|
EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 11622
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$723.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$708.54
|
| Rate for Payer: Aetna of WY Medicare |
$163.53
|
| Rate for Payer: Beech Street Commercial |
$686.85
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$701.31
|
| Rate for Payer: Cigna of WY Commercial |
$708.54
|
| Rate for Payer: First Choice Health Commercial |
$650.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$686.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.53
|
| Rate for Payer: HealthUtah PPO |
$723.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$701.31
|
| Rate for Payer: Multiplan Medicare/VA |
$139.00
|
| Rate for Payer: One Health Plan of WY PPO |
$708.54
|
| Rate for Payer: PacificSource Commercial |
$650.70
|
| Rate for Payer: PHCS PPO |
$686.85
|
| Rate for Payer: Three Rivers PPO |
$542.25
|
| Rate for Payer: TriWest Veterans Administration |
$163.53
|
| Rate for Payer: United Healthcare Commercial |
$686.85
|
| Rate for Payer: WINHealth Partners Commercial |
$614.55
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 11623
|
| Min. Negotiated Rate |
$171.05 |
| Max. Negotiated Rate |
$899.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$881.02
|
| Rate for Payer: Aetna of WY Medicare |
$201.23
|
| Rate for Payer: Beech Street Commercial |
$854.05
|
| Rate for Payer: Cash Price |
$629.30
|
| Rate for Payer: Cash Price |
$629.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$872.03
|
| Rate for Payer: Cigna of WY Commercial |
$881.02
|
| Rate for Payer: First Choice Health Commercial |
$809.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$854.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.23
|
| Rate for Payer: HealthUtah PPO |
$899.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$872.03
|
| Rate for Payer: Multiplan Medicare/VA |
$171.05
|
| Rate for Payer: One Health Plan of WY PPO |
$881.02
|
| Rate for Payer: PacificSource Commercial |
$809.10
|
| Rate for Payer: PHCS PPO |
$854.05
|
| Rate for Payer: Three Rivers PPO |
$674.25
|
| Rate for Payer: TriWest Veterans Administration |
$201.23
|
| Rate for Payer: United Healthcare Commercial |
$854.05
|
| Rate for Payer: WINHealth Partners Commercial |
$764.15
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 11624
|
| Min. Negotiated Rate |
$194.11 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$999.60
|
| Rate for Payer: Aetna of WY Medicare |
$228.37
|
| Rate for Payer: Beech Street Commercial |
$969.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$989.40
|
| Rate for Payer: Cigna of WY Commercial |
$999.60
|
| Rate for Payer: First Choice Health Commercial |
$918.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$969.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.37
|
| Rate for Payer: HealthUtah PPO |
$1,020.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$989.40
|
| Rate for Payer: Multiplan Medicare/VA |
$194.11
|
| Rate for Payer: One Health Plan of WY PPO |
$999.60
|
| Rate for Payer: PacificSource Commercial |
$918.00
|
| Rate for Payer: PHCS PPO |
$969.00
|
| Rate for Payer: Three Rivers PPO |
$765.00
|
| Rate for Payer: TriWest Veterans Administration |
$228.37
|
| Rate for Payer: United Healthcare Commercial |
$969.00
|
| Rate for Payer: WINHealth Partners Commercial |
$867.00
|
|
|
EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 11626
|
| Min. Negotiated Rate |
$236.27 |
| Max. Negotiated Rate |
$1,255.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,229.90
|
| Rate for Payer: Aetna of WY Medicare |
$277.97
|
| Rate for Payer: Beech Street Commercial |
$1,192.25
|
| Rate for Payer: Cash Price |
$878.50
|
| Rate for Payer: Cash Price |
$878.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,217.35
|
| Rate for Payer: Cigna of WY Commercial |
$1,229.90
|
| Rate for Payer: First Choice Health Commercial |
$1,129.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,192.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.97
|
| Rate for Payer: HealthUtah PPO |
$1,255.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,217.35
|
| Rate for Payer: Multiplan Medicare/VA |
$236.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,229.90
|
| Rate for Payer: PacificSource Commercial |
$1,129.50
|
| Rate for Payer: PHCS PPO |
$1,192.25
|
| Rate for Payer: Three Rivers PPO |
$941.25
|
| Rate for Payer: TriWest Veterans Administration |
$277.97
|
| Rate for Payer: United Healthcare Commercial |
$1,192.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,066.75
|
|
|
EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$1,360.00
|
|
|
Service Code
|
HCPCS 11606
|
| Min. Negotiated Rate |
$256.97 |
| Max. Negotiated Rate |
$1,360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,332.80
|
| Rate for Payer: Aetna of WY Medicare |
$302.32
|
| Rate for Payer: Beech Street Commercial |
$1,292.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,319.20
|
| Rate for Payer: Cigna of WY Commercial |
$1,332.80
|
| Rate for Payer: First Choice Health Commercial |
$1,224.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,292.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.32
|
| Rate for Payer: HealthUtah PPO |
$1,360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,319.20
|
| Rate for Payer: Multiplan Medicare/VA |
$256.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,332.80
|
| Rate for Payer: PacificSource Commercial |
$1,224.00
|
| Rate for Payer: PHCS PPO |
$1,292.00
|
| Rate for Payer: Three Rivers PPO |
$1,020.00
|
| Rate for Payer: TriWest Veterans Administration |
$302.32
|
| Rate for Payer: United Healthcare Commercial |
$1,292.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,156.00
|
|
|
EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 11600
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$514.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$503.72
|
| Rate for Payer: Aetna of WY Medicare |
$118.62
|
| Rate for Payer: Beech Street Commercial |
$488.30
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: Cash Price |
$359.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$498.58
|
| Rate for Payer: Cigna of WY Commercial |
$503.72
|
| Rate for Payer: First Choice Health Commercial |
$462.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$488.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.62
|
| Rate for Payer: HealthUtah PPO |
$514.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$498.58
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$503.72
|
| Rate for Payer: PacificSource Commercial |
$462.60
|
| Rate for Payer: PHCS PPO |
$488.30
|
| Rate for Payer: Three Rivers PPO |
$385.50
|
| Rate for Payer: TriWest Veterans Administration |
$118.62
|
| Rate for Payer: United Healthcare Commercial |
$488.30
|
| Rate for Payer: WINHealth Partners Commercial |
$436.90
|
|
|
EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 11601
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$633.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$620.34
|
| Rate for Payer: Aetna of WY Medicare |
$143.58
|
| Rate for Payer: Beech Street Commercial |
$601.35
|
| Rate for Payer: Cash Price |
$443.10
|
| Rate for Payer: Cash Price |
$443.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$614.01
|
| Rate for Payer: Cigna of WY Commercial |
$620.34
|
| Rate for Payer: First Choice Health Commercial |
$569.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$601.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.58
|
| Rate for Payer: HealthUtah PPO |
$633.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$614.01
|
| Rate for Payer: Multiplan Medicare/VA |
$122.04
|
| Rate for Payer: One Health Plan of WY PPO |
$620.34
|
| Rate for Payer: PacificSource Commercial |
$569.70
|
| Rate for Payer: PHCS PPO |
$601.35
|
| Rate for Payer: Three Rivers PPO |
$474.75
|
| Rate for Payer: TriWest Veterans Administration |
$143.58
|
| Rate for Payer: United Healthcare Commercial |
$601.35
|
| Rate for Payer: WINHealth Partners Commercial |
$538.05
|
|
|
EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 11602
|
| Min. Negotiated Rate |
$132.62 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$676.20
|
| Rate for Payer: Aetna of WY Medicare |
$156.02
|
| Rate for Payer: Beech Street Commercial |
$655.50
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$669.30
|
| Rate for Payer: Cigna of WY Commercial |
$676.20
|
| Rate for Payer: First Choice Health Commercial |
$621.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$655.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.02
|
| Rate for Payer: HealthUtah PPO |
$690.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$669.30
|
| Rate for Payer: Multiplan Medicare/VA |
$132.62
|
| Rate for Payer: One Health Plan of WY PPO |
$676.20
|
| Rate for Payer: PacificSource Commercial |
$621.00
|
| Rate for Payer: PHCS PPO |
$655.50
|
| Rate for Payer: Three Rivers PPO |
$517.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.02
|
| Rate for Payer: United Healthcare Commercial |
$655.50
|
| Rate for Payer: WINHealth Partners Commercial |
$586.50
|
|
|
EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 11603
|
| Min. Negotiated Rate |
$158.13 |
| Max. Negotiated Rate |
$827.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$810.46
|
| Rate for Payer: Aetna of WY Medicare |
$186.03
|
| Rate for Payer: Beech Street Commercial |
$785.65
|
| Rate for Payer: Cash Price |
$578.90
|
| Rate for Payer: Cash Price |
$578.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$802.19
|
| Rate for Payer: Cigna of WY Commercial |
$810.46
|
| Rate for Payer: First Choice Health Commercial |
$744.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$785.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.03
|
| Rate for Payer: HealthUtah PPO |
$827.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$802.19
|
| Rate for Payer: Multiplan Medicare/VA |
$158.13
|
| Rate for Payer: One Health Plan of WY PPO |
$810.46
|
| Rate for Payer: PacificSource Commercial |
$744.30
|
| Rate for Payer: PHCS PPO |
$785.65
|
| Rate for Payer: Three Rivers PPO |
$620.25
|
| Rate for Payer: TriWest Veterans Administration |
$186.03
|
| Rate for Payer: United Healthcare Commercial |
$785.65
|
| Rate for Payer: WINHealth Partners Commercial |
$702.95
|
|
|
EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 11604
|
| Min. Negotiated Rate |
$173.69 |
| Max. Negotiated Rate |
$911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$892.78
|
| Rate for Payer: Aetna of WY Medicare |
$204.34
|
| Rate for Payer: Beech Street Commercial |
$865.45
|
| Rate for Payer: Cash Price |
$637.70
|
| Rate for Payer: Cash Price |
$637.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$883.67
|
| Rate for Payer: Cigna of WY Commercial |
$892.78
|
| Rate for Payer: First Choice Health Commercial |
$819.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$865.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.34
|
| Rate for Payer: HealthUtah PPO |
$911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$883.67
|
| Rate for Payer: Multiplan Medicare/VA |
$173.69
|
| Rate for Payer: One Health Plan of WY PPO |
$892.78
|
| Rate for Payer: PacificSource Commercial |
$819.90
|
| Rate for Payer: PHCS PPO |
$865.45
|
| Rate for Payer: Three Rivers PPO |
$683.25
|
| Rate for Payer: TriWest Veterans Administration |
$204.34
|
| Rate for Payer: United Healthcare Commercial |
$865.45
|
| Rate for Payer: WINHealth Partners Commercial |
$774.35
|
|
|
EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS
|
Professional
|
Both
|
$2,990.00
|
|
|
Service Code
|
HCPCS 46230
|
| Min. Negotiated Rate |
$142.43 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,930.20
|
| Rate for Payer: Aetna of WY Medicare |
$167.56
|
| Rate for Payer: Beech Street Commercial |
$2,840.50
|
| Rate for Payer: Cash Price |
$2,093.00
|
| Rate for Payer: Cash Price |
$2,093.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,900.30
|
| Rate for Payer: Cigna of WY Commercial |
$2,930.20
|
| Rate for Payer: First Choice Health Commercial |
$2,691.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,840.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.56
|
| Rate for Payer: HealthUtah PPO |
$2,990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,900.30
|
| Rate for Payer: Multiplan Medicare/VA |
$142.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2,930.20
|
| Rate for Payer: PacificSource Commercial |
$2,691.00
|
| Rate for Payer: PHCS PPO |
$2,840.50
|
| Rate for Payer: Three Rivers PPO |
$2,242.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.56
|
| Rate for Payer: United Healthcare Commercial |
$2,840.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,541.50
|
|
|
EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 11750
|
| Min. Negotiated Rate |
$84.23 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$426.30
|
| Rate for Payer: Aetna of WY Medicare |
$99.09
|
| Rate for Payer: Beech Street Commercial |
$413.25
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$421.95
|
| Rate for Payer: Cigna of WY Commercial |
$426.30
|
| Rate for Payer: First Choice Health Commercial |
$391.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$413.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.09
|
| Rate for Payer: HealthUtah PPO |
$435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$421.95
|
| Rate for Payer: Multiplan Medicare/VA |
$84.23
|
| Rate for Payer: One Health Plan of WY PPO |
$426.30
|
| Rate for Payer: PacificSource Commercial |
$391.50
|
| Rate for Payer: PHCS PPO |
$413.25
|
| Rate for Payer: Three Rivers PPO |
$326.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.09
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: WINHealth Partners Commercial |
$369.75
|
|
|
EXCISION NASAL POLYP SIMPLE
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS 30110
|
| Min. Negotiated Rate |
$110.42 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$555.66
|
| Rate for Payer: Aetna of WY Medicare |
$129.91
|
| Rate for Payer: Beech Street Commercial |
$538.65
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$549.99
|
| Rate for Payer: Cigna of WY Commercial |
$555.66
|
| Rate for Payer: First Choice Health Commercial |
$510.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$538.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.91
|
| Rate for Payer: HealthUtah PPO |
$567.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$549.99
|
| Rate for Payer: Multiplan Medicare/VA |
$110.42
|
| Rate for Payer: One Health Plan of WY PPO |
$555.66
|
| Rate for Payer: PacificSource Commercial |
$510.30
|
| Rate for Payer: PHCS PPO |
$538.65
|
| Rate for Payer: Three Rivers PPO |
$425.25
|
| Rate for Payer: TriWest Veterans Administration |
$129.91
|
| Rate for Payer: United Healthcare Commercial |
$538.65
|
| Rate for Payer: WINHealth Partners Commercial |
$481.95
|
|
|
EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 24105
|
| Min. Negotiated Rate |
$304.05 |
| Max. Negotiated Rate |
$1,561.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,529.78
|
| Rate for Payer: Aetna of WY Medicare |
$357.71
|
| Rate for Payer: Beech Street Commercial |
$1,482.95
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,514.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,529.78
|
| Rate for Payer: First Choice Health Commercial |
$1,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$357.71
|
| Rate for Payer: HealthUtah PPO |
$1,561.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,514.17
|
| Rate for Payer: Multiplan Medicare/VA |
$304.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,529.78
|
| Rate for Payer: PacificSource Commercial |
$1,404.90
|
| Rate for Payer: PHCS PPO |
$1,482.95
|
| Rate for Payer: Three Rivers PPO |
$1,170.75
|
| Rate for Payer: TriWest Veterans Administration |
$357.71
|
| Rate for Payer: United Healthcare Commercial |
$1,482.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.85
|
|
|
EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 24105 80
|
| Min. Negotiated Rate |
$304.05 |
| Max. Negotiated Rate |
$1,561.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,529.78
|
| Rate for Payer: Beech Street Commercial |
$1,482.95
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,514.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,529.78
|
| Rate for Payer: First Choice Health Commercial |
$1,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.95
|
| Rate for Payer: HealthUtah PPO |
$1,561.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,514.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,529.78
|
| Rate for Payer: PacificSource Commercial |
$1,404.90
|
| Rate for Payer: PHCS PPO |
$1,482.95
|
| Rate for Payer: Three Rivers PPO |
$1,170.75
|
| Rate for Payer: United Healthcare Commercial |
$1,482.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.85
|
|
|
EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 24105 AS
|
| Min. Negotiated Rate |
$304.05 |
| Max. Negotiated Rate |
$1,561.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,529.78
|
| Rate for Payer: Beech Street Commercial |
$1,482.95
|
| Rate for Payer: Cash Price |
$1,092.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,514.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,529.78
|
| Rate for Payer: First Choice Health Commercial |
$1,404.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,482.95
|
| Rate for Payer: HealthUtah PPO |
$1,561.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,514.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,529.78
|
| Rate for Payer: PacificSource Commercial |
$1,404.90
|
| Rate for Payer: PHCS PPO |
$1,482.95
|
| Rate for Payer: Three Rivers PPO |
$1,170.75
|
| Rate for Payer: United Healthcare Commercial |
$1,482.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,326.85
|
|
|
EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
HCPCS 11770
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$791.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$775.18
|
| Rate for Payer: Aetna of WY Medicare |
$178.24
|
| Rate for Payer: Beech Street Commercial |
$751.45
|
| Rate for Payer: Cash Price |
$553.70
|
| Rate for Payer: Cash Price |
$553.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$767.27
|
| Rate for Payer: Cigna of WY Commercial |
$775.18
|
| Rate for Payer: First Choice Health Commercial |
$711.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$751.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.24
|
| Rate for Payer: HealthUtah PPO |
$791.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$767.27
|
| Rate for Payer: Multiplan Medicare/VA |
$151.50
|
| Rate for Payer: One Health Plan of WY PPO |
$775.18
|
| Rate for Payer: PacificSource Commercial |
$711.90
|
| Rate for Payer: PHCS PPO |
$751.45
|
| Rate for Payer: Three Rivers PPO |
$593.25
|
| Rate for Payer: TriWest Veterans Administration |
$178.24
|
| Rate for Payer: United Healthcare Commercial |
$751.45
|
| Rate for Payer: WINHealth Partners Commercial |
$672.35
|
|
|
EXCISION PREPATELLAR BURSA
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 27340 AS
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$458.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$448.84
|
| Rate for Payer: Beech Street Commercial |
$435.10
|
| Rate for Payer: Cash Price |
$320.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$444.26
|
| Rate for Payer: Cigna of WY Commercial |
$448.84
|
| Rate for Payer: First Choice Health Commercial |
$412.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$435.10
|
| Rate for Payer: HealthUtah PPO |
$458.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$444.26
|
| Rate for Payer: One Health Plan of WY PPO |
$448.84
|
| Rate for Payer: PacificSource Commercial |
$412.20
|
| Rate for Payer: PHCS PPO |
$435.10
|
| Rate for Payer: Three Rivers PPO |
$343.50
|
| Rate for Payer: United Healthcare Commercial |
$435.10
|
| Rate for Payer: WINHealth Partners Commercial |
$389.30
|
|
|
EXCISION PREPATELLAR BURSA
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 27340
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,605.24
|
| Rate for Payer: Aetna of WY Medicare |
$370.67
|
| Rate for Payer: Beech Street Commercial |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,588.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,605.24
|
| Rate for Payer: First Choice Health Commercial |
$1,474.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$370.67
|
| Rate for Payer: HealthUtah PPO |
$1,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,588.86
|
| Rate for Payer: Multiplan Medicare/VA |
$315.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,605.24
|
| Rate for Payer: PacificSource Commercial |
$1,474.20
|
| Rate for Payer: PHCS PPO |
$1,556.10
|
| Rate for Payer: Three Rivers PPO |
$1,228.50
|
| Rate for Payer: TriWest Veterans Administration |
$370.67
|
| Rate for Payer: United Healthcare Commercial |
$1,556.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,392.30
|
|
|
EXCISION PREPATELLAR BURSA
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 27340 80
|
| Min. Negotiated Rate |
$343.50 |
| Max. Negotiated Rate |
$458.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$448.84
|
| Rate for Payer: Beech Street Commercial |
$435.10
|
| Rate for Payer: Cash Price |
$320.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$444.26
|
| Rate for Payer: Cigna of WY Commercial |
$448.84
|
| Rate for Payer: First Choice Health Commercial |
$412.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$435.10
|
| Rate for Payer: HealthUtah PPO |
$458.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$444.26
|
| Rate for Payer: One Health Plan of WY PPO |
$448.84
|
| Rate for Payer: PacificSource Commercial |
$412.20
|
| Rate for Payer: PHCS PPO |
$435.10
|
| Rate for Payer: Three Rivers PPO |
$343.50
|
| Rate for Payer: United Healthcare Commercial |
$435.10
|
| Rate for Payer: WINHealth Partners Commercial |
$389.30
|
|
|
EXCISION RADIAL HEAD
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 24130 80
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$629.16
|
| Rate for Payer: Beech Street Commercial |
$609.90
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$622.74
|
| Rate for Payer: Cigna of WY Commercial |
$629.16
|
| Rate for Payer: First Choice Health Commercial |
$577.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$609.90
|
| Rate for Payer: HealthUtah PPO |
$642.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$622.74
|
| Rate for Payer: One Health Plan of WY PPO |
$629.16
|
| Rate for Payer: PacificSource Commercial |
$577.80
|
| Rate for Payer: PHCS PPO |
$609.90
|
| Rate for Payer: Three Rivers PPO |
$481.50
|
| Rate for Payer: United Healthcare Commercial |
$609.90
|
| Rate for Payer: WINHealth Partners Commercial |
$545.70
|
|
|
EXCISION RADIAL HEAD
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 24130 AS
|
| Min. Negotiated Rate |
$481.50 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$629.16
|
| Rate for Payer: Beech Street Commercial |
$609.90
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$622.74
|
| Rate for Payer: Cigna of WY Commercial |
$629.16
|
| Rate for Payer: First Choice Health Commercial |
$577.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$609.90
|
| Rate for Payer: HealthUtah PPO |
$642.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$622.74
|
| Rate for Payer: One Health Plan of WY PPO |
$629.16
|
| Rate for Payer: PacificSource Commercial |
$577.80
|
| Rate for Payer: PHCS PPO |
$609.90
|
| Rate for Payer: Three Rivers PPO |
$481.50
|
| Rate for Payer: United Healthcare Commercial |
$609.90
|
| Rate for Payer: WINHealth Partners Commercial |
$545.70
|
|
|
EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Professional
|
Both
|
$3,340.00
|
|
|
Service Code
|
HCPCS 46220
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$3,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,273.20
|
| Rate for Payer: Aetna of WY Medicare |
$117.93
|
| Rate for Payer: Beech Street Commercial |
$3,173.00
|
| Rate for Payer: Cash Price |
$2,338.00
|
| Rate for Payer: Cash Price |
$2,338.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,239.80
|
| Rate for Payer: Cigna of WY Commercial |
$3,273.20
|
| Rate for Payer: First Choice Health Commercial |
$3,006.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,173.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.93
|
| Rate for Payer: HealthUtah PPO |
$3,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,239.80
|
| Rate for Payer: Multiplan Medicare/VA |
$100.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3,273.20
|
| Rate for Payer: PacificSource Commercial |
$3,006.00
|
| Rate for Payer: PHCS PPO |
$3,173.00
|
| Rate for Payer: Three Rivers PPO |
$2,505.00
|
| Rate for Payer: TriWest Veterans Administration |
$117.93
|
| Rate for Payer: United Healthcare Commercial |
$3,173.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,839.00
|
|
|
EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$1,096.00
|
|
|
Service Code
|
HCPCS 69145
|
| Min. Negotiated Rate |
$214.46 |
| Max. Negotiated Rate |
$1,096.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,074.08
|
| Rate for Payer: Aetna of WY Medicare |
$252.31
|
| Rate for Payer: Beech Street Commercial |
$1,041.20
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: Cash Price |
$767.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,063.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,074.08
|
| Rate for Payer: First Choice Health Commercial |
$986.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,041.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$252.31
|
| Rate for Payer: HealthUtah PPO |
$1,096.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,063.12
|
| Rate for Payer: Multiplan Medicare/VA |
$214.46
|
| Rate for Payer: One Health Plan of WY PPO |
$1,074.08
|
| Rate for Payer: PacificSource Commercial |
$986.40
|
| Rate for Payer: PHCS PPO |
$1,041.20
|
| Rate for Payer: Three Rivers PPO |
$822.00
|
| Rate for Payer: TriWest Veterans Administration |
$252.31
|
| Rate for Payer: United Healthcare Commercial |
$1,041.20
|
| Rate for Payer: WINHealth Partners Commercial |
$931.60
|
|
|
EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Professional
|
Both
|
$5,394.00
|
|
|
Service Code
|
HCPCS 54840
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,286.12
|
| Rate for Payer: Aetna of WY Medicare |
$312.15
|
| Rate for Payer: Beech Street Commercial |
$5,124.30
|
| Rate for Payer: Cash Price |
$3,775.80
|
| Rate for Payer: Cash Price |
$3,775.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,232.18
|
| Rate for Payer: Cigna of WY Commercial |
$5,286.12
|
| Rate for Payer: First Choice Health Commercial |
$4,854.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,124.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$312.15
|
| Rate for Payer: HealthUtah PPO |
$5,394.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,232.18
|
| Rate for Payer: Multiplan Medicare/VA |
$265.33
|
| Rate for Payer: One Health Plan of WY PPO |
$5,286.12
|
| Rate for Payer: PacificSource Commercial |
$4,854.60
|
| Rate for Payer: PHCS PPO |
$5,124.30
|
| Rate for Payer: Three Rivers PPO |
$4,045.50
|
| Rate for Payer: TriWest Veterans Administration |
$312.15
|
| Rate for Payer: United Healthcare Commercial |
$5,124.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,584.90
|
|
