|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 11422
|
| Min. Negotiated Rate |
$112.59 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$568.40
|
| Rate for Payer: Aetna of WY Medicare |
$132.46
|
| Rate for Payer: Beech Street Commercial |
$551.00
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$562.60
|
| Rate for Payer: Cigna of WY Commercial |
$568.40
|
| Rate for Payer: First Choice Health Commercial |
$522.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$551.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.46
|
| Rate for Payer: HealthUtah PPO |
$580.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$562.60
|
| Rate for Payer: Multiplan Medicare/VA |
$112.59
|
| Rate for Payer: One Health Plan of WY PPO |
$568.40
|
| Rate for Payer: PacificSource Commercial |
$522.00
|
| Rate for Payer: PHCS PPO |
$551.00
|
| Rate for Payer: Three Rivers PPO |
$435.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.46
|
| Rate for Payer: United Healthcare Commercial |
$551.00
|
| Rate for Payer: WINHealth Partners Commercial |
$493.00
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 11423
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$152.90
|
| Rate for Payer: Beech Street Commercial |
$631.75
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: First Choice Health Commercial |
$598.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.90
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$129.96
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$631.75
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$152.90
|
| Rate for Payer: United Healthcare Commercial |
$631.75
|
| Rate for Payer: WINHealth Partners Commercial |
$565.25
|
|
|
EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$1,173.00
|
|
|
Service Code
|
HCPCS 11426
|
| Min. Negotiated Rate |
$219.75 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,149.54
|
| Rate for Payer: Aetna of WY Medicare |
$258.53
|
| Rate for Payer: Beech Street Commercial |
$1,114.35
|
| Rate for Payer: Cash Price |
$821.10
|
| Rate for Payer: Cash Price |
$821.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,137.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,149.54
|
| Rate for Payer: First Choice Health Commercial |
$1,055.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,114.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.53
|
| Rate for Payer: HealthUtah PPO |
$1,173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,137.81
|
| Rate for Payer: Multiplan Medicare/VA |
$219.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,149.54
|
| Rate for Payer: PacificSource Commercial |
$1,055.70
|
| Rate for Payer: PHCS PPO |
$1,114.35
|
| Rate for Payer: Three Rivers PPO |
$879.75
|
| Rate for Payer: TriWest Veterans Administration |
$258.53
|
| Rate for Payer: United Healthcare Commercial |
$1,114.35
|
| Rate for Payer: WINHealth Partners Commercial |
$997.05
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 11400
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Aetna of WY Medicare |
$82.47
|
| Rate for Payer: Beech Street Commercial |
$329.65
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: First Choice Health Commercial |
$312.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.47
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Multiplan Medicare/VA |
$70.10
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$329.65
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: TriWest Veterans Administration |
$82.47
|
| Rate for Payer: United Healthcare Commercial |
$329.65
|
| Rate for Payer: WINHealth Partners Commercial |
$294.95
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.16
|
| Rate for Payer: Aetna of WY Medicare |
$103.09
|
| Rate for Payer: Beech Street Commercial |
$419.90
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$428.74
|
| Rate for Payer: Cigna of WY Commercial |
$433.16
|
| Rate for Payer: First Choice Health Commercial |
$397.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$419.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.09
|
| Rate for Payer: HealthUtah PPO |
$442.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$428.74
|
| Rate for Payer: Multiplan Medicare/VA |
$87.63
|
| Rate for Payer: One Health Plan of WY PPO |
$433.16
|
| Rate for Payer: PacificSource Commercial |
$397.80
|
| Rate for Payer: PHCS PPO |
$419.90
|
| Rate for Payer: Three Rivers PPO |
$331.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.09
|
| Rate for Payer: United Healthcare Commercial |
$419.90
|
| Rate for Payer: WINHealth Partners Commercial |
$375.70
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$478.24
|
| Rate for Payer: Aetna of WY Medicare |
$112.65
|
| Rate for Payer: Beech Street Commercial |
$463.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$473.36
|
| Rate for Payer: Cigna of WY Commercial |
$478.24
|
| Rate for Payer: First Choice Health Commercial |
$439.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$463.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.65
|
| Rate for Payer: HealthUtah PPO |
$488.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$473.36
|
| Rate for Payer: Multiplan Medicare/VA |
$95.75
|
| Rate for Payer: One Health Plan of WY PPO |
$478.24
|
| Rate for Payer: PacificSource Commercial |
$439.20
|
| Rate for Payer: PHCS PPO |
$463.60
|
| Rate for Payer: Three Rivers PPO |
$366.00
|
| Rate for Payer: TriWest Veterans Administration |
$112.65
|
| Rate for Payer: United Healthcare Commercial |
$463.60
|
| Rate for Payer: WINHealth Partners Commercial |
$414.80
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$123.84 |
| Max. Negotiated Rate |
$631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$618.38
|
| Rate for Payer: Aetna of WY Medicare |
$145.70
|
| Rate for Payer: Beech Street Commercial |
$599.45
|
| Rate for Payer: Cash Price |
$441.70
|
| Rate for Payer: Cash Price |
$441.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$612.07
|
| Rate for Payer: Cigna of WY Commercial |
$618.38
|
| Rate for Payer: First Choice Health Commercial |
$567.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$599.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.70
|
| Rate for Payer: HealthUtah PPO |
$631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$612.07
|
| Rate for Payer: Multiplan Medicare/VA |
$123.84
|
| Rate for Payer: One Health Plan of WY PPO |
$618.38
|
| Rate for Payer: PacificSource Commercial |
$567.90
|
| Rate for Payer: PHCS PPO |
$599.45
|
| Rate for Payer: Three Rivers PPO |
$473.25
|
| Rate for Payer: TriWest Veterans Administration |
$145.70
|
| Rate for Payer: United Healthcare Commercial |
$599.45
|
| Rate for Payer: WINHealth Partners Commercial |
$536.35
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$135.79 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$679.14
|
| Rate for Payer: Aetna of WY Medicare |
$159.75
|
| Rate for Payer: Beech Street Commercial |
$658.35
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$672.21
|
| Rate for Payer: Cigna of WY Commercial |
$679.14
|
| Rate for Payer: First Choice Health Commercial |
$623.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$658.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.75
|
| Rate for Payer: HealthUtah PPO |
$693.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$672.21
|
| Rate for Payer: Multiplan Medicare/VA |
$135.79
|
| Rate for Payer: One Health Plan of WY PPO |
$679.14
|
| Rate for Payer: PacificSource Commercial |
$623.70
|
| Rate for Payer: PHCS PPO |
$658.35
|
| Rate for Payer: Three Rivers PPO |
$519.75
|
| Rate for Payer: TriWest Veterans Administration |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$658.35
|
| Rate for Payer: WINHealth Partners Commercial |
$589.05
|
|
|
EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$203.67 |
| Max. Negotiated Rate |
$1,052.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,030.96
|
| Rate for Payer: Aetna of WY Medicare |
$239.61
|
| Rate for Payer: Beech Street Commercial |
$999.40
|
| Rate for Payer: Cash Price |
$736.40
|
| Rate for Payer: Cash Price |
$736.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,020.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,030.96
|
| Rate for Payer: First Choice Health Commercial |
$946.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$999.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.61
|
| Rate for Payer: HealthUtah PPO |
$1,052.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,020.44
|
| Rate for Payer: Multiplan Medicare/VA |
$203.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,030.96
|
| Rate for Payer: PacificSource Commercial |
$946.80
|
| Rate for Payer: PHCS PPO |
$999.40
|
| Rate for Payer: Three Rivers PPO |
$789.00
|
| Rate for Payer: TriWest Veterans Administration |
$239.61
|
| Rate for Payer: United Healthcare Commercial |
$999.40
|
| Rate for Payer: WINHealth Partners Commercial |
$894.20
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$110.71 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$545.86
|
| Rate for Payer: Aetna of WY Medicare |
$130.25
|
| Rate for Payer: Beech Street Commercial |
$529.15
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$540.29
|
| Rate for Payer: Cigna of WY Commercial |
$545.86
|
| Rate for Payer: First Choice Health Commercial |
$501.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$529.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.25
|
| Rate for Payer: HealthUtah PPO |
$557.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$540.29
|
| Rate for Payer: Multiplan Medicare/VA |
$110.71
|
| Rate for Payer: One Health Plan of WY PPO |
$545.86
|
| Rate for Payer: PacificSource Commercial |
$501.30
|
| Rate for Payer: PHCS PPO |
$529.15
|
| Rate for Payer: Three Rivers PPO |
$417.75
|
| Rate for Payer: TriWest Veterans Administration |
$130.25
|
| Rate for Payer: United Healthcare Commercial |
$529.15
|
| Rate for Payer: WINHealth Partners Commercial |
$473.45
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$619.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$606.62
|
| Rate for Payer: Aetna of WY Medicare |
$143.33
|
| Rate for Payer: Beech Street Commercial |
$588.05
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: Cash Price |
$433.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$600.43
|
| Rate for Payer: Cigna of WY Commercial |
$606.62
|
| Rate for Payer: First Choice Health Commercial |
$557.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$588.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.33
|
| Rate for Payer: HealthUtah PPO |
$619.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$600.43
|
| Rate for Payer: Multiplan Medicare/VA |
$121.83
|
| Rate for Payer: One Health Plan of WY PPO |
$606.62
|
| Rate for Payer: PacificSource Commercial |
$557.10
|
| Rate for Payer: PHCS PPO |
$588.05
|
| Rate for Payer: Three Rivers PPO |
$464.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.33
|
| Rate for Payer: United Healthcare Commercial |
$588.05
|
| Rate for Payer: WINHealth Partners Commercial |
$526.15
|
|
|
EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$758.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$742.84
|
| Rate for Payer: Aetna of WY Medicare |
$174.08
|
| Rate for Payer: Beech Street Commercial |
$720.10
|
| Rate for Payer: Cash Price |
$530.60
|
| Rate for Payer: Cash Price |
$530.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$735.26
|
| Rate for Payer: Cigna of WY Commercial |
$742.84
|
| Rate for Payer: First Choice Health Commercial |
$682.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$720.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.08
|
| Rate for Payer: HealthUtah PPO |
$758.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$735.26
|
| Rate for Payer: Multiplan Medicare/VA |
$147.97
|
| Rate for Payer: One Health Plan of WY PPO |
$742.84
|
| Rate for Payer: PacificSource Commercial |
$682.20
|
| Rate for Payer: PHCS PPO |
$720.10
|
| Rate for Payer: Three Rivers PPO |
$568.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.08
|
| Rate for Payer: United Healthcare Commercial |
$720.10
|
| Rate for Payer: WINHealth Partners Commercial |
$644.30
|
|
|
EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$3,843.00
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$258.94 |
| Max. Negotiated Rate |
$3,843.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,766.14
|
| Rate for Payer: Aetna of WY Medicare |
$304.63
|
| Rate for Payer: Beech Street Commercial |
$3,650.85
|
| Rate for Payer: Cash Price |
$2,690.10
|
| Rate for Payer: Cash Price |
$2,690.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,727.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,766.14
|
| Rate for Payer: First Choice Health Commercial |
$3,458.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,650.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.63
|
| Rate for Payer: HealthUtah PPO |
$3,843.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,727.71
|
| Rate for Payer: Multiplan Medicare/VA |
$258.94
|
| Rate for Payer: One Health Plan of WY PPO |
$3,766.14
|
| Rate for Payer: PacificSource Commercial |
$3,458.70
|
| Rate for Payer: PHCS PPO |
$3,650.85
|
| Rate for Payer: Three Rivers PPO |
$2,882.25
|
| Rate for Payer: TriWest Veterans Administration |
$304.63
|
| Rate for Payer: United Healthcare Commercial |
$3,650.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,266.55
|
|
|
EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$445.33 |
| Max. Negotiated Rate |
$2,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,349.06
|
| Rate for Payer: Aetna of WY Medicare |
$523.92
|
| Rate for Payer: Beech Street Commercial |
$2,277.15
|
| Rate for Payer: Cash Price |
$1,677.90
|
| Rate for Payer: Cash Price |
$1,677.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,325.09
|
| Rate for Payer: Cigna of WY Commercial |
$2,349.06
|
| Rate for Payer: First Choice Health Commercial |
$2,157.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,277.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$523.92
|
| Rate for Payer: HealthUtah PPO |
$2,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,325.09
|
| Rate for Payer: Multiplan Medicare/VA |
$445.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,349.06
|
| Rate for Payer: PacificSource Commercial |
$2,157.30
|
| Rate for Payer: PHCS PPO |
$2,277.15
|
| Rate for Payer: Three Rivers PPO |
$1,797.75
|
| Rate for Payer: TriWest Veterans Administration |
$523.92
|
| Rate for Payer: United Healthcare Commercial |
$2,277.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,037.45
|
|
|
EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$4,026.00
|
|
|
Service Code
|
HCPCS 19125 50
|
| Min. Negotiated Rate |
$3,019.50 |
| Max. Negotiated Rate |
$4,026.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,945.48
|
| Rate for Payer: Beech Street Commercial |
$3,824.70
|
| Rate for Payer: Cash Price |
$2,818.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,905.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,945.48
|
| Rate for Payer: First Choice Health Commercial |
$3,623.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,824.70
|
| Rate for Payer: HealthUtah PPO |
$4,026.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,905.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3,945.48
|
| Rate for Payer: PacificSource Commercial |
$3,623.40
|
| Rate for Payer: PHCS PPO |
$3,824.70
|
| Rate for Payer: Three Rivers PPO |
$3,019.50
|
| Rate for Payer: United Healthcare Commercial |
$3,824.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,422.10
|
|
|
EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$2,013.00
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$377.38 |
| Max. Negotiated Rate |
$2,013.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,972.74
|
| Rate for Payer: Aetna of WY Medicare |
$443.98
|
| Rate for Payer: Beech Street Commercial |
$1,912.35
|
| Rate for Payer: Cash Price |
$1,409.10
|
| Rate for Payer: Cash Price |
$1,409.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,952.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,972.74
|
| Rate for Payer: First Choice Health Commercial |
$1,811.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,912.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.98
|
| Rate for Payer: HealthUtah PPO |
$2,013.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,952.61
|
| Rate for Payer: Multiplan Medicare/VA |
$377.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,972.74
|
| Rate for Payer: PacificSource Commercial |
$1,811.70
|
| Rate for Payer: PHCS PPO |
$1,912.35
|
| Rate for Payer: Three Rivers PPO |
$1,509.75
|
| Rate for Payer: TriWest Veterans Administration |
$443.98
|
| Rate for Payer: United Healthcare Commercial |
$1,912.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,711.05
|
|
|
EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL
|
Professional
|
Both
|
$5,786.00
|
|
|
Service Code
|
HCPCS 28104
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$5,786.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,670.28
|
| Rate for Payer: Aetna of WY Medicare |
$346.70
|
| Rate for Payer: Beech Street Commercial |
$5,496.70
|
| Rate for Payer: Cash Price |
$4,050.20
|
| Rate for Payer: Cash Price |
$4,050.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,612.42
|
| Rate for Payer: Cigna of WY Commercial |
$5,670.28
|
| Rate for Payer: First Choice Health Commercial |
$5,207.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,496.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.70
|
| Rate for Payer: HealthUtah PPO |
$5,786.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,612.42
|
| Rate for Payer: Multiplan Medicare/VA |
$294.70
|
| Rate for Payer: One Health Plan of WY PPO |
$5,670.28
|
| Rate for Payer: PacificSource Commercial |
$5,207.40
|
| Rate for Payer: PHCS PPO |
$5,496.70
|
| Rate for Payer: Three Rivers PPO |
$4,339.50
|
| Rate for Payer: TriWest Veterans Administration |
$346.70
|
| Rate for Payer: United Healthcare Commercial |
$5,496.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4,918.10
|
|
|
EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 24120 AS
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$791.84
|
| Rate for Payer: Beech Street Commercial |
$767.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$783.76
|
| Rate for Payer: Cigna of WY Commercial |
$791.84
|
| Rate for Payer: First Choice Health Commercial |
$727.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$767.60
|
| Rate for Payer: HealthUtah PPO |
$808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$783.76
|
| Rate for Payer: One Health Plan of WY PPO |
$791.84
|
| Rate for Payer: PacificSource Commercial |
$727.20
|
| Rate for Payer: PHCS PPO |
$767.60
|
| Rate for Payer: Three Rivers PPO |
$606.00
|
| Rate for Payer: United Healthcare Commercial |
$767.60
|
| Rate for Payer: WINHealth Partners Commercial |
$686.80
|
|
|
EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 24120 80
|
| Min. Negotiated Rate |
$606.00 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$791.84
|
| Rate for Payer: Beech Street Commercial |
$767.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$783.76
|
| Rate for Payer: Cigna of WY Commercial |
$791.84
|
| Rate for Payer: First Choice Health Commercial |
$727.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$767.60
|
| Rate for Payer: HealthUtah PPO |
$808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$783.76
|
| Rate for Payer: One Health Plan of WY PPO |
$791.84
|
| Rate for Payer: PacificSource Commercial |
$727.20
|
| Rate for Payer: PHCS PPO |
$767.60
|
| Rate for Payer: Three Rivers PPO |
$606.00
|
| Rate for Payer: United Healthcare Commercial |
$767.60
|
| Rate for Payer: WINHealth Partners Commercial |
$686.80
|
|
|
EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$4,032.00
|
|
|
Service Code
|
HCPCS 24120
|
| Min. Negotiated Rate |
$444.14 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,951.36
|
| Rate for Payer: Aetna of WY Medicare |
$522.52
|
| Rate for Payer: Beech Street Commercial |
$3,830.40
|
| Rate for Payer: Cash Price |
$2,822.40
|
| Rate for Payer: Cash Price |
$2,822.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,911.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,951.36
|
| Rate for Payer: First Choice Health Commercial |
$3,628.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,830.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.52
|
| Rate for Payer: HealthUtah PPO |
$4,032.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,911.04
|
| Rate for Payer: Multiplan Medicare/VA |
$444.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3,951.36
|
| Rate for Payer: PacificSource Commercial |
$3,628.80
|
| Rate for Payer: PHCS PPO |
$3,830.40
|
| Rate for Payer: Three Rivers PPO |
$3,024.00
|
| Rate for Payer: TriWest Veterans Administration |
$522.52
|
| Rate for Payer: United Healthcare Commercial |
$3,830.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,427.20
|
|
|
EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$2,970.00
|
|
|
Service Code
|
HCPCS 23156 AS
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$2,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,910.60
|
| Rate for Payer: Beech Street Commercial |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,880.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,910.60
|
| Rate for Payer: First Choice Health Commercial |
$2,673.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,821.50
|
| Rate for Payer: HealthUtah PPO |
$2,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,880.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,910.60
|
| Rate for Payer: PacificSource Commercial |
$2,673.00
|
| Rate for Payer: PHCS PPO |
$2,821.50
|
| Rate for Payer: Three Rivers PPO |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,821.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,524.50
|
|
|
EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$2,970.00
|
|
|
Service Code
|
HCPCS 23156
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$2,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,910.60
|
| Rate for Payer: Aetna of WY Medicare |
$661.82
|
| Rate for Payer: Beech Street Commercial |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,880.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,910.60
|
| Rate for Payer: First Choice Health Commercial |
$2,673.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,821.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.82
|
| Rate for Payer: HealthUtah PPO |
$2,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,880.90
|
| Rate for Payer: Multiplan Medicare/VA |
$562.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2,910.60
|
| Rate for Payer: PacificSource Commercial |
$2,673.00
|
| Rate for Payer: PHCS PPO |
$2,821.50
|
| Rate for Payer: Three Rivers PPO |
$2,227.50
|
| Rate for Payer: TriWest Veterans Administration |
$661.82
|
| Rate for Payer: United Healthcare Commercial |
$2,821.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,524.50
|
|
|
EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$2,970.00
|
|
|
Service Code
|
HCPCS 23156 80
|
| Min. Negotiated Rate |
$562.55 |
| Max. Negotiated Rate |
$2,970.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,910.60
|
| Rate for Payer: Beech Street Commercial |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,079.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,880.90
|
| Rate for Payer: Cigna of WY Commercial |
$2,910.60
|
| Rate for Payer: First Choice Health Commercial |
$2,673.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,821.50
|
| Rate for Payer: HealthUtah PPO |
$2,970.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,880.90
|
| Rate for Payer: One Health Plan of WY PPO |
$2,910.60
|
| Rate for Payer: PacificSource Commercial |
$2,673.00
|
| Rate for Payer: PHCS PPO |
$2,821.50
|
| Rate for Payer: Three Rivers PPO |
$2,227.50
|
| Rate for Payer: United Healthcare Commercial |
$2,821.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,524.50
|
|
|
EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$3,912.00
|
|
|
Service Code
|
HCPCS 25135 AS
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$3,912.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,833.76
|
| Rate for Payer: Beech Street Commercial |
$3,716.40
|
| Rate for Payer: Cash Price |
$2,738.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,794.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,833.76
|
| Rate for Payer: First Choice Health Commercial |
$3,520.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,716.40
|
| Rate for Payer: HealthUtah PPO |
$3,912.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,794.64
|
| Rate for Payer: One Health Plan of WY PPO |
$3,833.76
|
| Rate for Payer: PacificSource Commercial |
$3,520.80
|
| Rate for Payer: PHCS PPO |
$3,716.40
|
| Rate for Payer: Three Rivers PPO |
$2,934.00
|
| Rate for Payer: United Healthcare Commercial |
$3,716.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,325.20
|
|
|
EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$3,912.00
|
|
|
Service Code
|
HCPCS 25135
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$3,912.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,833.76
|
| Rate for Payer: Aetna of WY Medicare |
$550.96
|
| Rate for Payer: Beech Street Commercial |
$3,716.40
|
| Rate for Payer: Cash Price |
$2,738.40
|
| Rate for Payer: Cash Price |
$2,738.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,794.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,833.76
|
| Rate for Payer: First Choice Health Commercial |
$3,520.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,716.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$550.96
|
| Rate for Payer: HealthUtah PPO |
$3,912.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,794.64
|
| Rate for Payer: Multiplan Medicare/VA |
$468.32
|
| Rate for Payer: One Health Plan of WY PPO |
$3,833.76
|
| Rate for Payer: PacificSource Commercial |
$3,520.80
|
| Rate for Payer: PHCS PPO |
$3,716.40
|
| Rate for Payer: Three Rivers PPO |
$2,934.00
|
| Rate for Payer: TriWest Veterans Administration |
$550.96
|
| Rate for Payer: United Healthcare Commercial |
$3,716.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,325.20
|
|
