Commercial |
$4,128.74
|
| Rate for Payer: First Choice Health Commercial |
$3,791.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,002.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$444.55
|
| Rate for Payer: HealthUtah PPO |
$4,213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,086.61
|
| Rate for Payer: Multiplan Medicare/VA |
$377.87
|
| Rate for Payer: One Health Plan of WY PPO |
$4,128.74
|
| Rate for Payer: PacificSource Commercial |
$3,791.70
|
| Rate for Payer: PHCS PPO |
$4,002.35
|
| Rate for Payer: Three Rivers PPO |
$3,159.75
|
| Rate for Payer: TriWest Veterans Administration |
$444.55
|
| Rate for Payer: United Healthcare Commercial |
$3,665.31
|
| Rate for Payer: United Healthcare Medicare |
$444.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3,581.05
|
|
|
EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
26170
|
| Min. Negotiated Rate |
$342.89 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,369.06
|
| Rate for Payer: Aetna of WY Medicare |
$403.40
|
| Rate for Payer: Beech Street Commercial |
$1,327.15
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: Cash Price |
$977.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,355.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,369.06
|
| Rate for Payer: First Choice Health Commercial |
$1,257.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,327.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$403.40
|
| Rate for Payer: HealthUtah PPO |
$1,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,355.09
|
| Rate for Payer: Multiplan Medicare/VA |
$342.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,369.06
|
| Rate for Payer: PacificSource Commercial |
$1,257.30
|
| Rate for Payer: PHCS PPO |
$1,327.15
|
| Rate for Payer: Three Rivers PPO |
$1,047.75
|
| Rate for Payer: TriWest Veterans Administration |
$403.40
|
| Rate for Payer: United Healthcare Commercial |
$1,215.39
|
| Rate for Payer: United Healthcare Medicare |
$403.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,187.45
|
|
|
EXCISION TROCHANTERIC BURSA/CALCIFICATION
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 27062 AS
|
| Hospital Charge Code |
27062
|
| Min. Negotiated Rate |
$378.45 |
| Max. Negotiated Rate |
$1,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,557.22
|
| Rate for Payer: Aetna of WY Medicare |
$445.23
|
| Rate for Payer: Beech Street Commercial |
$1,509.55
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,541.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,557.22
|
| Rate for Payer: First Choice Health Commercial |
$1,430.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,509.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.23
|
| Rate for Payer: HealthUtah PPO |
$1,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,541.33
|
| Rate for Payer: Multiplan Medicare/VA |
$378.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,557.22
|
| Rate for Payer: PacificSource Commercial |
$1,430.10
|
| Rate for Payer: PHCS PPO |
$1,509.55
|
| Rate for Payer: Three Rivers PPO |
$1,191.75
|
| Rate for Payer: TriWest Veterans Administration |
$445.23
|
| Rate for Payer: United Healthcare Commercial |
$1,382.43
|
| Rate for Payer: United Healthcare Medicare |
$445.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,350.65
|
|
|
EXCISION TROCHANTERIC BURSA/CALCIFICATION
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
27062
|
| Min. Negotiated Rate |
$378.45 |
| Max. Negotiated Rate |
$1,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,557.22
|
| Rate for Payer: Aetna of WY Medicare |
$445.23
|
| Rate for Payer: Beech Street Commercial |
$1,509.55
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,541.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,557.22
|
| Rate for Payer: First Choice Health Commercial |
$1,430.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,509.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.23
|
| Rate for Payer: HealthUtah PPO |
$1,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,541.33
|
| Rate for Payer: Multiplan Medicare/VA |
$378.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,557.22
|
| Rate for Payer: PacificSource Commercial |
$1,430.10
|
| Rate for Payer: PHCS PPO |
$1,509.55
|
| Rate for Payer: Three Rivers PPO |
$1,191.75
|
| Rate for Payer: TriWest Veterans Administration |
$445.23
|
| Rate for Payer: United Healthcare Commercial |
$1,382.43
|
| Rate for Payer: United Healthcare Medicare |
$445.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,350.65
|
|
|
EXCISION TROCHANTERIC BURSA/CALCIFICATION
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 27062 80
|
| Hospital Charge Code |
27062
|
| Min. Negotiated Rate |
$378.45 |
| Max. Negotiated Rate |
$1,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,557.22
|
| Rate for Payer: Aetna of WY Medicare |
$445.23
|
| Rate for Payer: Beech Street Commercial |
$1,509.55
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,541.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,557.22
|
| Rate for Payer: First Choice Health Commercial |
$1,430.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,509.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.23
|
| Rate for Payer: HealthUtah PPO |
$1,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,541.33
|
| Rate for Payer: Multiplan Medicare/VA |
$378.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,557.22
|
| Rate for Payer: PacificSource Commercial |
$1,430.10
|
| Rate for Payer: PHCS PPO |
$1,509.55
|
| Rate for Payer: Three Rivers PPO |
$1,191.75
|
| Rate for Payer: TriWest Veterans Administration |
$445.23
|
| Rate for Payer: United Healthcare Commercial |
$1,382.43
|
| Rate for Payer: United Healthcare Medicare |
$445.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,350.65
|
|
|
EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 21931
|
| Hospital Charge Code |
21931
|
| Min. Negotiated Rate |
$384.42 |
| Max. Negotiated Rate |
$2,428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,379.44
|
| Rate for Payer: Aetna of WY Medicare |
$452.26
|
| Rate for Payer: Beech Street Commercial |
$2,306.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,355.16
|
| Rate for Payer: Cigna of WY Commercial |
$2,379.44
|
| Rate for Payer: First Choice Health Commercial |
$2,185.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,306.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.26
|
| Rate for Payer: HealthUtah PPO |
$2,428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,355.16
|
| Rate for Payer: Multiplan Medicare/VA |
$384.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,379.44
|
| Rate for Payer: PacificSource Commercial |
$2,185.20
|
| Rate for Payer: PHCS PPO |
$2,306.60
|
| Rate for Payer: Three Rivers PPO |
$1,821.00
|
| Rate for Payer: TriWest Veterans Administration |
$452.26
|
| Rate for Payer: United Healthcare Commercial |
$2,112.36
|
| Rate for Payer: United Healthcare Medicare |
$452.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2,063.80
|
|
|
EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>
|
Professional
|
Both
|
$3,569.00
|
|
|
Service Code
|
HCPCS 28039 50
|
| Hospital Charge Code |
28039
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$3,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,497.62
|
| Rate for Payer: Aetna of WY Medicare |
$329.76
|
| Rate for Payer: Beech Street Commercial |
$3,390.55
|
| Rate for Payer: Cash Price |
$2,498.30
|
| Rate for Payer: Cash Price |
$2,498.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,461.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,497.62
|
| Rate for Payer: First Choice Health Commercial |
$3,212.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,390.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.76
|
| Rate for Payer: HealthUtah PPO |
$3,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,461.93
|
| Rate for Payer: Multiplan Medicare/VA |
$280.30
|
| Rate for Payer: One Health Plan of WY PPO |
$3,497.62
|
| Rate for Payer: PacificSource Commercial |
$3,212.10
|
| Rate for Payer: PHCS PPO |
$3,390.55
|
| Rate for Payer: Three Rivers PPO |
$2,676.75
|
| Rate for Payer: TriWest Veterans Administration |
$329.76
|
| Rate for Payer: United Healthcare Commercial |
$3,105.03
|
| Rate for Payer: United Healthcare Medicare |
$329.76
|
| Rate for Payer: WINHealth Partners Commercial |
$3,033.65
|
|
|
EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>
|
Professional
|
Both
|
$1,784.00
|
|
|
Service Code
|
HCPCS 28039
|
| Hospital Charge Code |
28039
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$1,784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,748.32
|
| Rate for Payer: Aetna of WY Medicare |
$329.76
|
| Rate for Payer: Beech Street Commercial |
$1,694.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,730.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,748.32
|
| Rate for Payer: First Choice Health Commercial |
$1,605.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,694.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.76
|
| Rate for Payer: HealthUtah PPO |
$1,784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,730.48
|
| Rate for Payer: Multiplan Medicare/VA |
$280.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,748.32
|
| Rate for Payer: PacificSource Commercial |
$1,605.60
|
| Rate for Payer: PHCS PPO |
$1,694.80
|
| Rate for Payer: Three Rivers PPO |
$1,338.00
|
| Rate for Payer: TriWest Veterans Administration |
$329.76
|
| Rate for Payer: United Healthcare Commercial |
$1,552.08
|
| Rate for Payer: United Healthcare Medicare |
$329.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,516.40
|
|
|
EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>
|
Professional
|
Both
|
$1,784.00
|
|
|
Service Code
|
HCPCS 28039 80
|
| Hospital Charge Code |
28039
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$1,784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,748.32
|
| Rate for Payer: Aetna of WY Medicare |
$329.76
|
| Rate for Payer: Beech Street Commercial |
$1,694.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,730.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,748.32
|
| Rate for Payer: First Choice Health Commercial |
$1,605.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,694.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.76
|
| Rate for Payer: HealthUtah PPO |
$1,784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,730.48
|
| Rate for Payer: Multiplan Medicare/VA |
$280.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,748.32
|
| Rate for Payer: PacificSource Commercial |
$1,605.60
|
| Rate for Payer: PHCS PPO |
$1,694.80
|
| Rate for Payer: Three Rivers PPO |
$1,338.00
|
| Rate for Payer: TriWest Veterans Administration |
$329.76
|
| Rate for Payer: United Healthcare Commercial |
$1,552.08
|
| Rate for Payer: United Healthcare Medicare |
$329.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,516.40
|
|
|
EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>
|
Professional
|
Both
|
$1,784.00
|
|
|
Service Code
|
HCPCS 28039 AS
|
| Hospital Charge Code |
28039
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$1,784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,748.32
|
| Rate for Payer: Aetna of WY Medicare |
$329.76
|
| Rate for Payer: Beech Street Commercial |
$1,694.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,730.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,748.32
|
| Rate for Payer: First Choice Health Commercial |
$1,605.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,694.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.76
|
| Rate for Payer: HealthUtah PPO |
$1,784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,730.48
|
| Rate for Payer: Multiplan Medicare/VA |
$280.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,748.32
|
| Rate for Payer: PacificSource Commercial |
$1,605.60
|
| Rate for Payer: PHCS PPO |
$1,694.80
|
| Rate for Payer: Three Rivers PPO |
$1,338.00
|
| Rate for Payer: TriWest Veterans Administration |
$329.76
|
| Rate for Payer: United Healthcare Commercial |
$1,552.08
|
| Rate for Payer: United Healthcare Medicare |
$329.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,516.40
|
|
|
EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>
|
Professional
|
Both
|
$3,480.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
21012
|
| Min. Negotiated Rate |
$279.79 |
| Max. Negotiated Rate |
$3,480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,410.40
|
| Rate for Payer: Aetna of WY Medicare |
$329.16
|
| Rate for Payer: Beech Street Commercial |
$3,306.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,375.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,410.40
|
| Rate for Payer: First Choice Health Commercial |
$3,132.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,306.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.16
|
| Rate for Payer: HealthUtah PPO |
$3,480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,375.60
|
| Rate for Payer: Multiplan Medicare/VA |
$279.79
|
| Rate for Payer: One Health Plan of WY PPO |
$3,410.40
|
| Rate for Payer: PacificSource Commercial |
$3,132.00
|
| Rate for Payer: PHCS PPO |
$3,306.00
|
| Rate for Payer: Three Rivers PPO |
$2,610.00
|
| Rate for Payer: TriWest Veterans Administration |
$329.16
|
| Rate for Payer: United Healthcare Commercial |
$3,027.60
|
| Rate for Payer: United Healthcare Medicare |
$329.16
|
| Rate for Payer: WINHealth Partners Commercial |
$2,958.00
|
|
|
EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
21011
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$1,322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,295.56
|
| Rate for Payer: Aetna of WY Medicare |
$254.65
|
| Rate for Payer: Beech Street Commercial |
$1,255.90
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,282.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,295.56
|
| Rate for Payer: First Choice Health Commercial |
$1,189.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,255.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.65
|
| Rate for Payer: HealthUtah PPO |
$1,322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,282.34
|
| Rate for Payer: Multiplan Medicare/VA |
$216.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,295.56
|
| Rate for Payer: PacificSource Commercial |
$1,189.80
|
| Rate for Payer: PHCS PPO |
$1,255.90
|
| Rate for Payer: Three Rivers PPO |
$991.50
|
| Rate for Payer: TriWest Veterans Administration |
$254.65
|
| Rate for Payer: United Healthcare Commercial |
$1,150.14
|
| Rate for Payer: United Healthcare Medicare |
$254.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,123.70
|
|
|
EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM
|
Professional
|
Both
|
$1,871.00
|
|
|
Service Code
|
HCPCS 21930
|
| Hospital Charge Code |
21930
|
| Min. Negotiated Rate |
$301.10 |
| Max. Negotiated Rate |
$1,871.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,833.58
|
| Rate for Payer: Aetna of WY Medicare |
$354.23
|
| Rate for Payer: Beech Street Commercial |
$1,777.45
|
| Rate for Payer: Cash Price |
$1,309.70
|
| Rate for Payer: Cash Price |
$1,309.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,814.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,833.58
|
| Rate for Payer: First Choice Health Commercial |
$1,683.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,777.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$354.23
|
| Rate for Payer: HealthUtah PPO |
$1,871.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,814.87
|
| Rate for Payer: Multiplan Medicare/VA |
$301.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,833.58
|
| Rate for Payer: PacificSource Commercial |
$1,683.90
|
| Rate for Payer: PHCS PPO |
$1,777.45
|
| Rate for Payer: Three Rivers PPO |
$1,403.25
|
| Rate for Payer: TriWest Veterans Administration |
$354.23
|
| Rate for Payer: United Healthcare Commercial |
$1,627.77
|
| Rate for Payer: United Healthcare Medicare |
$354.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,590.35
|
|
|
EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>
|
Professional
|
Both
|
$7,926.00
|
|
|
Service Code
|
HCPCS 27632
|
| Hospital Charge Code |
27632
|
| Min. Negotiated Rate |
$335.91 |
| Max. Negotiated Rate |
$7,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,767.48
|
| Rate for Payer: Aetna of WY Medicare |
$395.19
|
| Rate for Payer: Beech Street Commercial |
$7,529.70
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,688.22
|
| Rate for Payer: Cigna of WY Commercial |
$7,767.48
|
| Rate for Payer: First Choice Health Commercial |
$7,133.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,529.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$395.19
|
| Rate for Payer: HealthUtah PPO |
$7,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,688.22
|
| Rate for Payer: Multiplan Medicare/VA |
$335.91
|
| Rate for Payer: One Health Plan of WY PPO |
$7,767.48
|
| Rate for Payer: PacificSource Commercial |
$7,133.40
|
| Rate for Payer: PHCS PPO |
$7,529.70
|
| Rate for Payer: Three Rivers PPO |
$5,944.50
|
| Rate for Payer: TriWest Veterans Administration |
$395.19
|
| Rate for Payer: United Healthcare Commercial |
$6,895.62
|
| Rate for Payer: United Healthcare Medicare |
$395.19
|
| Rate for Payer: WINHealth Partners Commercial |
$6,737.10
|
|
|
EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>
|
Professional
|
Both
|
$4,145.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
27043
|
| Min. Negotiated Rate |
$384.07 |
| Max. Negotiated Rate |
$4,145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,062.10
|
| Rate for Payer: Aetna of WY Medicare |
$451.85
|
| Rate for Payer: Beech Street Commercial |
$3,937.75
|
| Rate for Payer: Cash Price |
$2,901.50
|
| Rate for Payer: Cash Price |
$2,901.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,020.65
|
| Rate for Payer: Cigna of WY Commercial |
$4,062.10
|
| Rate for Payer: First Choice Health Commercial |
$3,730.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,937.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$451.85
|
| Rate for Payer: HealthUtah PPO |
$4,145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,020.65
|
| Rate for Payer: Multiplan Medicare/VA |
$384.07
|
| Rate for Payer: One Health Plan of WY PPO |
$4,062.10
|
| Rate for Payer: PacificSource Commercial |
$3,730.50
|
| Rate for Payer: PHCS PPO |
$3,937.75
|
| Rate for Payer: Three Rivers PPO |
$3,108.75
|
| Rate for Payer: TriWest Veterans Administration |
$451.85
|
| Rate for Payer: United Healthcare Commercial |
$3,606.15
|
| Rate for Payer: United Healthcare Medicare |
$451.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,523.25
|
|
|
EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
23071
|
| Min. Negotiated Rate |
$345.12 |
| Max. Negotiated Rate |
$2,153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,109.94
|
| Rate for Payer: Aetna of WY Medicare |
$406.02
|
| Rate for Payer: Beech Street Commercial |
$2,045.35
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,088.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,109.94
|
| Rate for Payer: First Choice Health Commercial |
$1,937.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,045.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.02
|
| Rate for Payer: HealthUtah PPO |
$2,153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,088.41
|
| Rate for Payer: Multiplan Medicare/VA |
$345.12
|
| Rate for Payer: One Health Plan of WY PPO |
$2,109.94
|
| Rate for Payer: PacificSource Commercial |
$1,937.70
|
| Rate for Payer: PHCS PPO |
$2,045.35
|
| Rate for Payer: Three Rivers PPO |
$1,614.75
|
| Rate for Payer: TriWest Veterans Administration |
$406.02
|
| Rate for Payer: United Healthcare Commercial |
$1,873.11
|
| Rate for Payer: United Healthcare Medicare |
$406.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,830.05
|
|
