|
EXCISION EXTERNAL EAR COMPLETE AMPUTATION
|
Professional
|
Both
|
$1,716.00
|
|
|
Service Code
|
HCPCS 69120
|
| Min. Negotiated Rate |
$321.71 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,681.68
|
| Rate for Payer: Aetna of WY Medicare |
$378.48
|
| Rate for Payer: Beech Street Commercial |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,201.20
|
| Rate for Payer: Cash Price |
$1,201.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,664.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,681.68
|
| Rate for Payer: First Choice Health Commercial |
$1,544.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,630.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.48
|
| Rate for Payer: HealthUtah PPO |
$1,716.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,664.52
|
| Rate for Payer: Multiplan Medicare/VA |
$321.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1,681.68
|
| Rate for Payer: PacificSource Commercial |
$1,544.40
|
| Rate for Payer: PHCS PPO |
$1,630.20
|
| Rate for Payer: Three Rivers PPO |
$1,287.00
|
| Rate for Payer: TriWest Veterans Administration |
$378.48
|
| Rate for Payer: United Healthcare Commercial |
$1,630.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,458.60
|
|
|
EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 69110
|
| Min. Negotiated Rate |
$272.04 |
| Max. Negotiated Rate |
$1,426.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,397.48
|
| Rate for Payer: Aetna of WY Medicare |
$320.05
|
| Rate for Payer: Beech Street Commercial |
$1,354.70
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: Cash Price |
$998.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,383.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,397.48
|
| Rate for Payer: First Choice Health Commercial |
$1,283.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,354.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.05
|
| Rate for Payer: HealthUtah PPO |
$1,426.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,383.22
|
| Rate for Payer: Multiplan Medicare/VA |
$272.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,397.48
|
| Rate for Payer: PacificSource Commercial |
$1,283.40
|
| Rate for Payer: PHCS PPO |
$1,354.70
|
| Rate for Payer: Three Rivers PPO |
$1,069.50
|
| Rate for Payer: TriWest Veterans Administration |
$320.05
|
| Rate for Payer: United Healthcare Commercial |
$1,354.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,212.10
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 25111
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$1,418.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,389.64
|
| Rate for Payer: Aetna of WY Medicare |
$322.94
|
| Rate for Payer: Beech Street Commercial |
$1,347.10
|
| Rate for Payer: Cash Price |
$992.60
|
| Rate for Payer: Cash Price |
$992.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,375.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,389.64
|
| Rate for Payer: First Choice Health Commercial |
$1,276.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,347.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$322.94
|
| Rate for Payer: HealthUtah PPO |
$1,418.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,375.46
|
| Rate for Payer: Multiplan Medicare/VA |
$274.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,389.64
|
| Rate for Payer: PacificSource Commercial |
$1,276.20
|
| Rate for Payer: PHCS PPO |
$1,347.10
|
| Rate for Payer: Three Rivers PPO |
$1,063.50
|
| Rate for Payer: TriWest Veterans Administration |
$322.94
|
| Rate for Payer: United Healthcare Commercial |
$1,347.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,205.30
|
|
|
EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT
|
Professional
|
Both
|
$6,724.00
|
|
|
Service Code
|
HCPCS 25112
|
| Min. Negotiated Rate |
$328.57 |
| Max. Negotiated Rate |
$6,724.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,589.52
|
| Rate for Payer: Aetna of WY Medicare |
$386.55
|
| Rate for Payer: Beech Street Commercial |
$6,387.80
|
| Rate for Payer: Cash Price |
$4,706.80
|
| Rate for Payer: Cash Price |
$4,706.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,522.28
|
| Rate for Payer: Cigna of WY Commercial |
$6,589.52
|
| Rate for Payer: First Choice Health Commercial |
$6,051.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,387.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$386.55
|
| Rate for Payer: HealthUtah PPO |
$6,724.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,522.28
|
| Rate for Payer: Multiplan Medicare/VA |
$328.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,589.52
|
| Rate for Payer: PacificSource Commercial |
$6,051.60
|
| Rate for Payer: PHCS PPO |
$6,387.80
|
| Rate for Payer: Three Rivers PPO |
$5,043.00
|
| Rate for Payer: TriWest Veterans Administration |
$386.55
|
| Rate for Payer: United Healthcare Commercial |
$6,387.80
|
| Rate for Payer: WINHealth Partners Commercial |
$5,715.40
|
|
|
EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
Both
|
$1,093.00
|
|
|
Service Code
|
HCPCS 11450
|
| Min. Negotiated Rate |
$215.61 |
| Max. Negotiated Rate |
$1,093.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,071.14
|
| Rate for Payer: Aetna of WY Medicare |
$253.66
|
| Rate for Payer: Beech Street Commercial |
$1,038.35
|
| Rate for Payer: Cash Price |
$765.10
|
| Rate for Payer: Cash Price |
$765.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,060.21
|
| Rate for Payer: Cigna of WY Commercial |
$1,071.14
|
| Rate for Payer: First Choice Health Commercial |
$983.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,038.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.66
|
| Rate for Payer: HealthUtah PPO |
$1,093.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,060.21
|
| Rate for Payer: Multiplan Medicare/VA |
$215.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,071.14
|
| Rate for Payer: PacificSource Commercial |
$983.70
|
| Rate for Payer: PHCS PPO |
$1,038.35
|
| Rate for Payer: Three Rivers PPO |
$819.75
|
| Rate for Payer: TriWest Veterans Administration |
$253.66
|
| Rate for Payer: United Healthcare Commercial |
$1,038.35
|
| Rate for Payer: WINHealth Partners Commercial |
$929.05
|
|
|
EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 11470
|
| Min. Negotiated Rate |
$235.92 |
| Max. Negotiated Rate |
$1,205.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,180.90
|
| Rate for Payer: Aetna of WY Medicare |
$277.55
|
| Rate for Payer: Beech Street Commercial |
$1,144.75
|
| Rate for Payer: Cash Price |
$843.50
|
| Rate for Payer: Cash Price |
$843.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,168.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,180.90
|
| Rate for Payer: First Choice Health Commercial |
$1,084.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,144.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.55
|
| Rate for Payer: HealthUtah PPO |
$1,205.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,168.85
|
| Rate for Payer: Multiplan Medicare/VA |
$235.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,180.90
|
| Rate for Payer: PacificSource Commercial |
$1,084.50
|
| Rate for Payer: PHCS PPO |
$1,144.75
|
| Rate for Payer: Three Rivers PPO |
$903.75
|
| Rate for Payer: TriWest Veterans Administration |
$277.55
|
| Rate for Payer: United Healthcare Commercial |
$1,144.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,024.25
|
|
|
EXCISION HYDROCELE UNILATERAL
|
Professional
|
Both
|
$1,396.00
|
|
|
Service Code
|
HCPCS 55040
|
| Min. Negotiated Rate |
$279.09 |
| Max. Negotiated Rate |
$1,396.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,368.08
|
| Rate for Payer: Aetna of WY Medicare |
$328.34
|
| Rate for Payer: Beech Street Commercial |
$1,326.20
|
| Rate for Payer: Cash Price |
$977.20
|
| Rate for Payer: Cash Price |
$977.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,354.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,368.08
|
| Rate for Payer: First Choice Health Commercial |
$1,256.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,326.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.34
|
| Rate for Payer: HealthUtah PPO |
$1,396.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,354.12
|
| Rate for Payer: Multiplan Medicare/VA |
$279.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,368.08
|
| Rate for Payer: PacificSource Commercial |
$1,256.40
|
| Rate for Payer: PHCS PPO |
$1,326.20
|
| Rate for Payer: Three Rivers PPO |
$1,047.00
|
| Rate for Payer: TriWest Veterans Administration |
$328.34
|
| Rate for Payer: United Healthcare Commercial |
$1,326.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,186.60
|
|
|
EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$4,861.00
|
|
|
Service Code
|
HCPCS 30130
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$4,861.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,763.78
|
| Rate for Payer: Aetna of WY Medicare |
$408.39
|
| Rate for Payer: Beech Street Commercial |
$4,617.95
|
| Rate for Payer: Cash Price |
$3,402.70
|
| Rate for Payer: Cash Price |
$3,402.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,715.17
|
| Rate for Payer: Cigna of WY Commercial |
$4,763.78
|
| Rate for Payer: First Choice Health Commercial |
$4,374.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,617.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.39
|
| Rate for Payer: HealthUtah PPO |
$4,861.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,715.17
|
| Rate for Payer: Multiplan Medicare/VA |
$347.13
|
| Rate for Payer: One Health Plan of WY PPO |
$4,763.78
|
| Rate for Payer: PacificSource Commercial |
$4,374.90
|
| Rate for Payer: PHCS PPO |
$4,617.95
|
| Rate for Payer: Three Rivers PPO |
$3,645.75
|
| Rate for Payer: TriWest Veterans Administration |
$408.39
|
| Rate for Payer: United Healthcare Commercial |
$4,617.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4,131.85
|
|
|
EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$9,722.00
|
|
|
Service Code
|
HCPCS 30130 50
|
| Min. Negotiated Rate |
$7,291.50 |
| Max. Negotiated Rate |
$9,722.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,527.56
|
| Rate for Payer: Beech Street Commercial |
$9,235.90
|
| Rate for Payer: Cash Price |
$6,805.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,430.34
|
| Rate for Payer: Cigna of WY Commercial |
$9,527.56
|
| Rate for Payer: First Choice Health Commercial |
$8,749.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,235.90
|
| Rate for Payer: HealthUtah PPO |
$9,722.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,430.34
|
| Rate for Payer: One Health Plan of WY PPO |
$9,527.56
|
| Rate for Payer: PacificSource Commercial |
$8,749.80
|
| Rate for Payer: PHCS PPO |
$9,235.90
|
| Rate for Payer: Three Rivers PPO |
$7,291.50
|
| Rate for Payer: United Healthcare Commercial |
$9,235.90
|
| Rate for Payer: WINHealth Partners Commercial |
$8,263.70
|
|
|
EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 28080
|
| Min. Negotiated Rate |
$316.09 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,600.34
|
| Rate for Payer: Aetna of WY Medicare |
$371.87
|
| Rate for Payer: Beech Street Commercial |
$1,551.35
|
| Rate for Payer: Cash Price |
$1,143.10
|
| Rate for Payer: Cash Price |
$1,143.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,584.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,600.34
|
| Rate for Payer: First Choice Health Commercial |
$1,469.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,551.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.87
|
| Rate for Payer: HealthUtah PPO |
$1,633.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,584.01
|
| Rate for Payer: Multiplan Medicare/VA |
$316.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,600.34
|
| Rate for Payer: PacificSource Commercial |
$1,469.70
|
| Rate for Payer: PHCS PPO |
$1,551.35
|
| Rate for Payer: Three Rivers PPO |
$1,224.75
|
| Rate for Payer: TriWest Veterans Administration |
$371.87
|
| Rate for Payer: United Healthcare Commercial |
$1,551.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,388.05
|
|
|
EXCISION LESION CONJUNCTIVA <1 CM
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 68110
|
| Min. Negotiated Rate |
$771.75 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,008.42
|
| Rate for Payer: Beech Street Commercial |
$977.55
|
| Rate for Payer: Cash Price |
$720.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$998.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,008.42
|
| Rate for Payer: First Choice Health Commercial |
$926.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$977.55
|
| Rate for Payer: HealthUtah PPO |
$1,029.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$998.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,008.42
|
| Rate for Payer: PacificSource Commercial |
$926.10
|
| Rate for Payer: PHCS PPO |
$977.55
|
| Rate for Payer: Three Rivers PPO |
$771.75
|
| Rate for Payer: United Healthcare Commercial |
$977.55
|
| Rate for Payer: WINHealth Partners Commercial |
$874.65
|
|
|
EXCISION LESION MENISCUS/CAPSULE KNEE
|
Professional
|
Both
|
$1,848.00
|
|
|
Service Code
|
HCPCS 27347
|
| Min. Negotiated Rate |
$439.48 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,811.04
|
| Rate for Payer: Aetna of WY Medicare |
$517.04
|
| Rate for Payer: Beech Street Commercial |
$1,755.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,792.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,811.04
|
| Rate for Payer: First Choice Health Commercial |
$1,663.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,755.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.04
|
| Rate for Payer: HealthUtah PPO |
$1,848.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,792.56
|
| Rate for Payer: Multiplan Medicare/VA |
$439.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,811.04
|
| Rate for Payer: PacificSource Commercial |
$1,663.20
|
| Rate for Payer: PHCS PPO |
$1,755.60
|
| Rate for Payer: Three Rivers PPO |
$1,386.00
|
| Rate for Payer: TriWest Veterans Administration |
$517.04
|
| Rate for Payer: United Healthcare Commercial |
$1,755.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,570.80
|
|
|
EXCISION LESION MENISCUS/CAPSULE KNEE
|
Professional
|
Both
|
$1,848.00
|
|
|
Service Code
|
HCPCS 27347 AS
|
| Min. Negotiated Rate |
$439.48 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,811.04
|
| Rate for Payer: Beech Street Commercial |
$1,755.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,792.56
|
| Rate for Payer: Cigna of WY Commercial |
$1,811.04
|
| Rate for Payer: First Choice Health Commercial |
$1,663.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,755.60
|
| Rate for Payer: HealthUtah PPO |
$1,848.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,792.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,811.04
|
| Rate for Payer: PacificSource Commercial |
$1,663.20
|
| Rate for Payer: PHCS PPO |
$1,755.60
|
| Rate for Payer: Three Rivers PPO |
$1,386.00
|
| Rate for Payer: United Healthcare Commercial |
$1,755.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,570.80
|
|
|
EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK
|
Professional
|
Both
|
$1,588.00
|
|
|
Service Code
|
HCPCS 27630
|
| Min. Negotiated Rate |
$297.66 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,556.24
|
| Rate for Payer: Aetna of WY Medicare |
$350.19
|
| Rate for Payer: Beech Street Commercial |
$1,508.60
|
| Rate for Payer: Cash Price |
$1,111.60
|
| Rate for Payer: Cash Price |
$1,111.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,540.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,556.24
|
| Rate for Payer: First Choice Health Commercial |
$1,429.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,508.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.19
|
| Rate for Payer: HealthUtah PPO |
$1,588.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,540.36
|
| Rate for Payer: Multiplan Medicare/VA |
$297.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,556.24
|
| Rate for Payer: PacificSource Commercial |
$1,429.20
|
| Rate for Payer: PHCS PPO |
$1,508.60
|
| Rate for Payer: Three Rivers PPO |
$1,191.00
|
| Rate for Payer: TriWest Veterans Administration |
$350.19
|
| Rate for Payer: United Healthcare Commercial |
$1,508.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,349.80
|
|
|
EXCISION LESION TENDON SHEATH FOREARM&/WRIST
|
Professional
|
Both
|
$5,477.00
|
|
|
Service Code
|
HCPCS 25110
|
| Min. Negotiated Rate |
$291.10 |
| 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 |
$342.47
|
| 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 |
$342.47
|
| Rate for Payer: HealthUtah PPO |
$5,477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,312.69
|
| Rate for Payer: Multiplan Medicare/VA |
$291.10
|
| 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 |
$342.47
|
| Rate for Payer: United Healthcare Commercial |
$5,203.15
|
| Rate for Payer: WINHealth Partners Commercial |
$4,655.45
|
|
|
EXCISION LESION TONGUE W/O CLOSURE
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 41110
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$126.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.62
|
| Rate for Payer: Aetna of WY Medicare |
$126.80
|
| Rate for Payer: Beech Street Commercial |
$65.55
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.93
|
| Rate for Payer: Cigna of WY Commercial |
$67.62
|
| Rate for Payer: First Choice Health Commercial |
$62.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.80
|
| Rate for Payer: HealthUtah PPO |
$69.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.93
|
| Rate for Payer: Multiplan Medicare/VA |
$107.78
|
| Rate for Payer: One Health Plan of WY PPO |
$67.62
|
| Rate for Payer: PacificSource Commercial |
$62.10
|
| Rate for Payer: PHCS PPO |
$65.55
|
| Rate for Payer: Three Rivers PPO |
$51.75
|
| Rate for Payer: TriWest Veterans Administration |
$126.80
|
| Rate for Payer: United Healthcare Commercial |
$65.55
|
| Rate for Payer: WINHealth Partners Commercial |
$58.65
|
|
|
EXCISION LINGUAL FRENUM FRENECTOMY
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 41115
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$625.24
|
| Rate for Payer: Aetna of WY Medicare |
$142.59
|
| Rate for Payer: Beech Street Commercial |
$606.10
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$618.86
|
| Rate for Payer: Cigna of WY Commercial |
$625.24
|
| Rate for Payer: First Choice Health Commercial |
$574.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$606.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.59
|
| Rate for Payer: HealthUtah PPO |
$638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$618.86
|
| Rate for Payer: Multiplan Medicare/VA |
$121.20
|
| Rate for Payer: One Health Plan of WY PPO |
$625.24
|
| Rate for Payer: PacificSource Commercial |
$574.20
|
| Rate for Payer: PHCS PPO |
$606.10
|
| Rate for Payer: Three Rivers PPO |
$478.50
|
| Rate for Payer: TriWest Veterans Administration |
$142.59
|
| Rate for Payer: United Healthcare Commercial |
$606.10
|
| Rate for Payer: WINHealth Partners Commercial |
$542.30
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 11640
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$526.26
|
| Rate for Payer: Aetna of WY Medicare |
$122.96
|
| Rate for Payer: Beech Street Commercial |
$510.15
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$520.89
|
| Rate for Payer: Cigna of WY Commercial |
$526.26
|
| Rate for Payer: First Choice Health Commercial |
$483.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$510.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.96
|
| Rate for Payer: HealthUtah PPO |
$537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$520.89
|
| Rate for Payer: Multiplan Medicare/VA |
$104.52
|
| Rate for Payer: One Health Plan of WY PPO |
$526.26
|
| Rate for Payer: PacificSource Commercial |
$483.30
|
| Rate for Payer: PHCS PPO |
$510.15
|
| Rate for Payer: Three Rivers PPO |
$402.75
|
| Rate for Payer: TriWest Veterans Administration |
$122.96
|
| Rate for Payer: United Healthcare Commercial |
$510.15
|
| Rate for Payer: WINHealth Partners Commercial |
$456.45
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 11641
|
| Min. Negotiated Rate |
$127.74 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$150.28
|
| 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 |
$150.28
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$127.74
|
| 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 |
$150.28
|
| Rate for Payer: United Healthcare Commercial |
$631.75
|
| Rate for Payer: WINHealth Partners Commercial |
$565.25
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 11642
|
| Min. Negotiated Rate |
$149.22 |
| Max. Negotiated Rate |
$777.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$761.46
|
| Rate for Payer: Aetna of WY Medicare |
$175.55
|
| Rate for Payer: Beech Street Commercial |
$738.15
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$753.69
|
| Rate for Payer: Cigna of WY Commercial |
$761.46
|
| Rate for Payer: First Choice Health Commercial |
$699.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$738.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.55
|
| Rate for Payer: HealthUtah PPO |
$777.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$753.69
|
| Rate for Payer: Multiplan Medicare/VA |
$149.22
|
| Rate for Payer: One Health Plan of WY PPO |
$761.46
|
| Rate for Payer: PacificSource Commercial |
$699.30
|
| Rate for Payer: PHCS PPO |
$738.15
|
| Rate for Payer: Three Rivers PPO |
$582.75
|
| Rate for Payer: TriWest Veterans Administration |
$175.55
|
| Rate for Payer: United Healthcare Commercial |
$738.15
|
| Rate for Payer: WINHealth Partners Commercial |
$660.45
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 11643
|
| Min. Negotiated Rate |
$185.64 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$955.50
|
| Rate for Payer: Aetna of WY Medicare |
$218.40
|
| Rate for Payer: Beech Street Commercial |
$926.25
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$945.75
|
| Rate for Payer: Cigna of WY Commercial |
$955.50
|
| Rate for Payer: First Choice Health Commercial |
$877.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$926.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.40
|
| Rate for Payer: HealthUtah PPO |
$975.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$945.75
|
| Rate for Payer: Multiplan Medicare/VA |
$185.64
|
| Rate for Payer: One Health Plan of WY PPO |
$955.50
|
| Rate for Payer: PacificSource Commercial |
$877.50
|
| Rate for Payer: PHCS PPO |
$926.25
|
| Rate for Payer: Three Rivers PPO |
$731.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.40
|
| Rate for Payer: United Healthcare Commercial |
$926.25
|
| Rate for Payer: WINHealth Partners Commercial |
$828.75
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
HCPCS 11644
|
| Min. Negotiated Rate |
$229.57 |
| Max. Negotiated Rate |
$1,211.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,186.78
|
| Rate for Payer: Aetna of WY Medicare |
$270.08
|
| Rate for Payer: Beech Street Commercial |
$1,150.45
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: Cash Price |
$847.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,174.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,186.78
|
| Rate for Payer: First Choice Health Commercial |
$1,089.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,150.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.08
|
| Rate for Payer: HealthUtah PPO |
$1,211.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,174.67
|
| Rate for Payer: Multiplan Medicare/VA |
$229.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,186.78
|
| Rate for Payer: PacificSource Commercial |
$1,089.90
|
| Rate for Payer: PHCS PPO |
$1,150.45
|
| Rate for Payer: Three Rivers PPO |
$908.25
|
| Rate for Payer: TriWest Veterans Administration |
$270.08
|
| Rate for Payer: United Healthcare Commercial |
$1,150.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,029.35
|
|
|
EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11646
|
| Min. Negotiated Rate |
$315.94 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,009.00
|
| Rate for Payer: Aetna of WY Medicare |
$371.70
|
| Rate for Payer: Beech Street Commercial |
$1,947.50
|
| Rate for Payer: Cash Price |
$1,435.00
|
| Rate for Payer: Cash Price |
$1,435.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,988.50
|
| Rate for Payer: Cigna of WY Commercial |
$2,009.00
|
| Rate for Payer: First Choice Health Commercial |
$1,845.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,947.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.70
|
| Rate for Payer: HealthUtah PPO |
$2,050.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,988.50
|
| Rate for Payer: Multiplan Medicare/VA |
$315.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,009.00
|
| Rate for Payer: PacificSource Commercial |
$1,845.00
|
| Rate for Payer: PHCS PPO |
$1,947.50
|
| Rate for Payer: Three Rivers PPO |
$1,537.50
|
| Rate for Payer: TriWest Veterans Administration |
$371.70
|
| Rate for Payer: United Healthcare Commercial |
$1,947.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,742.50
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 11620
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$523.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$512.54
|
| Rate for Payer: Aetna of WY Medicare |
$119.52
|
| Rate for Payer: Beech Street Commercial |
$496.85
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$507.31
|
| Rate for Payer: Cigna of WY Commercial |
$512.54
|
| Rate for Payer: First Choice Health Commercial |
$470.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$496.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.52
|
| Rate for Payer: HealthUtah PPO |
$523.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$507.31
|
| Rate for Payer: Multiplan Medicare/VA |
$101.59
|
| Rate for Payer: One Health Plan of WY PPO |
$512.54
|
| Rate for Payer: PacificSource Commercial |
$470.70
|
| Rate for Payer: PHCS PPO |
$496.85
|
| Rate for Payer: Three Rivers PPO |
$392.25
|
| Rate for Payer: TriWest Veterans Administration |
$119.52
|
| Rate for Payer: United Healthcare Commercial |
$496.85
|
| Rate for Payer: WINHealth Partners Commercial |
$444.55
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 11621
|
| Min. Negotiated Rate |
$122.52 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Aetna of WY Medicare |
$144.14
|
| Rate for Payer: Beech Street Commercial |
$604.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: First Choice Health Commercial |
$572.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.14
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$122.52
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$604.20
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$144.14
|
| Rate for Payer: United Healthcare Commercial |
$604.20
|
| Rate for Payer: WINHealth Partners Commercial |
$540.60
|
|
