|
EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
23075
|
| Min. Negotiated Rate |
$272.82 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,641.50
|
| Rate for Payer: Aetna of WY Medicare |
$320.97
|
| Rate for Payer: Beech Street Commercial |
$1,591.25
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,624.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,641.50
|
| Rate for Payer: First Choice Health Commercial |
$1,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,591.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.97
|
| Rate for Payer: HealthUtah PPO |
$1,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,624.75
|
| Rate for Payer: Multiplan Medicare/VA |
$272.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,641.50
|
| Rate for Payer: PacificSource Commercial |
$1,507.50
|
| Rate for Payer: PHCS PPO |
$1,591.25
|
| Rate for Payer: Three Rivers PPO |
$1,256.25
|
| Rate for Payer: TriWest Veterans Administration |
$320.97
|
| Rate for Payer: United Healthcare Commercial |
$1,457.25
|
| Rate for Payer: United Healthcare Medicare |
$320.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,423.75
|
|
|
EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM
|
Professional
|
Both
|
$3,482.00
|
|
|
Service Code
|
HCPCS 27327 50
|
| Hospital Charge Code |
27327
|
| Min. Negotiated Rate |
$261.43 |
| Max. Negotiated Rate |
$3,482.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,412.36
|
| Rate for Payer: Aetna of WY Medicare |
$307.56
|
| Rate for Payer: Beech Street Commercial |
$3,307.90
|
| Rate for Payer: Cash Price |
$2,437.40
|
| Rate for Payer: Cash Price |
$2,437.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,377.54
|
| Rate for Payer: Cigna of WY Commercial |
$3,412.36
|
| Rate for Payer: First Choice Health Commercial |
$3,133.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,307.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.56
|
| Rate for Payer: HealthUtah PPO |
$3,482.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,377.54
|
| Rate for Payer: Multiplan Medicare/VA |
$261.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,412.36
|
| Rate for Payer: PacificSource Commercial |
$3,133.80
|
| Rate for Payer: PHCS PPO |
$3,307.90
|
| Rate for Payer: Three Rivers PPO |
$2,611.50
|
| Rate for Payer: TriWest Veterans Administration |
$307.56
|
| Rate for Payer: United Healthcare Commercial |
$3,029.34
|
| Rate for Payer: United Healthcare Medicare |
$307.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,959.70
|
|
|
EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM
|
Professional
|
Both
|
$1,741.00
|
|
|
Service Code
|
HCPCS 27327
|
| Hospital Charge Code |
27327
|
| Min. Negotiated Rate |
$261.43 |
| Max. Negotiated Rate |
$1,741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,706.18
|
| Rate for Payer: Aetna of WY Medicare |
$307.56
|
| Rate for Payer: Beech Street Commercial |
$1,653.95
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: Cash Price |
$1,218.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,688.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,706.18
|
| Rate for Payer: First Choice Health Commercial |
$1,566.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,653.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$307.56
|
| Rate for Payer: HealthUtah PPO |
$1,741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,688.77
|
| Rate for Payer: Multiplan Medicare/VA |
$261.43
|
| Rate for Payer: One Health Plan of WY PPO |
$1,706.18
|
| Rate for Payer: PacificSource Commercial |
$1,566.90
|
| Rate for Payer: PHCS PPO |
$1,653.95
|
| Rate for Payer: Three Rivers PPO |
$1,305.75
|
| Rate for Payer: TriWest Veterans Administration |
$307.56
|
| Rate for Payer: United Healthcare Commercial |
$1,514.67
|
| Rate for Payer: United Healthcare Medicare |
$307.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,479.85
|
|
|
EXCISION VAGINAL CYST/TUMOR
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
57135
|
| Min. Negotiated Rate |
$155.17 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,164.24
|
| Rate for Payer: Aetna of WY Medicare |
$182.55
|
| Rate for Payer: Beech Street Commercial |
$1,128.60
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,152.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,164.24
|
| Rate for Payer: First Choice Health Commercial |
$1,069.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,128.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.55
|
| Rate for Payer: HealthUtah PPO |
$1,188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,152.36
|
| Rate for Payer: Multiplan Medicare/VA |
$155.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,164.24
|
| Rate for Payer: PacificSource Commercial |
$1,069.20
|
| Rate for Payer: PHCS PPO |
$1,128.60
|
| Rate for Payer: Three Rivers PPO |
$891.00
|
| Rate for Payer: TriWest Veterans Administration |
$182.55
|
| Rate for Payer: United Healthcare Commercial |
$1,033.56
|
| Rate for Payer: United Healthcare Medicare |
$182.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,009.80
|
|
|
EXCISION VAGINAL SEPTUM
|
Professional
|
Both
|
$4,015.00
|
|
|
Service Code
|
HCPCS 57130
|
| Hospital Charge Code |
57130
|
| Min. Negotiated Rate |
$142.87 |
| Max. Negotiated Rate |
$4,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,934.70
|
| Rate for Payer: Aetna of WY Medicare |
$168.08
|
| Rate for Payer: Beech Street Commercial |
$3,814.25
|
| Rate for Payer: Cash Price |
$2,810.50
|
| Rate for Payer: Cash Price |
$2,810.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,894.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,934.70
|
| Rate for Payer: First Choice Health Commercial |
$3,613.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,814.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.08
|
| Rate for Payer: HealthUtah PPO |
$4,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,894.55
|
| Rate for Payer: Multiplan Medicare/VA |
$142.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3,934.70
|
| Rate for Payer: PacificSource Commercial |
$3,613.50
|
| Rate for Payer: PHCS PPO |
$3,814.25
|
| Rate for Payer: Three Rivers PPO |
$3,011.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.08
|
| Rate for Payer: United Healthcare Commercial |
$3,493.05
|
| Rate for Payer: United Healthcare Medicare |
$168.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,412.75
|
|
|
EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>
|
Professional
|
Both
|
$2,987.00
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
27337
|
| Min. Negotiated Rate |
$344.56 |
| Max. Negotiated Rate |
$2,987.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,927.26
|
| Rate for Payer: Aetna of WY Medicare |
$405.37
|
| Rate for Payer: Beech Street Commercial |
$2,837.65
|
| Rate for Payer: Cash Price |
$2,090.90
|
| Rate for Payer: Cash Price |
$2,090.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,897.39
|
| Rate for Payer: Cigna of WY Commercial |
$2,927.26
|
| Rate for Payer: First Choice Health Commercial |
$2,688.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,837.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.37
|
| Rate for Payer: HealthUtah PPO |
$2,987.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,897.39
|
| Rate for Payer: Multiplan Medicare/VA |
$344.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,927.26
|
| Rate for Payer: PacificSource Commercial |
$2,688.30
|
| Rate for Payer: PHCS PPO |
$2,837.65
|
| Rate for Payer: Three Rivers PPO |
$2,240.25
|
| Rate for Payer: TriWest Veterans Administration |
$405.37
|
| Rate for Payer: United Healthcare Commercial |
$2,598.69
|
| Rate for Payer: United Healthcare Medicare |
$405.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,538.95
|
|
|
EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
67840
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$1,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.98
|
| Rate for Payer: Aetna of WY Medicare |
$151.46
|
| Rate for Payer: Beech Street Commercial |
$1,378.45
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: Cash Price |
$1,015.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.47
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.98
|
| Rate for Payer: First Choice Health Commercial |
$1,305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.46
|
| Rate for Payer: HealthUtah PPO |
$1,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.47
|
| Rate for Payer: Multiplan Medicare/VA |
$128.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.98
|
| Rate for Payer: PacificSource Commercial |
$1,305.90
|
| Rate for Payer: PHCS PPO |
$1,378.45
|
| Rate for Payer: Three Rivers PPO |
$1,088.25
|
| Rate for Payer: TriWest Veterans Administration |
$151.46
|
| Rate for Payer: United Healthcare Commercial |
$1,262.37
|
| Rate for Payer: United Healthcare Medicare |
$151.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,233.35
|
|
|
EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$1,921.00
|
|
|
Service Code
|
HCPCS 40814
|
| Hospital Charge Code |
40814
|
| Min. Negotiated Rate |
$234.23 |
| Max. Negotiated Rate |
$1,921.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,882.58
|
| Rate for Payer: Aetna of WY Medicare |
$275.56
|
| Rate for Payer: Beech Street Commercial |
$1,824.95
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: Cash Price |
$1,344.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,863.37
|
| Rate for Payer: Cigna of WY Commercial |
$1,882.58
|
| Rate for Payer: First Choice Health Commercial |
$1,728.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,824.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.56
|
| Rate for Payer: HealthUtah PPO |
$1,921.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,863.37
|
| Rate for Payer: Multiplan Medicare/VA |
$234.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,882.58
|
| Rate for Payer: PacificSource Commercial |
$1,728.90
|
| Rate for Payer: PHCS PPO |
$1,824.95
|
| Rate for Payer: Three Rivers PPO |
$1,440.75
|
| Rate for Payer: TriWest Veterans Administration |
$275.56
|
| Rate for Payer: United Healthcare Commercial |
$1,671.27
|
| Rate for Payer: United Healthcare Medicare |
$275.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,632.85
|
|
|
EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 40812
|
| Hospital Charge Code |
40812
|
| Min. Negotiated Rate |
$150.64 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$960.40
|
| Rate for Payer: Aetna of WY Medicare |
$177.22
|
| Rate for Payer: Beech Street Commercial |
$931.00
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$950.60
|
| Rate for Payer: Cigna of WY Commercial |
$960.40
|
| Rate for Payer: First Choice Health Commercial |
$882.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$931.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.22
|
| Rate for Payer: HealthUtah PPO |
$980.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$950.60
|
| Rate for Payer: Multiplan Medicare/VA |
$150.64
|
| Rate for Payer: One Health Plan of WY PPO |
$960.40
|
| Rate for Payer: PacificSource Commercial |
$882.00
|
| Rate for Payer: PHCS PPO |
$931.00
|
| Rate for Payer: Three Rivers PPO |
$735.00
|
| Rate for Payer: TriWest Veterans Administration |
$177.22
|
| Rate for Payer: United Healthcare Commercial |
$852.60
|
| Rate for Payer: United Healthcare Medicare |
$177.22
|
| Rate for Payer: WINHealth Partners Commercial |
$833.00
|
|
|
EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
42104
|
| Min. Negotiated Rate |
$111.89 |
| Max. Negotiated Rate |
$1,117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,094.66
|
| Rate for Payer: Aetna of WY Medicare |
$131.63
|
| Rate for Payer: Beech Street Commercial |
$1,061.15
|
| Rate for Payer: Cash Price |
$781.90
|
| Rate for Payer: Cash Price |
$781.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,083.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,094.66
|
| Rate for Payer: First Choice Health Commercial |
$1,005.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,061.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.63
|
| Rate for Payer: HealthUtah PPO |
$1,117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,083.49
|
| Rate for Payer: Multiplan Medicare/VA |
$111.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,094.66
|
| Rate for Payer: PacificSource Commercial |
$1,005.30
|
| Rate for Payer: PHCS PPO |
$1,061.15
|
| Rate for Payer: Three Rivers PPO |
$837.75
|
| Rate for Payer: TriWest Veterans Administration |
$131.63
|
| Rate for Payer: United Healthcare Commercial |
$971.79
|
| Rate for Payer: United Healthcare Medicare |
$131.63
|
| Rate for Payer: WINHealth Partners Commercial |
$949.45
|
|
|
EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 55520 AS
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$374.54 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,540.56
|
| Rate for Payer: Aetna of WY Medicare |
$440.64
|
| Rate for Payer: Beech Street Commercial |
$1,493.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,524.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,540.56
|
| Rate for Payer: First Choice Health Commercial |
$1,414.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,493.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.64
|
| Rate for Payer: HealthUtah PPO |
$1,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,524.84
|
| Rate for Payer: Multiplan Medicare/VA |
$374.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,540.56
|
| Rate for Payer: PacificSource Commercial |
$1,414.80
|
| Rate for Payer: PHCS PPO |
$1,493.40
|
| Rate for Payer: Three Rivers PPO |
$1,179.00
|
| Rate for Payer: TriWest Veterans Administration |
$440.64
|
| Rate for Payer: United Healthcare Commercial |
$1,367.64
|
| Rate for Payer: United Healthcare Medicare |
$440.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,336.20
|
|
|
EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 55520 80
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$374.54 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,540.56
|
| Rate for Payer: Aetna of WY Medicare |
$440.64
|
| Rate for Payer: Beech Street Commercial |
$1,493.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,524.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,540.56
|
| Rate for Payer: First Choice Health Commercial |
$1,414.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,493.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.64
|
| Rate for Payer: HealthUtah PPO |
$1,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,524.84
|
| Rate for Payer: Multiplan Medicare/VA |
$374.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,540.56
|
| Rate for Payer: PacificSource Commercial |
$1,414.80
|
| Rate for Payer: PHCS PPO |
$1,493.40
|
| Rate for Payer: Three Rivers PPO |
$1,179.00
|
| Rate for Payer: TriWest Veterans Administration |
$440.64
|
| Rate for Payer: United Healthcare Commercial |
$1,367.64
|
| Rate for Payer: United Healthcare Medicare |
$440.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,336.20
|
|
|
EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$374.54 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,540.56
|
| Rate for Payer: Aetna of WY Medicare |
$440.64
|
| Rate for Payer: Beech Street Commercial |
$1,493.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,524.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,540.56
|
| Rate for Payer: First Choice Health Commercial |
$1,414.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,493.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.64
|
| Rate for Payer: HealthUtah PPO |
$1,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,524.84
|
| Rate for Payer: Multiplan Medicare/VA |
$374.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,540.56
|
| Rate for Payer: PacificSource Commercial |
$1,414.80
|
| Rate for Payer: PHCS PPO |
$1,493.40
|
| Rate for Payer: Three Rivers PPO |
$1,179.00
|
| Rate for Payer: TriWest Veterans Administration |
$440.64
|
| Rate for Payer: United Healthcare Commercial |
$1,367.64
|
| Rate for Payer: United Healthcare Medicare |
$440.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,336.20
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$266.15 |
| Max. Negotiated Rate |
$2,396.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,348.08
|
| Rate for Payer: Aetna of WY Medicare |
$313.12
|
| Rate for Payer: Beech Street Commercial |
$2,276.20
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,324.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,348.08
|
| Rate for Payer: First Choice Health Commercial |
$2,156.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,276.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.12
|
| Rate for Payer: HealthUtah PPO |
$2,396.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,324.12
|
| Rate for Payer: Multiplan Medicare/VA |
$266.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,348.08
|
| Rate for Payer: PacificSource Commercial |
$2,156.40
|
| Rate for Payer: PHCS PPO |
$2,276.20
|
| Rate for Payer: Three Rivers PPO |
$1,797.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.12
|
| Rate for Payer: United Healthcare Commercial |
$2,084.52
|
| Rate for Payer: United Healthcare Medicare |
$313.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,036.60
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 26160 80
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$266.15 |
| Max. Negotiated Rate |
$2,396.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,348.08
|
| Rate for Payer: Aetna of WY Medicare |
$313.12
|
| Rate for Payer: Beech Street Commercial |
$2,276.20
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,324.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,348.08
|
| Rate for Payer: First Choice Health Commercial |
$2,156.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,276.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.12
|
| Rate for Payer: HealthUtah PPO |
$2,396.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,324.12
|
| Rate for Payer: Multiplan Medicare/VA |
$266.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,348.08
|
| Rate for Payer: PacificSource Commercial |
$2,156.40
|
| Rate for Payer: PHCS PPO |
$2,276.20
|
| Rate for Payer: Three Rivers PPO |
$1,797.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.12
|
| Rate for Payer: United Healthcare Commercial |
$2,084.52
|
| Rate for Payer: United Healthcare Medicare |
$313.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,036.60
|
|
|
EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$1,622.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$257.10 |
| Max. Negotiated Rate |
$1,622.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,589.56
|
| Rate for Payer: Aetna of WY Medicare |
$302.47
|
| Rate for Payer: Beech Street Commercial |
$1,540.90
|
| Rate for Payer: Cash Price |
$1,135.40
|
| Rate for Payer: Cash Price |
$1,135.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,573.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,589.56
|
| Rate for Payer: First Choice Health Commercial |
$1,459.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,540.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.47
|
| Rate for Payer: HealthUtah PPO |
$1,622.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,573.34
|
| Rate for Payer: Multiplan Medicare/VA |
$257.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,589.56
|
| Rate for Payer: PacificSource Commercial |
$1,459.80
|
| Rate for Payer: PHCS PPO |
$1,540.90
|
| Rate for Payer: Three Rivers PPO |
$1,216.50
|
| Rate for Payer: TriWest Veterans Administration |
$302.47
|
| Rate for Payer: United Healthcare Commercial |
$1,411.14
|
| Rate for Payer: United Healthcare Medicare |
$302.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,378.70
|
|
|
EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$1,622.00
|
|
|
Service Code
|
HCPCS 28090 80
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$257.10 |
| Max. Negotiated Rate |
$1,622.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,589.56
|
| Rate for Payer: Aetna of WY Medicare |
$302.47
|
| Rate for Payer: Beech Street Commercial |
$1,540.90
|
| Rate for Payer: Cash Price |
$1,135.40
|
| Rate for Payer: Cash Price |
$1,135.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,573.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,589.56
|
| Rate for Payer: First Choice Health Commercial |
$1,459.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,540.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.47
|
| Rate for Payer: HealthUtah PPO |
$1,622.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,573.34
|
| Rate for Payer: Multiplan Medicare/VA |
$257.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,589.56
|
| Rate for Payer: PacificSource Commercial |
$1,459.80
|
| Rate for Payer: PHCS PPO |
$1,540.90
|
| Rate for Payer: Three Rivers PPO |
$1,216.50
|
| Rate for Payer: TriWest Veterans Administration |
$302.47
|
| Rate for Payer: United Healthcare Commercial |
$1,411.14
|
| Rate for Payer: United Healthcare Medicare |
$302.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,378.70
|
|
|
EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
28092
|
| Min. Negotiated Rate |
$227.62 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.56
|
| Rate for Payer: Aetna of WY Medicare |
$267.79
|
| Rate for Payer: Beech Street Commercial |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.56
|
| Rate for Payer: First Choice Health Commercial |
$1,324.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.79
|
| Rate for Payer: HealthUtah PPO |
$1,472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Medicare/VA |
$227.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.56
|
| Rate for Payer: PacificSource Commercial |
$1,324.80
|
| Rate for Payer: PHCS PPO |
$1,398.40
|
| Rate for Payer: Three Rivers PPO |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration |
$267.79
|
| Rate for Payer: United Healthcare Commercial |
$1,280.64
|
| Rate for Payer: United Healthcare Medicare |
$267.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,251.20
|
|
|
EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 40810
|
| Hospital Charge Code |
40810
|
| Min. Negotiated Rate |
$101.74 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Aetna of WY Medicare |
$119.70
|
| Rate for Payer: Beech Street Commercial |
$604.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: First Choice Health Commercial |
$572.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.70
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$101.74
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$604.20
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$553.32
|
| Rate for Payer: United Healthcare Medicare |
$119.70
|
| Rate for Payer: WINHealth Partners Commercial |
$540.60
|
|
|
EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$630.78 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,003.12
|
| Rate for Payer: Aetna of WY Medicare |
$742.09
|
| Rate for Payer: Beech Street Commercial |
$1,941.80
|
| Rate for Payer: Cash Price |
$1,430.80
|
| Rate for Payer: Cash Price |
$1,430.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,982.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,003.12
|
| Rate for Payer: First Choice Health Commercial |
$1,839.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,941.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$742.09
|
| Rate for Payer: HealthUtah PPO |
$2,044.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,982.68
|
| Rate for Payer: Multiplan Medicare/VA |
$630.78
|
| Rate for Payer: One Health Plan of WY PPO |
$2,003.12
|
| Rate for Payer: PacificSource Commercial |
$1,839.60
|
| Rate for Payer: PHCS PPO |
$1,941.80
|
| Rate for Payer: Three Rivers PPO |
$1,533.00
|
| Rate for Payer: TriWest Veterans Administration |
$742.09
|
| Rate for Payer: United Healthcare Commercial |
$1,778.28
|
| Rate for Payer: United Healthcare Medicare |
$742.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,737.40
|
|
|
EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$4,216.00
|
|
|
Service Code
|
HCPCS 64790
|
| Hospital Charge Code |
64790
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$4,216.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,131.68
|
| Rate for Payer: Aetna of WY Medicare |
$816.57
|
| Rate for Payer: Beech Street Commercial |
$4,005.20
|
| Rate for Payer: Cash Price |
$2,951.20
|
| Rate for Payer: Cash Price |
$2,951.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,089.52
|
| Rate for Payer: Cigna of WY Commercial |
$4,131.68
|
| Rate for Payer: First Choice Health Commercial |
$3,794.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,005.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$816.57
|
| Rate for Payer: HealthUtah PPO |
$4,216.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,089.52
|
| Rate for Payer: Multiplan Medicare/VA |
$694.08
|
| Rate for Payer: One Health Plan of WY PPO |
$4,131.68
|
| Rate for Payer: PacificSource Commercial |
$3,794.40
|
| Rate for Payer: PHCS PPO |
$4,005.20
|
| Rate for Payer: Three Rivers PPO |
$3,162.00
|
| Rate for Payer: TriWest Veterans Administration |
$816.57
|
| Rate for Payer: United Healthcare Commercial |
$3,667.92
|
| Rate for Payer: United Healthcare Medicare |
$816.57
|
| Rate for Payer: WINHealth Partners Commercial |
$3,583.60
|
|
|
EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 64774 80
|
| Hospital Charge Code |
64774
|
| Min. Negotiated Rate |
$353.68 |
| Max. Negotiated Rate |
$2,114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,071.72
|
| Rate for Payer: Aetna of WY Medicare |
$416.09
|
| Rate for Payer: Beech Street Commercial |
$2,008.30
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,050.58
|
| Rate for Payer: Cigna of WY Commercial |
$2,071.72
|
| Rate for Payer: First Choice Health Commercial |
$1,902.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,008.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.09
|
| Rate for Payer: HealthUtah PPO |
$2,114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,050.58
|
| Rate for Payer: Multiplan Medicare/VA |
$353.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,071.72
|
| Rate for Payer: PacificSource Commercial |
$1,902.60
|
| Rate for Payer: PHCS PPO |
$2,008.30
|
| Rate for Payer: Three Rivers PPO |
$1,585.50
|
| Rate for Payer: TriWest Veterans Administration |
$416.09
|
| Rate for Payer: United Healthcare Commercial |
$1,839.18
|
| Rate for Payer: United Healthcare Medicare |
$416.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,796.90
|
|
|
EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 64774
|
| Hospital Charge Code |
64774
|
| Min. Negotiated Rate |
$353.68 |
| Max. Negotiated Rate |
$2,114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,071.72
|
| Rate for Payer: Aetna of WY Medicare |
$416.09
|
| Rate for Payer: Beech Street Commercial |
$2,008.30
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,050.58
|
| Rate for Payer: Cigna of WY Commercial |
$2,071.72
|
| Rate for Payer: First Choice Health Commercial |
$1,902.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,008.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.09
|
| Rate for Payer: HealthUtah PPO |
$2,114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,050.58
|
| Rate for Payer: Multiplan Medicare/VA |
$353.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,071.72
|
| Rate for Payer: PacificSource Commercial |
$1,902.60
|
| Rate for Payer: PHCS PPO |
$2,008.30
|
| Rate for Payer: Three Rivers PPO |
$1,585.50
|
| Rate for Payer: TriWest Veterans Administration |
$416.09
|
| Rate for Payer: United Healthcare Commercial |
$1,839.18
|
| Rate for Payer: United Healthcare Medicare |
$416.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,796.90
|
|
|
EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 64782
|
| Hospital Charge Code |
64782
|
| Min. Negotiated Rate |
$376.76 |
| Max. Negotiated Rate |
$2,143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,100.14
|
| Rate for Payer: Aetna of WY Medicare |
$443.25
|
| Rate for Payer: Beech Street Commercial |
$2,035.85
|
| Rate for Payer: Cash Price |
$1,500.10
|
| Rate for Payer: Cash Price |
$1,500.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,078.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,100.14
|
| Rate for Payer: First Choice Health Commercial |
$1,928.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,035.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.25
|
| Rate for Payer: HealthUtah PPO |
$2,143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,078.71
|
| Rate for Payer: Multiplan Medicare/VA |
$376.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,100.14
|
| Rate for Payer: PacificSource Commercial |
$1,928.70
|
| Rate for Payer: PHCS PPO |
$2,035.85
|
| Rate for Payer: Three Rivers PPO |
$1,607.25
|
| Rate for Payer: TriWest Veterans Administration |
$443.25
|
| Rate for Payer: United Healthcare Commercial |
$1,864.41
|
| Rate for Payer: United Healthcare Medicare |
$443.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,821.55
|
|
|
EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$5,790.00
|
|
|
Service Code
|
HCPCS 64784 AS
|
| Hospital Charge Code |
64784
|
| Min. Negotiated Rate |
$594.14 |
| Max. Negotiated Rate |
$5,790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,674.20
|
| Rate for Payer: Aetna of WY Medicare |
$698.99
|
| Rate for Payer: Beech Street Commercial |
$5,500.50
|
| Rate for Payer: Cash Price |
$4,053.00
|
| Rate for Payer: Cash Price |
$4,053.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,616.30
|
| Rate for Payer: Cigna of WY Commercial |
$5,674.20
|
| Rate for Payer: First Choice Health Commercial |
$5,211.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,500.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.99
|
| Rate for Payer: HealthUtah PPO |
$5,790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,616.30
|
| Rate for Payer: Multiplan Medicare/VA |
$594.14
|
| Rate for Payer: One Health Plan of WY PPO |
$5,674.20
|
| Rate for Payer: PacificSource Commercial |
$5,211.00
|
| Rate for Payer: PHCS PPO |
$5,500.50
|
| Rate for Payer: Three Rivers PPO |
$4,342.50
|
| Rate for Payer: TriWest Veterans Administration |
$698.99
|
| Rate for Payer: United Healthcare Commercial |
$5,037.30
|
| Rate for Payer: United Healthcare Medicare |
$698.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,921.50
|
|
