|
EXCISION VAGINAL SEPTUM
|
Professional
|
Both
|
$3,432.00
|
|
|
Service Code
|
HCPCS 57130
|
| Min. Negotiated Rate |
$142.87 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,363.36
|
| Rate for Payer: Aetna of WY Medicare |
$168.08
|
| Rate for Payer: Beech Street Commercial |
$3,260.40
|
| Rate for Payer: Cash Price |
$2,402.40
|
| Rate for Payer: Cash Price |
$2,402.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,329.04
|
| Rate for Payer: Cigna of WY Commercial |
$3,363.36
|
| Rate for Payer: First Choice Health Commercial |
$3,088.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,260.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.08
|
| Rate for Payer: HealthUtah PPO |
$3,432.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,329.04
|
| Rate for Payer: Multiplan Medicare/VA |
$142.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3,363.36
|
| Rate for Payer: PacificSource Commercial |
$3,088.80
|
| Rate for Payer: PHCS PPO |
$3,260.40
|
| Rate for Payer: Three Rivers PPO |
$2,574.00
|
| Rate for Payer: TriWest Veterans Administration |
$168.08
|
| Rate for Payer: United Healthcare Commercial |
$3,260.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,917.20
|
|
|
EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>
|
Professional
|
Both
|
$2,553.00
|
|
|
Service Code
|
HCPCS 27337
|
| Min. Negotiated Rate |
$344.56 |
| Max. Negotiated Rate |
$2,553.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,501.94
|
| Rate for Payer: Aetna of WY Medicare |
$405.37
|
| Rate for Payer: Beech Street Commercial |
$2,425.35
|
| Rate for Payer: Cash Price |
$1,787.10
|
| Rate for Payer: Cash Price |
$1,787.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,476.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,501.94
|
| Rate for Payer: First Choice Health Commercial |
$2,297.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,425.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.37
|
| Rate for Payer: HealthUtah PPO |
$2,553.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,476.41
|
| Rate for Payer: Multiplan Medicare/VA |
$344.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,501.94
|
| Rate for Payer: PacificSource Commercial |
$2,297.70
|
| Rate for Payer: PHCS PPO |
$2,425.35
|
| Rate for Payer: Three Rivers PPO |
$1,914.75
|
| Rate for Payer: TriWest Veterans Administration |
$405.37
|
| Rate for Payer: United Healthcare Commercial |
$2,425.35
|
| Rate for Payer: WINHealth Partners Commercial |
$2,170.05
|
|
|
EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 67840
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,215.20
|
| Rate for Payer: Aetna of WY Medicare |
$151.46
|
| Rate for Payer: Beech Street Commercial |
$1,178.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,202.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,215.20
|
| Rate for Payer: First Choice Health Commercial |
$1,116.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,178.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.46
|
| Rate for Payer: HealthUtah PPO |
$1,240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,202.80
|
| Rate for Payer: Multiplan Medicare/VA |
$128.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,215.20
|
| Rate for Payer: PacificSource Commercial |
$1,116.00
|
| Rate for Payer: PHCS PPO |
$1,178.00
|
| Rate for Payer: Three Rivers PPO |
$930.00
|
| Rate for Payer: TriWest Veterans Administration |
$151.46
|
| Rate for Payer: United Healthcare Commercial |
$1,178.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1,054.00
|
|
|
EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$1,642.00
|
|
|
Service Code
|
HCPCS 40814
|
| Min. Negotiated Rate |
$234.23 |
| Max. Negotiated Rate |
$1,642.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,609.16
|
| Rate for Payer: Aetna of WY Medicare |
$275.56
|
| Rate for Payer: Beech Street Commercial |
$1,559.90
|
| Rate for Payer: Cash Price |
$1,149.40
|
| Rate for Payer: Cash Price |
$1,149.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,592.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,609.16
|
| Rate for Payer: First Choice Health Commercial |
$1,477.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,559.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.56
|
| Rate for Payer: HealthUtah PPO |
$1,642.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,592.74
|
| Rate for Payer: Multiplan Medicare/VA |
$234.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,609.16
|
| Rate for Payer: PacificSource Commercial |
$1,477.80
|
| Rate for Payer: PHCS PPO |
$1,559.90
|
| Rate for Payer: Three Rivers PPO |
$1,231.50
|
| Rate for Payer: TriWest Veterans Administration |
$275.56
|
| Rate for Payer: United Healthcare Commercial |
$1,559.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,395.70
|
|
|
EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 40812
|
| Min. Negotiated Rate |
$150.64 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$821.24
|
| Rate for Payer: Aetna of WY Medicare |
$177.22
|
| Rate for Payer: Beech Street Commercial |
$796.10
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$812.86
|
| Rate for Payer: Cigna of WY Commercial |
$821.24
|
| Rate for Payer: First Choice Health Commercial |
$754.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$796.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.22
|
| Rate for Payer: HealthUtah PPO |
$838.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$812.86
|
| Rate for Payer: Multiplan Medicare/VA |
$150.64
|
| Rate for Payer: One Health Plan of WY PPO |
$821.24
|
| Rate for Payer: PacificSource Commercial |
$754.20
|
| Rate for Payer: PHCS PPO |
$796.10
|
| Rate for Payer: Three Rivers PPO |
$628.50
|
| Rate for Payer: TriWest Veterans Administration |
$177.22
|
| Rate for Payer: United Healthcare Commercial |
$796.10
|
| Rate for Payer: WINHealth Partners Commercial |
$712.30
|
|
|
EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$111.89 |
| Max. Negotiated Rate |
$955.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$935.90
|
| Rate for Payer: Aetna of WY Medicare |
$131.63
|
| Rate for Payer: Beech Street Commercial |
$907.25
|
| Rate for Payer: Cash Price |
$668.50
|
| Rate for Payer: Cash Price |
$668.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$926.35
|
| Rate for Payer: Cigna of WY Commercial |
$935.90
|
| Rate for Payer: First Choice Health Commercial |
$859.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$907.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.63
|
| Rate for Payer: HealthUtah PPO |
$955.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$926.35
|
| Rate for Payer: Multiplan Medicare/VA |
$111.89
|
| Rate for Payer: One Health Plan of WY PPO |
$935.90
|
| Rate for Payer: PacificSource Commercial |
$859.50
|
| Rate for Payer: PHCS PPO |
$907.25
|
| Rate for Payer: Three Rivers PPO |
$716.25
|
| Rate for Payer: TriWest Veterans Administration |
$131.63
|
| Rate for Payer: United Healthcare Commercial |
$907.25
|
| Rate for Payer: WINHealth Partners Commercial |
$811.75
|
|
|
EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$5,341.00
|
|
|
Service Code
|
HCPCS 55520
|
| Min. Negotiated Rate |
$374.54 |
| Max. Negotiated Rate |
$5,341.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,234.18
|
| Rate for Payer: Aetna of WY Medicare |
$440.64
|
| Rate for Payer: Beech Street Commercial |
$5,073.95
|
| Rate for Payer: Cash Price |
$3,738.70
|
| Rate for Payer: Cash Price |
$3,738.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,180.77
|
| Rate for Payer: Cigna of WY Commercial |
$5,234.18
|
| Rate for Payer: First Choice Health Commercial |
$4,806.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,073.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.64
|
| Rate for Payer: HealthUtah PPO |
$5,341.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,180.77
|
| Rate for Payer: Multiplan Medicare/VA |
$374.54
|
| Rate for Payer: One Health Plan of WY PPO |
$5,234.18
|
| Rate for Payer: PacificSource Commercial |
$4,806.90
|
| Rate for Payer: PHCS PPO |
$5,073.95
|
| Rate for Payer: Three Rivers PPO |
$4,005.75
|
| Rate for Payer: TriWest Veterans Administration |
$440.64
|
| Rate for Payer: United Healthcare Commercial |
$5,073.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4,539.85
|
|
|
EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,019.00
|
|
|
Service Code
|
HCPCS 55520 80
|
| Min. Negotiated Rate |
$764.25 |
| Max. Negotiated Rate |
$1,019.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$998.62
|
| Rate for Payer: Beech Street Commercial |
$968.05
|
| Rate for Payer: Cash Price |
$713.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$988.43
|
| Rate for Payer: Cigna of WY Commercial |
$998.62
|
| Rate for Payer: First Choice Health Commercial |
$917.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$968.05
|
| Rate for Payer: HealthUtah PPO |
$1,019.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$988.43
|
| Rate for Payer: One Health Plan of WY PPO |
$998.62
|
| Rate for Payer: PacificSource Commercial |
$917.10
|
| Rate for Payer: PHCS PPO |
$968.05
|
| Rate for Payer: Three Rivers PPO |
$764.25
|
| Rate for Payer: United Healthcare Commercial |
$968.05
|
| Rate for Payer: WINHealth Partners Commercial |
$866.15
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
HCPCS 26160 80
|
| Min. Negotiated Rate |
$699.75 |
| Max. Negotiated Rate |
$933.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$914.34
|
| Rate for Payer: Beech Street Commercial |
$886.35
|
| Rate for Payer: Cash Price |
$653.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$905.01
|
| Rate for Payer: Cigna of WY Commercial |
$914.34
|
| Rate for Payer: First Choice Health Commercial |
$839.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$886.35
|
| Rate for Payer: HealthUtah PPO |
$933.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$905.01
|
| Rate for Payer: One Health Plan of WY PPO |
$914.34
|
| Rate for Payer: PacificSource Commercial |
$839.70
|
| Rate for Payer: PHCS PPO |
$886.35
|
| Rate for Payer: Three Rivers PPO |
$699.75
|
| Rate for Payer: United Healthcare Commercial |
$886.35
|
| Rate for Payer: WINHealth Partners Commercial |
$793.05
|
|
|
EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$2,048.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$266.15 |
| Max. Negotiated Rate |
$2,048.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,007.04
|
| Rate for Payer: Aetna of WY Medicare |
$313.12
|
| Rate for Payer: Beech Street Commercial |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,986.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,007.04
|
| Rate for Payer: First Choice Health Commercial |
$1,843.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,945.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.12
|
| Rate for Payer: HealthUtah PPO |
$2,048.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,986.56
|
| Rate for Payer: Multiplan Medicare/VA |
$266.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,007.04
|
| Rate for Payer: PacificSource Commercial |
$1,843.20
|
| Rate for Payer: PHCS PPO |
$1,945.60
|
| Rate for Payer: Three Rivers PPO |
$1,536.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.12
|
| Rate for Payer: United Healthcare Commercial |
$1,945.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,740.80
|
|
|
EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$257.10 |
| Max. Negotiated Rate |
$1,357.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,329.86
|
| Rate for Payer: Aetna of WY Medicare |
$302.47
|
| Rate for Payer: Beech Street Commercial |
$1,289.15
|
| Rate for Payer: Cash Price |
$949.90
|
| Rate for Payer: Cash Price |
$949.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,316.29
|
| Rate for Payer: Cigna of WY Commercial |
$1,329.86
|
| Rate for Payer: First Choice Health Commercial |
$1,221.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,289.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.47
|
| Rate for Payer: HealthUtah PPO |
$1,357.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,316.29
|
| Rate for Payer: Multiplan Medicare/VA |
$257.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,329.86
|
| Rate for Payer: PacificSource Commercial |
$1,221.30
|
| Rate for Payer: PHCS PPO |
$1,289.15
|
| Rate for Payer: Three Rivers PPO |
$1,017.75
|
| Rate for Payer: TriWest Veterans Administration |
$302.47
|
| Rate for Payer: United Healthcare Commercial |
$1,289.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1,153.45
|
|
|
EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 28090 80
|
| Min. Negotiated Rate |
$212.25 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$277.34
|
| Rate for Payer: Beech Street Commercial |
$268.85
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$274.51
|
| Rate for Payer: Cigna of WY Commercial |
$277.34
|
| Rate for Payer: First Choice Health Commercial |
$254.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$268.85
|
| Rate for Payer: HealthUtah PPO |
$283.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$274.51
|
| Rate for Payer: One Health Plan of WY PPO |
$277.34
|
| Rate for Payer: PacificSource Commercial |
$254.70
|
| Rate for Payer: PHCS PPO |
$268.85
|
| Rate for Payer: Three Rivers PPO |
$212.25
|
| Rate for Payer: United Healthcare Commercial |
$268.85
|
| Rate for Payer: WINHealth Partners Commercial |
$240.55
|
|
|
EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$5,396.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$227.62 |
| Max. Negotiated Rate |
$5,396.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,288.08
|
| Rate for Payer: Aetna of WY Medicare |
$267.79
|
| Rate for Payer: Beech Street Commercial |
$5,126.20
|
| Rate for Payer: Cash Price |
$3,777.20
|
| Rate for Payer: Cash Price |
$3,777.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,234.12
|
| Rate for Payer: Cigna of WY Commercial |
$5,288.08
|
| Rate for Payer: First Choice Health Commercial |
$4,856.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,126.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.79
|
| Rate for Payer: HealthUtah PPO |
$5,396.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,234.12
|
| Rate for Payer: Multiplan Medicare/VA |
$227.62
|
| Rate for Payer: One Health Plan of WY PPO |
$5,288.08
|
| Rate for Payer: PacificSource Commercial |
$4,856.40
|
| Rate for Payer: PHCS PPO |
$5,126.20
|
| Rate for Payer: Three Rivers PPO |
$4,047.00
|
| Rate for Payer: TriWest Veterans Administration |
$267.79
|
| Rate for Payer: United Healthcare Commercial |
$5,126.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,586.60
|
|
|
EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$101.74 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$533.12
|
| Rate for Payer: Aetna of WY Medicare |
$119.70
|
| Rate for Payer: Beech Street Commercial |
$516.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$527.68
|
| Rate for Payer: Cigna of WY Commercial |
$533.12
|
| Rate for Payer: First Choice Health Commercial |
$489.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$516.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.70
|
| Rate for Payer: HealthUtah PPO |
$544.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$527.68
|
| Rate for Payer: Multiplan Medicare/VA |
$101.74
|
| Rate for Payer: One Health Plan of WY PPO |
$533.12
|
| Rate for Payer: PacificSource Commercial |
$489.60
|
| Rate for Payer: PHCS PPO |
$516.80
|
| Rate for Payer: Three Rivers PPO |
$408.00
|
| Rate for Payer: TriWest Veterans Administration |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$516.80
|
| Rate for Payer: WINHealth Partners Commercial |
$462.40
|
|
|
EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$1,747.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$630.78 |
| Max. Negotiated Rate |
$1,747.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,712.06
|
| Rate for Payer: Aetna of WY Medicare |
$742.09
|
| Rate for Payer: Beech Street Commercial |
$1,659.65
|
| Rate for Payer: Cash Price |
$1,222.90
|
| Rate for Payer: Cash Price |
$1,222.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,694.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,712.06
|
| Rate for Payer: First Choice Health Commercial |
$1,572.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,659.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$742.09
|
| Rate for Payer: HealthUtah PPO |
$1,747.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,694.59
|
| Rate for Payer: Multiplan Medicare/VA |
$630.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,712.06
|
| Rate for Payer: PacificSource Commercial |
$1,572.30
|
| Rate for Payer: PHCS PPO |
$1,659.65
|
| Rate for Payer: Three Rivers PPO |
$1,310.25
|
| Rate for Payer: TriWest Veterans Administration |
$742.09
|
| Rate for Payer: United Healthcare Commercial |
$1,659.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,484.95
|
|
|
EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$3,603.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$3,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,530.94
|
| Rate for Payer: Aetna of WY Medicare |
$816.57
|
| Rate for Payer: Beech Street Commercial |
$3,422.85
|
| Rate for Payer: Cash Price |
$2,522.10
|
| Rate for Payer: Cash Price |
$2,522.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,494.91
|
| Rate for Payer: Cigna of WY Commercial |
$3,530.94
|
| Rate for Payer: First Choice Health Commercial |
$3,242.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,422.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$816.57
|
| Rate for Payer: HealthUtah PPO |
$3,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,494.91
|
| Rate for Payer: Multiplan Medicare/VA |
$694.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3,530.94
|
| Rate for Payer: PacificSource Commercial |
$3,242.70
|
| Rate for Payer: PHCS PPO |
$3,422.85
|
| Rate for Payer: Three Rivers PPO |
$2,702.25
|
| Rate for Payer: TriWest Veterans Administration |
$816.57
|
| Rate for Payer: United Healthcare Commercial |
$3,422.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,062.55
|
|
|
EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$3,631.00
|
|
|
Service Code
|
HCPCS 64774 80
|
| Min. Negotiated Rate |
$2,723.25 |
| Max. Negotiated Rate |
$3,631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,558.38
|
| Rate for Payer: Beech Street Commercial |
$3,449.45
|
| Rate for Payer: Cash Price |
$2,541.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,522.07
|
| Rate for Payer: Cigna of WY Commercial |
$3,558.38
|
| Rate for Payer: First Choice Health Commercial |
$3,267.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,449.45
|
| Rate for Payer: HealthUtah PPO |
$3,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,522.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,558.38
|
| Rate for Payer: PacificSource Commercial |
$3,267.90
|
| Rate for Payer: PHCS PPO |
$3,449.45
|
| Rate for Payer: Three Rivers PPO |
$2,723.25
|
| Rate for Payer: United Healthcare Commercial |
$3,449.45
|
| Rate for Payer: WINHealth Partners Commercial |
$3,086.35
|
|
|
EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,807.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$353.68 |
| Max. Negotiated Rate |
$1,807.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,770.86
|
| Rate for Payer: Aetna of WY Medicare |
$416.09
|
| Rate for Payer: Beech Street Commercial |
$1,716.65
|
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,752.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,770.86
|
| Rate for Payer: First Choice Health Commercial |
$1,626.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,716.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.09
|
| Rate for Payer: HealthUtah PPO |
$1,807.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,752.79
|
| Rate for Payer: Multiplan Medicare/VA |
$353.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,770.86
|
| Rate for Payer: PacificSource Commercial |
$1,626.30
|
| Rate for Payer: PHCS PPO |
$1,716.65
|
| Rate for Payer: Three Rivers PPO |
$1,355.25
|
| Rate for Payer: TriWest Veterans Administration |
$416.09
|
| Rate for Payer: United Healthcare Commercial |
$1,716.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,535.95
|
|
|
EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,832.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$376.76 |
| Max. Negotiated Rate |
$1,832.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,795.36
|
| Rate for Payer: Aetna of WY Medicare |
$443.25
|
| Rate for Payer: Beech Street Commercial |
$1,740.40
|
| Rate for Payer: Cash Price |
$1,282.40
|
| Rate for Payer: Cash Price |
$1,282.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,777.04
|
| Rate for Payer: Cigna of WY Commercial |
$1,795.36
|
| Rate for Payer: First Choice Health Commercial |
$1,648.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,740.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.25
|
| Rate for Payer: HealthUtah PPO |
$1,832.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,777.04
|
| Rate for Payer: Multiplan Medicare/VA |
$376.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,795.36
|
| Rate for Payer: PacificSource Commercial |
$1,648.80
|
| Rate for Payer: PHCS PPO |
$1,740.40
|
| Rate for Payer: Three Rivers PPO |
$1,374.00
|
| Rate for Payer: TriWest Veterans Administration |
$443.25
|
| Rate for Payer: United Healthcare Commercial |
$1,740.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,557.20
|
|
|
EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 64784 80
|
| Min. Negotiated Rate |
$424.50 |
| Max. Negotiated Rate |
$566.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$554.68
|
| Rate for Payer: Beech Street Commercial |
$537.70
|
| Rate for Payer: Cash Price |
$396.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$549.02
|
| Rate for Payer: Cigna of WY Commercial |
$554.68
|
| Rate for Payer: First Choice Health Commercial |
$509.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$537.70
|
| Rate for Payer: HealthUtah PPO |
$566.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$549.02
|
| Rate for Payer: One Health Plan of WY PPO |
$554.68
|
| Rate for Payer: PacificSource Commercial |
$509.40
|
| Rate for Payer: PHCS PPO |
$537.70
|
| Rate for Payer: Three Rivers PPO |
$424.50
|
| Rate for Payer: United Healthcare Commercial |
$537.70
|
| Rate for Payer: WINHealth Partners Commercial |
$481.10
|
|
|
EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$4,949.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$594.14 |
| Max. Negotiated Rate |
$4,949.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,850.02
|
| Rate for Payer: Aetna of WY Medicare |
$698.99
|
| Rate for Payer: Beech Street Commercial |
$4,701.55
|
| Rate for Payer: Cash Price |
$3,464.30
|
| Rate for Payer: Cash Price |
$3,464.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,800.53
|
| Rate for Payer: Cigna of WY Commercial |
$4,850.02
|
| Rate for Payer: First Choice Health Commercial |
$4,454.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,701.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.99
|
| Rate for Payer: HealthUtah PPO |
$4,949.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,800.53
|
| Rate for Payer: Multiplan Medicare/VA |
$594.14
|
| Rate for Payer: One Health Plan of WY PPO |
$4,850.02
|
| Rate for Payer: PacificSource Commercial |
$4,454.10
|
| Rate for Payer: PHCS PPO |
$4,701.55
|
| Rate for Payer: Three Rivers PPO |
$3,711.75
|
| Rate for Payer: TriWest Veterans Administration |
$698.99
|
| Rate for Payer: United Healthcare Commercial |
$4,701.55
|
| Rate for Payer: WINHealth Partners Commercial |
$4,206.65
|
|
|
EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 64784 AS
|
| Min. Negotiated Rate |
$424.50 |
| Max. Negotiated Rate |
$566.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$554.68
|
| Rate for Payer: Beech Street Commercial |
$537.70
|
| Rate for Payer: Cash Price |
$396.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$549.02
|
| Rate for Payer: Cigna of WY Commercial |
$554.68
|
| Rate for Payer: First Choice Health Commercial |
$509.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$537.70
|
| Rate for Payer: HealthUtah PPO |
$566.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$549.02
|
| Rate for Payer: One Health Plan of WY PPO |
$554.68
|
| Rate for Payer: PacificSource Commercial |
$509.40
|
| Rate for Payer: PHCS PPO |
$537.70
|
| Rate for Payer: Three Rivers PPO |
$424.50
|
| Rate for Payer: United Healthcare Commercial |
$537.70
|
| Rate for Payer: WINHealth Partners Commercial |
$481.10
|
|
|
EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$2,742.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$519.17 |
| Max. Negotiated Rate |
$2,742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,687.16
|
| Rate for Payer: Aetna of WY Medicare |
$610.79
|
| Rate for Payer: Beech Street Commercial |
$2,604.90
|
| Rate for Payer: Cash Price |
$1,919.40
|
| Rate for Payer: Cash Price |
$1,919.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,659.74
|
| Rate for Payer: Cigna of WY Commercial |
$2,687.16
|
| Rate for Payer: First Choice Health Commercial |
$2,467.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,604.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.79
|
| Rate for Payer: HealthUtah PPO |
$2,742.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,659.74
|
| Rate for Payer: Multiplan Medicare/VA |
$519.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2,687.16
|
| Rate for Payer: PacificSource Commercial |
$2,467.80
|
| Rate for Payer: PHCS PPO |
$2,604.90
|
| Rate for Payer: Three Rivers PPO |
$2,056.50
|
| Rate for Payer: TriWest Veterans Administration |
$610.79
|
| Rate for Payer: United Healthcare Commercial |
$2,604.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,330.70
|
|
|
EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$2,742.00
|
|
|
Service Code
|
HCPCS 42410 80
|
| Min. Negotiated Rate |
$519.17 |
| Max. Negotiated Rate |
$2,742.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,687.16
|
| Rate for Payer: Beech Street Commercial |
$2,604.90
|
| Rate for Payer: Cash Price |
$1,919.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,659.74
|
| Rate for Payer: Cigna of WY Commercial |
$2,687.16
|
| Rate for Payer: First Choice Health Commercial |
$2,467.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,604.90
|
| Rate for Payer: HealthUtah PPO |
$2,742.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,659.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,687.16
|
| Rate for Payer: PacificSource Commercial |
$2,467.80
|
| Rate for Payer: PHCS PPO |
$2,604.90
|
| Rate for Payer: Three Rivers PPO |
$2,056.50
|
| Rate for Payer: United Healthcare Commercial |
$2,604.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,330.70
|
|
|
EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$24,564.00
|
|
|
Service Code
|
HCPCS 42420 80
|
| Min. Negotiated Rate |
$971.80 |
| Max. Negotiated Rate |
$24,564.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24,072.72
|
| Rate for Payer: Beech Street Commercial |
$23,335.80
|
| Rate for Payer: Cash Price |
$17,194.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$23,827.08
|
| Rate for Payer: Cigna of WY Commercial |
$24,072.72
|
| Rate for Payer: First Choice Health Commercial |
$22,107.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23,335.80
|
| Rate for Payer: HealthUtah PPO |
$24,564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23,827.08
|
| Rate for Payer: One Health Plan of WY PPO |
$24,072.72
|
| Rate for Payer: PacificSource Commercial |
$22,107.60
|
| Rate for Payer: PHCS PPO |
$23,335.80
|
| Rate for Payer: Three Rivers PPO |
$18,423.00
|
| Rate for Payer: United Healthcare Commercial |
$23,335.80
|
| Rate for Payer: WINHealth Partners Commercial |
$20,879.40
|
|
