|
EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,815.00
|
|
|
Service Code
|
HCPCS 19120
|
| Min. Negotiated Rate |
$341.68 |
| Max. Negotiated Rate |
$1,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,778.70
|
| Rate for Payer: Aetna of WY Medicare |
$401.98
|
| Rate for Payer: Beech Street Commercial |
$1,724.25
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: Cash Price |
$1,270.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,760.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,778.70
|
| Rate for Payer: First Choice Health Commercial |
$1,633.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,724.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.98
|
| Rate for Payer: HealthUtah PPO |
$1,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,760.55
|
| Rate for Payer: Multiplan Medicare/VA |
$341.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,778.70
|
| Rate for Payer: PacificSource Commercial |
$1,633.50
|
| Rate for Payer: PHCS PPO |
$1,724.25
|
| Rate for Payer: Three Rivers PPO |
$1,361.25
|
| Rate for Payer: TriWest Veterans Administration |
$401.98
|
| Rate for Payer: United Healthcare Commercial |
$1,724.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,542.75
|
|
|
EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$3,627.00
|
|
|
Service Code
|
HCPCS 19120 50
|
| Min. Negotiated Rate |
$2,720.25 |
| Max. Negotiated Rate |
$3,627.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,554.46
|
| Rate for Payer: Beech Street Commercial |
$3,445.65
|
| Rate for Payer: Cash Price |
$2,538.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,518.19
|
| Rate for Payer: Cigna of WY Commercial |
$3,554.46
|
| Rate for Payer: First Choice Health Commercial |
$3,264.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,445.65
|
| Rate for Payer: HealthUtah PPO |
$3,627.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,518.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,554.46
|
| Rate for Payer: PacificSource Commercial |
$3,264.30
|
| Rate for Payer: PHCS PPO |
$3,445.65
|
| Rate for Payer: Three Rivers PPO |
$2,720.25
|
| Rate for Payer: United Healthcare Commercial |
$3,445.65
|
| Rate for Payer: WINHealth Partners Commercial |
$3,082.95
|
|
|
EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$9,948.00
|
|
|
Service Code
|
HCPCS 26390 AS
|
| Min. Negotiated Rate |
$7,461.00 |
| Max. Negotiated Rate |
$9,948.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,749.04
|
| Rate for Payer: Beech Street Commercial |
$9,450.60
|
| Rate for Payer: Cash Price |
$6,963.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,649.56
|
| Rate for Payer: Cigna of WY Commercial |
$9,749.04
|
| Rate for Payer: First Choice Health Commercial |
$8,953.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,450.60
|
| Rate for Payer: HealthUtah PPO |
$9,948.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,649.56
|
| Rate for Payer: One Health Plan of WY PPO |
$9,749.04
|
| Rate for Payer: PacificSource Commercial |
$8,953.20
|
| Rate for Payer: PHCS PPO |
$9,450.60
|
| Rate for Payer: Three Rivers PPO |
$7,461.00
|
| Rate for Payer: United Healthcare Commercial |
$9,450.60
|
| Rate for Payer: WINHealth Partners Commercial |
$8,455.80
|
|
|
EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$9,949.00
|
|
|
Service Code
|
HCPCS 26390
|
| Min. Negotiated Rate |
$727.29 |
| Max. Negotiated Rate |
$9,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,750.02
|
| Rate for Payer: Aetna of WY Medicare |
$855.64
|
| Rate for Payer: Beech Street Commercial |
$9,451.55
|
| Rate for Payer: Cash Price |
$6,964.30
|
| Rate for Payer: Cash Price |
$6,964.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,650.53
|
| Rate for Payer: Cigna of WY Commercial |
$9,750.02
|
| Rate for Payer: First Choice Health Commercial |
$8,954.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,451.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$855.64
|
| Rate for Payer: HealthUtah PPO |
$9,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,650.53
|
| Rate for Payer: Multiplan Medicare/VA |
$727.29
|
| Rate for Payer: One Health Plan of WY PPO |
$9,750.02
|
| Rate for Payer: PacificSource Commercial |
$8,954.10
|
| Rate for Payer: PHCS PPO |
$9,451.55
|
| Rate for Payer: Three Rivers PPO |
$7,461.75
|
| Rate for Payer: TriWest Veterans Administration |
$855.64
|
| Rate for Payer: United Healthcare Commercial |
$9,451.55
|
| Rate for Payer: WINHealth Partners Commercial |
$8,456.65
|
|
|
EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 40819
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$916.30
|
| Rate for Payer: Aetna of WY Medicare |
$194.74
|
| Rate for Payer: Beech Street Commercial |
$888.25
|
| Rate for Payer: Cash Price |
$654.50
|
| Rate for Payer: Cash Price |
$654.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$906.95
|
| Rate for Payer: Cigna of WY Commercial |
$916.30
|
| Rate for Payer: First Choice Health Commercial |
$841.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$888.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.74
|
| Rate for Payer: HealthUtah PPO |
$935.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$906.95
|
| Rate for Payer: Multiplan Medicare/VA |
$165.53
|
| Rate for Payer: One Health Plan of WY PPO |
$916.30
|
| Rate for Payer: PacificSource Commercial |
$841.50
|
| Rate for Payer: PHCS PPO |
$888.25
|
| Rate for Payer: Three Rivers PPO |
$701.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.74
|
| Rate for Payer: United Healthcare Commercial |
$888.25
|
| Rate for Payer: WINHealth Partners Commercial |
$794.75
|
|
|
EXCIS CHEST WALL TUMOR/RIBS
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
HCPCS 19260
|
| Min. Negotiated Rate |
$2,580.75 |
| Max. Negotiated Rate |
$3,441.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,372.18
|
| Rate for Payer: Beech Street Commercial |
$3,268.95
|
| Rate for Payer: Cash Price |
$2,408.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,337.77
|
| Rate for Payer: Cigna of WY Commercial |
$3,372.18
|
| Rate for Payer: First Choice Health Commercial |
$3,096.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,268.95
|
| Rate for Payer: HealthUtah PPO |
$3,441.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,337.77
|
| Rate for Payer: One Health Plan of WY PPO |
$3,372.18
|
| Rate for Payer: PacificSource Commercial |
$3,096.90
|
| Rate for Payer: PHCS PPO |
$3,268.95
|
| Rate for Payer: Three Rivers PPO |
$2,580.75
|
| Rate for Payer: United Healthcare Commercial |
$3,268.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,924.85
|
|
|
EXCISION AURAL GLOMUS TUMOR TRANSCANAL
|
Professional
|
Both
|
$3,104.00
|
|
|
Service Code
|
HCPCS 69550
|
| Min. Negotiated Rate |
$879.43 |
| Max. Negotiated Rate |
$3,104.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,041.92
|
| Rate for Payer: Aetna of WY Medicare |
$1,034.62
|
| Rate for Payer: Beech Street Commercial |
$2,948.80
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,010.88
|
| Rate for Payer: Cigna of WY Commercial |
$3,041.92
|
| Rate for Payer: First Choice Health Commercial |
$2,793.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,948.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,034.62
|
| Rate for Payer: HealthUtah PPO |
$3,104.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,010.88
|
| Rate for Payer: Multiplan Medicare/VA |
$879.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,041.92
|
| Rate for Payer: PacificSource Commercial |
$2,793.60
|
| Rate for Payer: PHCS PPO |
$2,948.80
|
| Rate for Payer: Three Rivers PPO |
$2,328.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,034.62
|
| Rate for Payer: United Healthcare Commercial |
$2,948.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,638.40
|
|
|
EXCISION AURAL POLYP
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
HCPCS 69540
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Three Rivers PPO |
$414.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$540.96
|
| Rate for Payer: Aetna of WY Medicare |
$127.72
|
| Rate for Payer: Beech Street Commercial |
$524.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$535.44
|
| Rate for Payer: Cigna of WY Commercial |
$540.96
|
| Rate for Payer: First Choice Health Commercial |
$496.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$524.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.72
|
| Rate for Payer: HealthUtah PPO |
$552.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$535.44
|
| Rate for Payer: Multiplan Medicare/VA |
$108.56
|
| Rate for Payer: One Health Plan of WY PPO |
$540.96
|
| Rate for Payer: PacificSource Commercial |
$496.80
|
| Rate for Payer: PHCS PPO |
$524.40
|
| Rate for Payer: TriWest Veterans Administration |
$127.72
|
| Rate for Payer: United Healthcare Commercial |
$524.40
|
| Rate for Payer: WINHealth Partners Commercial |
$469.20
|
|
|
EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA
|
Professional
|
Both
|
$6,488.00
|
|
|
Service Code
|
HCPCS 27635
|
| Min. Negotiated Rate |
$479.82 |
| Max. Negotiated Rate |
$6,488.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,358.24
|
| Rate for Payer: Aetna of WY Medicare |
$564.49
|
| Rate for Payer: Beech Street Commercial |
$6,163.60
|
| Rate for Payer: Cash Price |
$4,541.60
|
| Rate for Payer: Cash Price |
$4,541.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,293.36
|
| Rate for Payer: Cigna of WY Commercial |
$6,358.24
|
| Rate for Payer: First Choice Health Commercial |
$5,839.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,163.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$564.49
|
| Rate for Payer: HealthUtah PPO |
$6,488.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,293.36
|
| Rate for Payer: Multiplan Medicare/VA |
$479.82
|
| Rate for Payer: One Health Plan of WY PPO |
$6,358.24
|
| Rate for Payer: PacificSource Commercial |
$5,839.20
|
| Rate for Payer: PHCS PPO |
$6,163.60
|
| Rate for Payer: Three Rivers PPO |
$4,866.00
|
| Rate for Payer: TriWest Veterans Administration |
$564.49
|
| Rate for Payer: United Healthcare Commercial |
$6,163.60
|
| Rate for Payer: WINHealth Partners Commercial |
$5,514.80
|
|
|
EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA
|
Professional
|
Both
|
$5,322.00
|
|
|
Service Code
|
HCPCS 27635 80
|
| Min. Negotiated Rate |
$3,991.50 |
| Max. Negotiated Rate |
$5,322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,215.56
|
| Rate for Payer: Beech Street Commercial |
$5,055.90
|
| Rate for Payer: Cash Price |
$3,725.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,162.34
|
| Rate for Payer: Cigna of WY Commercial |
$5,215.56
|
| Rate for Payer: First Choice Health Commercial |
$4,789.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,055.90
|
| Rate for Payer: HealthUtah PPO |
$5,322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,162.34
|
| Rate for Payer: One Health Plan of WY PPO |
$5,215.56
|
| Rate for Payer: PacificSource Commercial |
$4,789.80
|
| Rate for Payer: PHCS PPO |
$5,055.90
|
| Rate for Payer: Three Rivers PPO |
$3,991.50
|
| Rate for Payer: United Healthcare Commercial |
$5,055.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,523.70
|
|
|
EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES
|
Professional
|
Both
|
$4,455.00
|
|
|
Service Code
|
HCPCS 25130
|
| Min. Negotiated Rate |
$378.62 |
| Max. Negotiated Rate |
$4,455.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,365.90
|
| Rate for Payer: Aetna of WY Medicare |
$445.44
|
| Rate for Payer: Beech Street Commercial |
$4,232.25
|
| Rate for Payer: Cash Price |
$3,118.50
|
| Rate for Payer: Cash Price |
$3,118.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,321.35
|
| Rate for Payer: Cigna of WY Commercial |
$4,365.90
|
| Rate for Payer: First Choice Health Commercial |
$4,009.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,232.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.44
|
| Rate for Payer: HealthUtah PPO |
$4,455.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,321.35
|
| Rate for Payer: Multiplan Medicare/VA |
$378.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4,365.90
|
| Rate for Payer: PacificSource Commercial |
$4,009.50
|
| Rate for Payer: PHCS PPO |
$4,232.25
|
| Rate for Payer: Three Rivers PPO |
$3,341.25
|
| Rate for Payer: TriWest Veterans Administration |
$445.44
|
| Rate for Payer: United Healthcare Commercial |
$4,232.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,786.75
|
|
|
EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$4,947.00
|
|
|
Service Code
|
HCPCS 27355 80
|
| Min. Negotiated Rate |
$504.38 |
| Max. Negotiated Rate |
$4,947.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,848.06
|
| Rate for Payer: Beech Street Commercial |
$4,699.65
|
| Rate for Payer: Cash Price |
$3,462.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,798.59
|
| Rate for Payer: Cigna of WY Commercial |
$4,848.06
|
| Rate for Payer: First Choice Health Commercial |
$4,452.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,699.65
|
| Rate for Payer: HealthUtah PPO |
$4,947.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,798.59
|
| Rate for Payer: One Health Plan of WY PPO |
$4,848.06
|
| Rate for Payer: PacificSource Commercial |
$4,452.30
|
| Rate for Payer: PHCS PPO |
$4,699.65
|
| Rate for Payer: Three Rivers PPO |
$3,710.25
|
| Rate for Payer: United Healthcare Commercial |
$4,699.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,204.95
|
|
|
EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$4,947.00
|
|
|
Service Code
|
HCPCS 27355
|
| Min. Negotiated Rate |
$504.38 |
| Max. Negotiated Rate |
$4,947.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,848.06
|
| Rate for Payer: Aetna of WY Medicare |
$593.39
|
| Rate for Payer: Beech Street Commercial |
$4,699.65
|
| Rate for Payer: Cash Price |
$3,462.90
|
| Rate for Payer: Cash Price |
$3,462.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,798.59
|
| Rate for Payer: Cigna of WY Commercial |
$4,848.06
|
| Rate for Payer: First Choice Health Commercial |
$4,452.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,699.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.39
|
| Rate for Payer: HealthUtah PPO |
$4,947.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,798.59
|
| Rate for Payer: Multiplan Medicare/VA |
$504.38
|
| Rate for Payer: One Health Plan of WY PPO |
$4,848.06
|
| Rate for Payer: PacificSource Commercial |
$4,452.30
|
| Rate for Payer: PHCS PPO |
$4,699.65
|
| Rate for Payer: Three Rivers PPO |
$3,710.25
|
| Rate for Payer: TriWest Veterans Administration |
$593.39
|
| Rate for Payer: United Healthcare Commercial |
$4,699.65
|
| Rate for Payer: WINHealth Partners Commercial |
$4,204.95
|
|
|
EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 27355 AS
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$968.24
|
| Rate for Payer: Beech Street Commercial |
$938.60
|
| Rate for Payer: Cash Price |
$691.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$958.36
|
| Rate for Payer: Cigna of WY Commercial |
$968.24
|
| Rate for Payer: First Choice Health Commercial |
$889.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$938.60
|
| Rate for Payer: HealthUtah PPO |
$988.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$958.36
|
| Rate for Payer: One Health Plan of WY PPO |
$968.24
|
| Rate for Payer: PacificSource Commercial |
$889.20
|
| Rate for Payer: PHCS PPO |
$938.60
|
| Rate for Payer: Three Rivers PPO |
$741.00
|
| Rate for Payer: United Healthcare Commercial |
$938.60
|
| Rate for Payer: WINHealth Partners Commercial |
$839.80
|
|
|
EXCISION/CURETTAGE CYST/TUMOR METACARPAL
|
Professional
|
Both
|
$4,808.00
|
|
|
Service Code
|
HCPCS 26200
|
| Min. Negotiated Rate |
$377.36 |
| Max. Negotiated Rate |
$4,808.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,711.84
|
| Rate for Payer: Aetna of WY Medicare |
$443.95
|
| Rate for Payer: Beech Street Commercial |
$4,567.60
|
| Rate for Payer: Cash Price |
$3,365.60
|
| Rate for Payer: Cash Price |
$3,365.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,663.76
|
| Rate for Payer: Cigna of WY Commercial |
$4,711.84
|
| Rate for Payer: First Choice Health Commercial |
$4,327.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,567.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.95
|
| Rate for Payer: HealthUtah PPO |
$4,808.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,663.76
|
| Rate for Payer: Multiplan Medicare/VA |
$377.36
|
| Rate for Payer: One Health Plan of WY PPO |
$4,711.84
|
| Rate for Payer: PacificSource Commercial |
$4,327.20
|
| Rate for Payer: PHCS PPO |
$4,567.60
|
| Rate for Payer: Three Rivers PPO |
$3,606.00
|
| Rate for Payer: TriWest Veterans Administration |
$443.95
|
| Rate for Payer: United Healthcare Commercial |
$4,567.60
|
| Rate for Payer: WINHealth Partners Commercial |
$4,086.80
|
|
|
EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER
|
Professional
|
Both
|
$4,332.00
|
|
|
Service Code
|
HCPCS 26210
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$4,332.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,245.36
|
| Rate for Payer: Aetna of WY Medicare |
$442.58
|
| Rate for Payer: Beech Street Commercial |
$4,115.40
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,202.04
|
| Rate for Payer: Cigna of WY Commercial |
$4,245.36
|
| Rate for Payer: First Choice Health Commercial |
$3,898.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,115.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$442.58
|
| Rate for Payer: HealthUtah PPO |
$4,332.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,202.04
|
| Rate for Payer: Multiplan Medicare/VA |
$376.19
|
| Rate for Payer: One Health Plan of WY PPO |
$4,245.36
|
| Rate for Payer: PacificSource Commercial |
$3,898.80
|
| Rate for Payer: PHCS PPO |
$4,115.40
|
| Rate for Payer: Three Rivers PPO |
$3,249.00
|
| Rate for Payer: TriWest Veterans Administration |
$442.58
|
| Rate for Payer: United Healthcare Commercial |
$4,115.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,682.20
|
|
|
EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA
|
Professional
|
Both
|
$4,771.00
|
|
|
Service Code
|
HCPCS 25120
|
| Min. Negotiated Rate |
$419.55 |
| Max. Negotiated Rate |
$4,771.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,675.58
|
| Rate for Payer: Aetna of WY Medicare |
$493.59
|
| Rate for Payer: Beech Street Commercial |
$4,532.45
|
| Rate for Payer: Cash Price |
$3,339.70
|
| Rate for Payer: Cash Price |
$3,339.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,627.87
|
| Rate for Payer: Cigna of WY Commercial |
$4,675.58
|
| Rate for Payer: First Choice Health Commercial |
$4,293.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,532.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$493.59
|
| Rate for Payer: HealthUtah PPO |
$4,771.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,627.87
|
| Rate for Payer: Multiplan Medicare/VA |
$419.55
|
| Rate for Payer: One Health Plan of WY PPO |
$4,675.58
|
| Rate for Payer: PacificSource Commercial |
$4,293.90
|
| Rate for Payer: PHCS PPO |
$4,532.45
|
| Rate for Payer: Three Rivers PPO |
$3,578.25
|
| Rate for Payer: TriWest Veterans Administration |
$493.59
|
| Rate for Payer: United Healthcare Commercial |
$4,532.45
|
| Rate for Payer: WINHealth Partners Commercial |
$4,055.35
|
|
|
EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA
|
Professional
|
Both
|
$4,771.00
|
|
|
Service Code
|
HCPCS 25120 AS
|
| Min. Negotiated Rate |
$419.55 |
| Max. Negotiated Rate |
$4,771.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,675.58
|
| Rate for Payer: Beech Street Commercial |
$4,532.45
|
| Rate for Payer: Cash Price |
$3,339.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,627.87
|
| Rate for Payer: Cigna of WY Commercial |
$4,675.58
|
| Rate for Payer: First Choice Health Commercial |
$4,293.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,532.45
|
| Rate for Payer: HealthUtah PPO |
$4,771.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,627.87
|
| Rate for Payer: One Health Plan of WY PPO |
$4,675.58
|
| Rate for Payer: PacificSource Commercial |
$4,293.90
|
| Rate for Payer: PHCS PPO |
$4,532.45
|
| Rate for Payer: Three Rivers PPO |
$3,578.25
|
| Rate for Payer: United Healthcare Commercial |
$4,532.45
|
| Rate for Payer: WINHealth Partners Commercial |
$4,055.35
|
|
|
EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS
|
Professional
|
Both
|
$3,168.00
|
|
|
Service Code
|
HCPCS 28100
|
| Min. Negotiated Rate |
$346.68 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,104.64
|
| Rate for Payer: Aetna of WY Medicare |
$407.86
|
| Rate for Payer: Beech Street Commercial |
$3,009.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,072.96
|
| Rate for Payer: Cigna of WY Commercial |
$3,104.64
|
| Rate for Payer: First Choice Health Commercial |
$2,851.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,009.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.86
|
| Rate for Payer: HealthUtah PPO |
$3,168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,072.96
|
| Rate for Payer: Multiplan Medicare/VA |
$346.68
|
| Rate for Payer: One Health Plan of WY PPO |
$3,104.64
|
| Rate for Payer: PacificSource Commercial |
$2,851.20
|
| Rate for Payer: PHCS PPO |
$3,009.60
|
| Rate for Payer: Three Rivers PPO |
$2,376.00
|
| Rate for Payer: TriWest Veterans Administration |
$407.86
|
| Rate for Payer: United Healthcare Commercial |
$3,009.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,692.80
|
|
|
EXCISION/DESTRUCTION INTRANASAL LESION INT APPR
|
Professional
|
Both
|
$1,456.00
|
|
|
Service Code
|
HCPCS 30117
|
| Min. Negotiated Rate |
$343.84 |
| Max. Negotiated Rate |
$1,456.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,426.88
|
| Rate for Payer: Aetna of WY Medicare |
$404.52
|
| Rate for Payer: Beech Street Commercial |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,412.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,426.88
|
| Rate for Payer: First Choice Health Commercial |
$1,310.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,383.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$404.52
|
| Rate for Payer: HealthUtah PPO |
$1,456.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,412.32
|
| Rate for Payer: Multiplan Medicare/VA |
$343.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1,426.88
|
| Rate for Payer: PacificSource Commercial |
$1,310.40
|
| Rate for Payer: PHCS PPO |
$1,383.20
|
| Rate for Payer: Three Rivers PPO |
$1,092.00
|
| Rate for Payer: TriWest Veterans Administration |
$404.52
|
| Rate for Payer: United Healthcare Commercial |
$1,383.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,237.60
|
|
|
EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$5,280.00
|
|
|
Service Code
|
HCPCS 49203 80
|
| Min. Negotiated Rate |
$965.47 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,174.40
|
| Rate for Payer: Beech Street Commercial |
$5,016.00
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,121.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,174.40
|
| Rate for Payer: First Choice Health Commercial |
$4,752.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,016.00
|
| Rate for Payer: HealthUtah PPO |
$5,280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,121.60
|
| Rate for Payer: One Health Plan of WY PPO |
$5,174.40
|
| Rate for Payer: PacificSource Commercial |
$4,752.00
|
| Rate for Payer: PHCS PPO |
$5,016.00
|
| Rate for Payer: Three Rivers PPO |
$3,960.00
|
| Rate for Payer: United Healthcare Commercial |
$5,016.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,488.00
|
|
|
EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$5,280.00
|
|
|
Service Code
|
HCPCS 49203 AS
|
| Min. Negotiated Rate |
$965.47 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,174.40
|
| Rate for Payer: Beech Street Commercial |
$5,016.00
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,121.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,174.40
|
| Rate for Payer: First Choice Health Commercial |
$4,752.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,016.00
|
| Rate for Payer: HealthUtah PPO |
$5,280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,121.60
|
| Rate for Payer: One Health Plan of WY PPO |
$5,174.40
|
| Rate for Payer: PacificSource Commercial |
$4,752.00
|
| Rate for Payer: PHCS PPO |
$5,016.00
|
| Rate for Payer: Three Rivers PPO |
$3,960.00
|
| Rate for Payer: United Healthcare Commercial |
$5,016.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,488.00
|
|
|
EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$5,280.00
|
|
|
Service Code
|
HCPCS 49203
|
| Min. Negotiated Rate |
$965.47 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,174.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.85
|
| Rate for Payer: Beech Street Commercial |
$5,016.00
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: Cash Price |
$3,696.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,121.60
|
| Rate for Payer: Cigna of WY Commercial |
$5,174.40
|
| Rate for Payer: First Choice Health Commercial |
$4,752.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,016.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.85
|
| Rate for Payer: HealthUtah PPO |
$5,280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,121.60
|
| Rate for Payer: Multiplan Medicare/VA |
$965.47
|
| Rate for Payer: One Health Plan of WY PPO |
$5,174.40
|
| Rate for Payer: PacificSource Commercial |
$4,752.00
|
| Rate for Payer: PHCS PPO |
$5,016.00
|
| Rate for Payer: Three Rivers PPO |
$3,960.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.85
|
| Rate for Payer: United Healthcare Commercial |
$5,016.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,488.00
|
|
|
EXCISION DISTAL ULNA PARTIAL/COMPLETE
|
Professional
|
Both
|
$3,033.00
|
|
|
Service Code
|
HCPCS 25240
|
| Min. Negotiated Rate |
$360.82 |
| Max. Negotiated Rate |
$3,033.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,972.34
|
| Rate for Payer: Aetna of WY Medicare |
$424.49
|
| Rate for Payer: Beech Street Commercial |
$2,881.35
|
| Rate for Payer: Cash Price |
$2,123.10
|
| Rate for Payer: Cash Price |
$2,123.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,942.01
|
| Rate for Payer: Cigna of WY Commercial |
$2,972.34
|
| Rate for Payer: First Choice Health Commercial |
$2,729.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,881.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.49
|
| Rate for Payer: HealthUtah PPO |
$3,033.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,942.01
|
| Rate for Payer: Multiplan Medicare/VA |
$360.82
|
| Rate for Payer: One Health Plan of WY PPO |
$2,972.34
|
| Rate for Payer: PacificSource Commercial |
$2,729.70
|
| Rate for Payer: PHCS PPO |
$2,881.35
|
| Rate for Payer: Three Rivers PPO |
$2,274.75
|
| Rate for Payer: TriWest Veterans Administration |
$424.49
|
| Rate for Payer: United Healthcare Commercial |
$2,881.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,578.05
|
|
|
EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$3,718.00
|
|
|
Service Code
|
HCPCS 69140
|
| Min. Negotiated Rate |
$748.54 |
| Max. Negotiated Rate |
$3,718.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,643.64
|
| Rate for Payer: Aetna of WY Medicare |
$880.63
|
| Rate for Payer: Beech Street Commercial |
$3,532.10
|
| Rate for Payer: Cash Price |
$2,602.60
|
| Rate for Payer: Cash Price |
$2,602.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,606.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,643.64
|
| Rate for Payer: First Choice Health Commercial |
$3,346.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,532.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$880.63
|
| Rate for Payer: HealthUtah PPO |
$3,718.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,606.46
|
| Rate for Payer: Multiplan Medicare/VA |
$748.54
|
| Rate for Payer: One Health Plan of WY PPO |
$3,643.64
|
| Rate for Payer: PacificSource Commercial |
$3,346.20
|
| Rate for Payer: PHCS PPO |
$3,532.10
|
| Rate for Payer: Three Rivers PPO |
$2,788.50
|
| Rate for Payer: TriWest Veterans Administration |
$880.63
|
| Rate for Payer: United Healthcare Commercial |
$3,532.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,160.30
|
|
