|
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
|
|
|
EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$5,790.00
|
|
|
Service Code
|
HCPCS 64784 80
|
| 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
|
|
|
EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$3,208.00
|
|
|
Service Code
|
HCPCS 42410 80
|
| Hospital Charge Code |
42410
|
| Min. Negotiated Rate |
$519.17 |
| Max. Negotiated Rate |
$3,208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,143.84
|
| Rate for Payer: Aetna of WY Medicare |
$610.79
|
| Rate for Payer: Beech Street Commercial |
$3,047.60
|
| Rate for Payer: Cash Price |
$2,245.60
|
| Rate for Payer: Cash Price |
$2,245.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,111.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,143.84
|
| Rate for Payer: First Choice Health Commercial |
$2,887.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,047.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.79
|
| Rate for Payer: HealthUtah PPO |
$3,208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,111.76
|
| Rate for Payer: Multiplan Medicare/VA |
$519.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,143.84
|
| Rate for Payer: PacificSource Commercial |
$2,887.20
|
| Rate for Payer: PHCS PPO |
$3,047.60
|
| Rate for Payer: Three Rivers PPO |
$2,406.00
|
| Rate for Payer: TriWest Veterans Administration |
$610.79
|
| Rate for Payer: United Healthcare Commercial |
$2,790.96
|
| Rate for Payer: United Healthcare Medicare |
$610.79
|
| Rate for Payer: WINHealth Partners Commercial |
$2,726.80
|
|
|
EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$3,208.00
|
|
|
Service Code
|
HCPCS 42410
|
| Hospital Charge Code |
42410
|
| Min. Negotiated Rate |
$519.17 |
| Max. Negotiated Rate |
$3,208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,143.84
|
| Rate for Payer: Aetna of WY Medicare |
$610.79
|
| Rate for Payer: Beech Street Commercial |
$3,047.60
|
| Rate for Payer: Cash Price |
$2,245.60
|
| Rate for Payer: Cash Price |
$2,245.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,111.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,143.84
|
| Rate for Payer: First Choice Health Commercial |
$2,887.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,047.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.79
|
| Rate for Payer: HealthUtah PPO |
$3,208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,111.76
|
| Rate for Payer: Multiplan Medicare/VA |
$519.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,143.84
|
| Rate for Payer: PacificSource Commercial |
$2,887.20
|
| Rate for Payer: PHCS PPO |
$3,047.60
|
| Rate for Payer: Three Rivers PPO |
$2,406.00
|
| Rate for Payer: TriWest Veterans Administration |
$610.79
|
| Rate for Payer: United Healthcare Commercial |
$2,790.96
|
| Rate for Payer: United Healthcare Medicare |
$610.79
|
| Rate for Payer: WINHealth Partners Commercial |
$2,726.80
|
|
|
EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 42420 80
|
| Hospital Charge Code |
42420
|
| Min. Negotiated Rate |
$971.80 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,998.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.29
|
| Rate for Payer: Beech Street Commercial |
$3,876.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,957.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,998.40
|
| Rate for Payer: First Choice Health Commercial |
$3,672.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,876.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,143.29
|
| Rate for Payer: HealthUtah PPO |
$4,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,957.60
|
| Rate for Payer: Multiplan Medicare/VA |
$971.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,998.40
|
| Rate for Payer: PacificSource Commercial |
$3,672.00
|
| Rate for Payer: PHCS PPO |
$3,876.00
|
| Rate for Payer: Three Rivers PPO |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,143.29
|
| Rate for Payer: United Healthcare Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare Medicare |
$1,143.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,468.00
|
|
|
EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 42420
|
| Hospital Charge Code |
42420
|
| Min. Negotiated Rate |
$971.80 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,998.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.29
|
| Rate for Payer: Beech Street Commercial |
$3,876.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,957.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,998.40
|
| Rate for Payer: First Choice Health Commercial |
$3,672.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,876.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,143.29
|
| Rate for Payer: HealthUtah PPO |
$4,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,957.60
|
| Rate for Payer: Multiplan Medicare/VA |
$971.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,998.40
|
| Rate for Payer: PacificSource Commercial |
$3,672.00
|
| Rate for Payer: PHCS PPO |
$3,876.00
|
| Rate for Payer: Three Rivers PPO |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,143.29
|
| Rate for Payer: United Healthcare Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare Medicare |
$1,143.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,468.00
|
|
|
EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$3,132.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$506.15 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,069.36
|
| Rate for Payer: Aetna of WY Medicare |
$595.47
|
| Rate for Payer: Beech Street Commercial |
$2,975.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,038.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,069.36
|
| Rate for Payer: First Choice Health Commercial |
$2,818.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,975.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$595.47
|
| Rate for Payer: HealthUtah PPO |
$3,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,038.04
|
| Rate for Payer: Multiplan Medicare/VA |
$506.15
|
| Rate for Payer: One Health Plan of WY PPO |
$3,069.36
|
| Rate for Payer: PacificSource Commercial |
$2,818.80
|
| Rate for Payer: PHCS PPO |
$2,975.40
|
| Rate for Payer: Three Rivers PPO |
$2,349.00
|
| Rate for Payer: TriWest Veterans Administration |
$595.47
|
| Rate for Payer: United Healthcare Commercial |
$2,724.84
|
| Rate for Payer: United Healthcare Medicare |
$595.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2,662.20
|
|
|
EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
46320
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$564.48
|
| Rate for Payer: Aetna of WY Medicare |
$109.83
|
| Rate for Payer: Beech Street Commercial |
$547.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$558.72
|
| Rate for Payer: Cigna of WY Commercial |
$564.48
|
| Rate for Payer: First Choice Health Commercial |
$518.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.83
|
| Rate for Payer: HealthUtah PPO |
$576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$558.72
|
| Rate for Payer: Multiplan Medicare/VA |
$93.36
|
| Rate for Payer: One Health Plan of WY PPO |
$564.48
|
| Rate for Payer: PacificSource Commercial |
$518.40
|
| Rate for Payer: PHCS PPO |
$547.20
|
| Rate for Payer: Three Rivers PPO |
$432.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.83
|
| Rate for Payer: United Healthcare Commercial |
$501.12
|
| Rate for Payer: United Healthcare Medicare |
$109.83
|
| Rate for Payer: WINHealth Partners Commercial |
$489.60
|
|
|
EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,759.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$443.83 |
| Max. Negotiated Rate |
$2,759.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,703.82
|
| Rate for Payer: Aetna of WY Medicare |
$522.15
|
| Rate for Payer: Beech Street Commercial |
$2,621.05
|
| Rate for Payer: Cash Price |
$1,931.30
|
| Rate for Payer: Cash Price |
$1,931.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,676.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,703.82
|
| Rate for Payer: First Choice Health Commercial |
$2,483.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,621.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.15
|
| Rate for Payer: HealthUtah PPO |
$2,759.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,676.23
|
| Rate for Payer: Multiplan Medicare/VA |
$443.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,703.82
|
| Rate for Payer: PacificSource Commercial |
$2,483.10
|
| Rate for Payer: PHCS PPO |
$2,621.05
|
| Rate for Payer: Three Rivers PPO |
$2,069.25
|
| Rate for Payer: TriWest Veterans Administration |
$522.15
|
| Rate for Payer: United Healthcare Commercial |
$2,400.33
|
| Rate for Payer: United Healthcare Medicare |
$522.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,345.15
|
|
|
EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
21552
|
| Min. Negotiated Rate |
$366.44 |
| Max. Negotiated Rate |
$2,298.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,252.04
|
| Rate for Payer: Aetna of WY Medicare |
$431.11
|
| Rate for Payer: Beech Street Commercial |
$2,183.10
|
| Rate for Payer: Cash Price |
$1,608.60
|
| Rate for Payer: Cash Price |
$1,608.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,229.06
|
| Rate for Payer: Cigna of WY Commercial |
$2,252.04
|
| Rate for Payer: First Choice Health Commercial |
$2,068.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,183.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.11
|
| Rate for Payer: HealthUtah PPO |
$2,298.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,229.06
|
| Rate for Payer: Multiplan Medicare/VA |
$366.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,252.04
|
| Rate for Payer: PacificSource Commercial |
$2,068.20
|
| Rate for Payer: PHCS PPO |
$2,183.10
|
| Rate for Payer: Three Rivers PPO |
$1,723.50
|
| Rate for Payer: TriWest Veterans Administration |
$431.11
|
| Rate for Payer: United Healthcare Commercial |
$1,999.26
|
| Rate for Payer: United Healthcare Medicare |
$431.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1,953.30
|
|
|
EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$3,810.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
21933
|
| Min. Negotiated Rate |
$601.36 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,733.80
|
| Rate for Payer: Aetna of WY Medicare |
$707.48
|
| Rate for Payer: Beech Street Commercial |
$3,619.50
|
| Rate for Payer: Cash Price |
$2,667.00
|
| Rate for Payer: Cash Price |
$2,667.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,695.70
|
| Rate for Payer: Cigna of WY Commercial |
$3,733.80
|
| Rate for Payer: First Choice Health Commercial |
$3,429.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,619.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.48
|
| Rate for Payer: HealthUtah PPO |
$3,810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,695.70
|
| Rate for Payer: Multiplan Medicare/VA |
$601.36
|
| Rate for Payer: One Health Plan of WY PPO |
$3,733.80
|
| Rate for Payer: PacificSource Commercial |
$3,429.00
|
| Rate for Payer: PHCS PPO |
$3,619.50
|
| Rate for Payer: Three Rivers PPO |
$2,857.50
|
| Rate for Payer: TriWest Veterans Administration |
$707.48
|
| Rate for Payer: United Healthcare Commercial |
$3,314.70
|
| Rate for Payer: United Healthcare Medicare |
$707.48
|
| Rate for Payer: WINHealth Partners Commercial |
$3,238.50
|
|
|
EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
|
Professional
|
Both
|
$3,111.00
|
|
|
Service Code
|
HCPCS 21932
|
| Hospital Charge Code |
21932
|
| Min. Negotiated Rate |
$541.64 |
| Max. Negotiated Rate |
$3,111.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,048.78
|
| Rate for Payer: Aetna of WY Medicare |
$637.22
|
| Rate for Payer: Beech Street Commercial |
$2,955.45
|
| Rate for Payer: Cash Price |
$2,177.70
|
| Rate for Payer: Cash Price |
$2,177.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,017.67
|
| Rate for Payer: Cigna of WY Commercial |
$3,048.78
|
| Rate for Payer: First Choice Health Commercial |
$2,799.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,955.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$637.22
|
| Rate for Payer: HealthUtah PPO |
$3,111.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,017.67
|
| Rate for Payer: Multiplan Medicare/VA |
$541.64
|
| Rate for Payer: One Health Plan of WY PPO |
$3,048.78
|
| Rate for Payer: PacificSource Commercial |
$2,799.90
|
| Rate for Payer: PHCS PPO |
$2,955.45
|
| Rate for Payer: Three Rivers PPO |
$2,333.25
|
| Rate for Payer: TriWest Veterans Administration |
$637.22
|
| Rate for Payer: United Healthcare Commercial |
$2,706.57
|
| Rate for Payer: United Healthcare Medicare |
$637.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2,644.35
|
|
|
EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$2,683.00
|
|
|
Service Code
|
HCPCS 21014
|
| Hospital Charge Code |
21014
|
| Min. Negotiated Rate |
$429.39 |
| Max. Negotiated Rate |
$2,683.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,629.34
|
| Rate for Payer: Aetna of WY Medicare |
$505.17
|
| Rate for Payer: Beech Street Commercial |
$2,548.85
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: Cash Price |
$1,878.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,602.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,629.34
|
| Rate for Payer: First Choice Health Commercial |
$2,414.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,548.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$505.17
|
| Rate for Payer: HealthUtah PPO |
$2,683.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,602.51
|
| Rate for Payer: Multiplan Medicare/VA |
$429.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,629.34
|
| Rate for Payer: PacificSource Commercial |
$2,414.70
|
| Rate for Payer: PHCS PPO |
$2,548.85
|
| Rate for Payer: Three Rivers PPO |
$2,012.25
|
| Rate for Payer: TriWest Veterans Administration |
$505.17
|
| Rate for Payer: United Healthcare Commercial |
$2,334.21
|
| Rate for Payer: United Healthcare Medicare |
$505.17
|
| Rate for Payer: WINHealth Partners Commercial |
$2,280.55
|
|
|
EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>
|
Professional
|
Both
|
$2,187.00
|
|
|
Service Code
|
HCPCS 25071
|
| Hospital Charge Code |
25071
|
| Min. Negotiated Rate |
$350.09 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,143.26
|
| Rate for Payer: Aetna of WY Medicare |
$411.87
|
| Rate for Payer: Beech Street Commercial |
$2,077.65
|
| Rate for Payer: Cash Price |
$1,530.90
|
| Rate for Payer: Cash Price |
$1,530.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,121.39
|
| Rate for Payer: Cigna of WY Commercial |
$2,143.26
|
| Rate for Payer: First Choice Health Commercial |
$1,968.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,077.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.87
|
| Rate for Payer: HealthUtah PPO |
$2,187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,121.39
|
| Rate for Payer: Multiplan Medicare/VA |
$350.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,143.26
|
| Rate for Payer: PacificSource Commercial |
$1,968.30
|
| Rate for Payer: PHCS PPO |
$2,077.65
|
| Rate for Payer: Three Rivers PPO |
$1,640.25
|
| Rate for Payer: TriWest Veterans Administration |
$411.87
|
| Rate for Payer: United Healthcare Commercial |
$1,902.69
|
| Rate for Payer: United Healthcare Medicare |
$411.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,858.95
|
|
|
EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM
|
Professional
|
Both
|
$2,670.00
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
25076
|
| Min. Negotiated Rate |
$431.35 |
| Max. Negotiated Rate |
$2,670.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,616.60
|
| Rate for Payer: Aetna of WY Medicare |
$507.47
|
| Rate for Payer: Beech Street Commercial |
$2,536.50
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: Cash Price |
$1,869.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,589.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,616.60
|
| Rate for Payer: First Choice Health Commercial |
$2,403.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,536.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.47
|
| Rate for Payer: HealthUtah PPO |
$2,670.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,589.90
|
| Rate for Payer: Multiplan Medicare/VA |
$431.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2,616.60
|
| Rate for Payer: PacificSource Commercial |
$2,403.00
|
| Rate for Payer: PHCS PPO |
$2,536.50
|
| Rate for Payer: Three Rivers PPO |
$2,002.50
|
| Rate for Payer: TriWest Veterans Administration |
$507.47
|
| Rate for Payer: United Healthcare Commercial |
$2,322.90
|
| Rate for Payer: United Healthcare Medicare |
$507.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2,269.50
|
|
|
EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
21556
|
| Min. Negotiated Rate |
$435.54 |
| Max. Negotiated Rate |
$2,721.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,666.58
|
| Rate for Payer: Aetna of WY Medicare |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$2,584.95
|
| Rate for Payer: Cash Price |
$1,904.70
|
| Rate for Payer: Cash Price |
$1,904.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,639.37
|
| Rate for Payer: Cigna of WY Commercial |
$2,666.58
|
| Rate for Payer: First Choice Health Commercial |
$2,448.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,584.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$512.40
|
| Rate for Payer: HealthUtah PPO |
$2,721.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,639.37
|
| Rate for Payer: Multiplan Medicare/VA |
$435.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,666.58
|
| Rate for Payer: PacificSource Commercial |
$2,448.90
|
| Rate for Payer: PHCS PPO |
$2,584.95
|
| Rate for Payer: Three Rivers PPO |
$2,040.75
|
| Rate for Payer: TriWest Veterans Administration |
$512.40
|
| Rate for Payer: United Healthcare Commercial |
$2,367.27
|
| Rate for Payer: United Healthcare Medicare |
$512.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,312.85
|
|
|
EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Professional
|
Both
|
$5,543.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
23076
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$5,543.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,432.14
|
| Rate for Payer: Aetna of WY Medicare |
$526.59
|
| Rate for Payer: Beech Street Commercial |
$5,265.85
|
| Rate for Payer: Cash Price |
$3,880.10
|
| Rate for Payer: Cash Price |
$3,880.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,376.71
|
| Rate for Payer: Cigna of WY Commercial |
$5,432.14
|
| Rate for Payer: First Choice Health Commercial |
$4,988.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,265.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.59
|
| Rate for Payer: HealthUtah PPO |
$5,543.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,376.71
|
| Rate for Payer: Multiplan Medicare/VA |
$447.60
|
| Rate for Payer: One Health Plan of WY PPO |
$5,432.14
|
| Rate for Payer: PacificSource Commercial |
$4,988.70
|
| Rate for Payer: PHCS PPO |
$5,265.85
|
| Rate for Payer: Three Rivers PPO |
$4,157.25
|
| Rate for Payer: TriWest Veterans Administration |
$526.59
|
| Rate for Payer: United Healthcare Commercial |
$4,822.41
|
| Rate for Payer: United Healthcare Medicare |
$526.59
|
| Rate for Payer: WINHealth Partners Commercial |
$4,711.55
|
|
|
EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
22900
|
| Min. Negotiated Rate |
$463.16 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,097.20
|
| Rate for Payer: Aetna of WY Medicare |
$544.90
|
| Rate for Payer: Beech Street Commercial |
$2,033.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,075.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,097.20
|
| Rate for Payer: First Choice Health Commercial |
$1,926.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,033.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$544.90
|
| Rate for Payer: HealthUtah PPO |
$2,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,075.80
|
| Rate for Payer: Multiplan Medicare/VA |
$463.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,097.20
|
| Rate for Payer: PacificSource Commercial |
$1,926.00
|
| Rate for Payer: PHCS PPO |
$2,033.00
|
| Rate for Payer: Three Rivers PPO |
$1,605.00
|
| Rate for Payer: TriWest Veterans Administration |
$544.90
|
| Rate for Payer: United Healthcare Commercial |
$1,861.80
|
| Rate for Payer: United Healthcare Medicare |
$544.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,819.00
|
|
|
EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 22900 80
|
| Hospital Charge Code |
22900
|
| Min. Negotiated Rate |
$463.16 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,097.20
|
| Rate for Payer: Aetna of WY Medicare |
$544.90
|
| Rate for Payer: Beech Street Commercial |
$2,033.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,075.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,097.20
|
| Rate for Payer: First Choice Health Commercial |
$1,926.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,033.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$544.90
|
| Rate for Payer: HealthUtah PPO |
$2,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,075.80
|
| Rate for Payer: Multiplan Medicare/VA |
$463.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,097.20
|
| Rate for Payer: PacificSource Commercial |
$1,926.00
|
| Rate for Payer: PHCS PPO |
$2,033.00
|
| Rate for Payer: Three Rivers PPO |
$1,605.00
|
| Rate for Payer: TriWest Veterans Administration |
$544.90
|
| Rate for Payer: United Healthcare Commercial |
$1,861.80
|
| Rate for Payer: United Healthcare Medicare |
$544.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,819.00
|
|
|
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 22903
|
| Hospital Charge Code |
22903
|
| Min. Negotiated Rate |
$360.23 |
| Max. Negotiated Rate |
$2,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,031.54
|
| Rate for Payer: Aetna of WY Medicare |
$423.80
|
| Rate for Payer: Beech Street Commercial |
$1,969.35
|
| Rate for Payer: Cash Price |
$1,451.10
|
| Rate for Payer: Cash Price |
$1,451.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,010.81
|
| Rate for Payer: Cigna of WY Commercial |
$2,031.54
|
| Rate for Payer: First Choice Health Commercial |
$1,865.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,969.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.80
|
| Rate for Payer: HealthUtah PPO |
$2,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,010.81
|
| Rate for Payer: Multiplan Medicare/VA |
$360.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2,031.54
|
| Rate for Payer: PacificSource Commercial |
$1,865.70
|
| Rate for Payer: PHCS PPO |
$1,969.35
|
| Rate for Payer: Three Rivers PPO |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration |
$423.80
|
| Rate for Payer: United Healthcare Commercial |
$1,803.51
|
| Rate for Payer: United Healthcare Medicare |
$423.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,762.05
|
|
|
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
|
Professional
|
Both
|
$5,477.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
22902
|
| Min. Negotiated Rate |
$275.08 |
| Max. Negotiated Rate |
$5,477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,367.46
|
| Rate for Payer: Aetna of WY Medicare |
$323.62
|
| Rate for Payer: Beech Street Commercial |
$5,203.15
|
| Rate for Payer: Cash Price |
$3,833.90
|
| Rate for Payer: Cash Price |
$3,833.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,312.69
|
| Rate for Payer: Cigna of WY Commercial |
$5,367.46
|
| Rate for Payer: First Choice Health Commercial |
$4,929.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,203.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.62
|
| Rate for Payer: HealthUtah PPO |
$5,477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,312.69
|
| Rate for Payer: Multiplan Medicare/VA |
$275.08
|
| Rate for Payer: One Health Plan of WY PPO |
$5,367.46
|
| Rate for Payer: PacificSource Commercial |
$4,929.30
|
| Rate for Payer: PHCS PPO |
$5,203.15
|
| Rate for Payer: Three Rivers PPO |
$4,107.75
|
| Rate for Payer: TriWest Veterans Administration |
$323.62
|
| Rate for Payer: United Healthcare Commercial |
$4,764.99
|
| Rate for Payer: United Healthcare Medicare |
$323.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,655.45
|
|
|
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
|
Professional
|
Both
|
$5,477.00
|
|
|
Service Code
|
HCPCS 22902 80
|
| Hospital Charge Code |
22902
|
| Min. Negotiated Rate |
$275.08 |
| Max. Negotiated Rate |
$5,477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,367.46
|
| Rate for Payer: Aetna of WY Medicare |
$323.62
|
| Rate for Payer: Beech Street Commercial |
$5,203.15
|
| Rate for Payer: Cash Price |
$3,833.90
|
| Rate for Payer: Cash Price |
$3,833.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,312.69
|
| Rate for Payer: Cigna of WY Commercial |
$5,367.46
|
| Rate for Payer: First Choice Health Commercial |
$4,929.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,203.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.62
|
| Rate for Payer: HealthUtah PPO |
$5,477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,312.69
|
| Rate for Payer: Multiplan Medicare/VA |
$275.08
|
| Rate for Payer: One Health Plan of WY PPO |
$5,367.46
|
| Rate for Payer: PacificSource Commercial |
$4,929.30
|
| Rate for Payer: PHCS PPO |
$5,203.15
|
| Rate for Payer: Three Rivers PPO |
$4,107.75
|
| Rate for Payer: TriWest Veterans Administration |
$323.62
|
| Rate for Payer: United Healthcare Commercial |
$4,764.99
|
| Rate for Payer: United Healthcare Medicare |
$323.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,655.45
|
|
|
EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 28041
|
| Hospital Charge Code |
28041
|
| Min. Negotiated Rate |
$373.18 |
| Max. Negotiated Rate |
$1,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,537.62
|
| Rate for Payer: Aetna of WY Medicare |
$439.04
|
| Rate for Payer: Beech Street Commercial |
$1,490.55
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,521.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,537.62
|
| Rate for Payer: First Choice Health Commercial |
$1,412.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,490.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$439.04
|
| Rate for Payer: HealthUtah PPO |
$1,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,521.93
|
| Rate for Payer: Multiplan Medicare/VA |
$373.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,537.62
|
| Rate for Payer: PacificSource Commercial |
$1,412.10
|
| Rate for Payer: PHCS PPO |
$1,490.55
|
| Rate for Payer: Three Rivers PPO |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration |
$439.04
|
| Rate for Payer: United Healthcare Commercial |
$1,365.03
|
| Rate for Payer: United Healthcare Medicare |
$439.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,333.65
|
|
|
EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 28041 80
|
| Hospital Charge Code |
28041
|
| Min. Negotiated Rate |
$373.18 |
| Max. Negotiated Rate |
$1,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,537.62
|
| Rate for Payer: Aetna of WY Medicare |
$439.04
|
| Rate for Payer: Beech Street Commercial |
$1,490.55
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,521.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,537.62
|
| Rate for Payer: First Choice Health Commercial |
$1,412.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,490.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$439.04
|
| Rate for Payer: HealthUtah PPO |
$1,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,521.93
|
| Rate for Payer: Multiplan Medicare/VA |
$373.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,537.62
|
| Rate for Payer: PacificSource Commercial |
$1,412.10
|
| Rate for Payer: PHCS PPO |
$1,490.55
|
| Rate for Payer: Three Rivers PPO |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration |
$439.04
|
| Rate for Payer: United Healthcare Commercial |
$1,365.03
|
| Rate for Payer: United Healthcare Medicare |
$439.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,333.65
|
|
|
EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
25075
|
| Min. Negotiated Rate |
$262.85 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,592.50
|
| Rate for Payer: Aetna of WY Medicare |
$309.23
|
| Rate for Payer: Beech Street Commercial |
$1,543.75
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,576.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,592.50
|
| Rate for Payer: First Choice Health Commercial |
$1,462.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,543.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.23
|
| Rate for Payer: HealthUtah PPO |
$1,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,576.25
|
| Rate for Payer: Multiplan Medicare/VA |
$262.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,592.50
|
| Rate for Payer: PacificSource Commercial |
$1,462.50
|
| Rate for Payer: PHCS PPO |
$1,543.75
|
| Rate for Payer: Three Rivers PPO |
$1,218.75
|
| Rate for Payer: TriWest Veterans Administration |
$309.23
|
| Rate for Payer: United Healthcare Commercial |
$1,413.75
|
| Rate for Payer: United Healthcare Medicare |
$309.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,381.25
|
|
