|
EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$24,564.00
|
|
|
Service Code
|
HCPCS 42420
|
| 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: Aetna of WY Medicare |
$1,143.29
|
| Rate for Payer: Beech Street Commercial |
$23,335.80
|
| Rate for Payer: Cash Price |
$17,194.80
|
| 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: Government Employees Health Association (GEHA) Medicare |
$1,143.29
|
| Rate for Payer: HealthUtah PPO |
$24,564.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23,827.08
|
| Rate for Payer: Multiplan Medicare/VA |
$971.80
|
| 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: TriWest Veterans Administration |
$1,143.29
|
| Rate for Payer: United Healthcare Commercial |
$23,335.80
|
| Rate for Payer: WINHealth Partners Commercial |
$20,879.40
|
|
|
EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$2,677.00
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$506.15 |
| Max. Negotiated Rate |
$2,677.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,623.46
|
| Rate for Payer: Aetna of WY Medicare |
$595.47
|
| Rate for Payer: Beech Street Commercial |
$2,543.15
|
| Rate for Payer: Cash Price |
$1,873.90
|
| Rate for Payer: Cash Price |
$1,873.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,596.69
|
| Rate for Payer: Cigna of WY Commercial |
$2,623.46
|
| Rate for Payer: First Choice Health Commercial |
$2,409.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,543.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$595.47
|
| Rate for Payer: HealthUtah PPO |
$2,677.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,596.69
|
| Rate for Payer: Multiplan Medicare/VA |
$506.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,623.46
|
| Rate for Payer: PacificSource Commercial |
$2,409.30
|
| Rate for Payer: PHCS PPO |
$2,543.15
|
| Rate for Payer: Three Rivers PPO |
$2,007.75
|
| Rate for Payer: TriWest Veterans Administration |
$595.47
|
| Rate for Payer: United Healthcare Commercial |
$2,543.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,275.45
|
|
|
EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$482.16
|
| Rate for Payer: Aetna of WY Medicare |
$109.83
|
| Rate for Payer: Beech Street Commercial |
$467.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$477.24
|
| Rate for Payer: Cigna of WY Commercial |
$482.16
|
| Rate for Payer: First Choice Health Commercial |
$442.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$467.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.83
|
| Rate for Payer: HealthUtah PPO |
$492.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$477.24
|
| Rate for Payer: Multiplan Medicare/VA |
$93.36
|
| Rate for Payer: One Health Plan of WY PPO |
$482.16
|
| Rate for Payer: PacificSource Commercial |
$442.80
|
| Rate for Payer: PHCS PPO |
$467.40
|
| Rate for Payer: Three Rivers PPO |
$369.00
|
| Rate for Payer: TriWest Veterans Administration |
$109.83
|
| Rate for Payer: United Healthcare Commercial |
$467.40
|
| Rate for Payer: WINHealth Partners Commercial |
$418.20
|
|
|
EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,358.00
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$443.83 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,310.84
|
| Rate for Payer: Aetna of WY Medicare |
$522.15
|
| Rate for Payer: Beech Street Commercial |
$2,240.10
|
| Rate for Payer: Cash Price |
$1,650.60
|
| Rate for Payer: Cash Price |
$1,650.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,287.26
|
| Rate for Payer: Cigna of WY Commercial |
$2,310.84
|
| Rate for Payer: First Choice Health Commercial |
$2,122.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,240.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.15
|
| Rate for Payer: HealthUtah PPO |
$2,358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,287.26
|
| Rate for Payer: Multiplan Medicare/VA |
$443.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,310.84
|
| Rate for Payer: PacificSource Commercial |
$2,122.20
|
| Rate for Payer: PHCS PPO |
$2,240.10
|
| Rate for Payer: Three Rivers PPO |
$1,768.50
|
| Rate for Payer: TriWest Veterans Administration |
$522.15
|
| Rate for Payer: United Healthcare Commercial |
$2,240.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,004.30
|
|
|
EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$1,964.00
|
|
|
Service Code
|
HCPCS 21552
|
| Min. Negotiated Rate |
$366.44 |
| Max. Negotiated Rate |
$1,964.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,924.72
|
| Rate for Payer: Aetna of WY Medicare |
$431.11
|
| Rate for Payer: Beech Street Commercial |
$1,865.80
|
| Rate for Payer: Cash Price |
$1,374.80
|
| Rate for Payer: Cash Price |
$1,374.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,905.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,924.72
|
| Rate for Payer: First Choice Health Commercial |
$1,767.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,865.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.11
|
| Rate for Payer: HealthUtah PPO |
$1,964.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,905.08
|
| Rate for Payer: Multiplan Medicare/VA |
$366.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,924.72
|
| Rate for Payer: PacificSource Commercial |
$1,767.60
|
| Rate for Payer: PHCS PPO |
$1,865.80
|
| Rate for Payer: Three Rivers PPO |
$1,473.00
|
| Rate for Payer: TriWest Veterans Administration |
$431.11
|
| Rate for Payer: United Healthcare Commercial |
$1,865.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,669.40
|
|
|
EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$3,256.00
|
|
|
Service Code
|
HCPCS 21933
|
| Min. Negotiated Rate |
$601.36 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,190.88
|
| Rate for Payer: Aetna of WY Medicare |
$707.48
|
| Rate for Payer: Beech Street Commercial |
$3,093.20
|
| Rate for Payer: Cash Price |
$2,279.20
|
| Rate for Payer: Cash Price |
$2,279.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,158.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,190.88
|
| Rate for Payer: First Choice Health Commercial |
$2,930.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,093.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.48
|
| Rate for Payer: HealthUtah PPO |
$3,256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,158.32
|
| Rate for Payer: Multiplan Medicare/VA |
$601.36
|
| Rate for Payer: One Health Plan of WY PPO |
$3,190.88
|
| Rate for Payer: PacificSource Commercial |
$2,930.40
|
| Rate for Payer: PHCS PPO |
$3,093.20
|
| Rate for Payer: Three Rivers PPO |
$2,442.00
|
| Rate for Payer: TriWest Veterans Administration |
$707.48
|
| Rate for Payer: United Healthcare Commercial |
$3,093.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2,767.60
|
|
|
EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,659.00
|
|
|
Service Code
|
HCPCS 21932
|
| Min. Negotiated Rate |
$541.64 |
| Max. Negotiated Rate |
$2,659.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,605.82
|
| Rate for Payer: Aetna of WY Medicare |
$637.22
|
| Rate for Payer: Beech Street Commercial |
$2,526.05
|
| Rate for Payer: Cash Price |
$1,861.30
|
| Rate for Payer: Cash Price |
$1,861.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,579.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,605.82
|
| Rate for Payer: First Choice Health Commercial |
$2,393.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,526.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$637.22
|
| Rate for Payer: HealthUtah PPO |
$2,659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,579.23
|
| Rate for Payer: Multiplan Medicare/VA |
$541.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,605.82
|
| Rate for Payer: PacificSource Commercial |
$2,393.10
|
| Rate for Payer: PHCS PPO |
$2,526.05
|
| Rate for Payer: Three Rivers PPO |
$1,994.25
|
| Rate for Payer: TriWest Veterans Administration |
$637.22
|
| Rate for Payer: United Healthcare Commercial |
$2,526.05
|
| Rate for Payer: WINHealth Partners Commercial |
$2,260.15
|
|
|
EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
HCPCS 21014
|
| Min. Negotiated Rate |
$429.39 |
| Max. Negotiated Rate |
$2,293.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,247.14
|
| Rate for Payer: Aetna of WY Medicare |
$505.17
|
| Rate for Payer: Beech Street Commercial |
$2,178.35
|
| Rate for Payer: Cash Price |
$1,605.10
|
| Rate for Payer: Cash Price |
$1,605.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,224.21
|
| Rate for Payer: Cigna of WY Commercial |
$2,247.14
|
| Rate for Payer: First Choice Health Commercial |
$2,063.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,178.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$505.17
|
| Rate for Payer: HealthUtah PPO |
$2,293.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,224.21
|
| Rate for Payer: Multiplan Medicare/VA |
$429.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,247.14
|
| Rate for Payer: PacificSource Commercial |
$2,063.70
|
| Rate for Payer: PHCS PPO |
$2,178.35
|
| Rate for Payer: Three Rivers PPO |
$1,719.75
|
| Rate for Payer: TriWest Veterans Administration |
$505.17
|
| Rate for Payer: United Healthcare Commercial |
$2,178.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,949.05
|
|
|
EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>
|
Professional
|
Both
|
$1,869.00
|
|
|
Service Code
|
HCPCS 25071
|
| Min. Negotiated Rate |
$350.09 |
| Max. Negotiated Rate |
$1,869.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,831.62
|
| Rate for Payer: Aetna of WY Medicare |
$411.87
|
| Rate for Payer: Beech Street Commercial |
$1,775.55
|
| Rate for Payer: Cash Price |
$1,308.30
|
| Rate for Payer: Cash Price |
$1,308.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,812.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,831.62
|
| Rate for Payer: First Choice Health Commercial |
$1,682.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,775.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.87
|
| Rate for Payer: HealthUtah PPO |
$1,869.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,812.93
|
| Rate for Payer: Multiplan Medicare/VA |
$350.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,831.62
|
| Rate for Payer: PacificSource Commercial |
$1,682.10
|
| Rate for Payer: PHCS PPO |
$1,775.55
|
| Rate for Payer: Three Rivers PPO |
$1,401.75
|
| Rate for Payer: TriWest Veterans Administration |
$411.87
|
| Rate for Payer: United Healthcare Commercial |
$1,775.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,588.65
|
|
|
EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM
|
Professional
|
Both
|
$2,282.00
|
|
|
Service Code
|
HCPCS 25076
|
| Min. Negotiated Rate |
$431.35 |
| Max. Negotiated Rate |
$2,282.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,236.36
|
| Rate for Payer: Aetna of WY Medicare |
$507.47
|
| Rate for Payer: Beech Street Commercial |
$2,167.90
|
| Rate for Payer: Cash Price |
$1,597.40
|
| Rate for Payer: Cash Price |
$1,597.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,213.54
|
| Rate for Payer: Cigna of WY Commercial |
$2,236.36
|
| Rate for Payer: First Choice Health Commercial |
$2,053.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,167.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.47
|
| Rate for Payer: HealthUtah PPO |
$2,282.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,213.54
|
| Rate for Payer: Multiplan Medicare/VA |
$431.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2,236.36
|
| Rate for Payer: PacificSource Commercial |
$2,053.80
|
| Rate for Payer: PHCS PPO |
$2,167.90
|
| Rate for Payer: Three Rivers PPO |
$1,711.50
|
| Rate for Payer: TriWest Veterans Administration |
$507.47
|
| Rate for Payer: United Healthcare Commercial |
$2,167.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,939.70
|
|
|
EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 21556
|
| Min. Negotiated Rate |
$435.54 |
| Max. Negotiated Rate |
$2,326.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,279.48
|
| Rate for Payer: Aetna of WY Medicare |
$512.40
|
| Rate for Payer: Beech Street Commercial |
$2,209.70
|
| Rate for Payer: Cash Price |
$1,628.20
|
| Rate for Payer: Cash Price |
$1,628.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,256.22
|
| Rate for Payer: Cigna of WY Commercial |
$2,279.48
|
| Rate for Payer: First Choice Health Commercial |
$2,093.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$512.40
|
| Rate for Payer: HealthUtah PPO |
$2,326.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,256.22
|
| Rate for Payer: Multiplan Medicare/VA |
$435.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,279.48
|
| Rate for Payer: PacificSource Commercial |
$2,093.40
|
| Rate for Payer: PHCS PPO |
$2,209.70
|
| Rate for Payer: Three Rivers PPO |
$1,744.50
|
| Rate for Payer: TriWest Veterans Administration |
$512.40
|
| Rate for Payer: United Healthcare Commercial |
$2,209.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,977.10
|
|
|
EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Professional
|
Both
|
$4,738.00
|
|
|
Service Code
|
HCPCS 23076
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$4,738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,643.24
|
| Rate for Payer: Aetna of WY Medicare |
$526.59
|
| Rate for Payer: Beech Street Commercial |
$4,501.10
|
| Rate for Payer: Cash Price |
$3,316.60
|
| Rate for Payer: Cash Price |
$3,316.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,595.86
|
| Rate for Payer: Cigna of WY Commercial |
$4,643.24
|
| Rate for Payer: First Choice Health Commercial |
$4,264.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,501.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.59
|
| Rate for Payer: HealthUtah PPO |
$4,738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,595.86
|
| Rate for Payer: Multiplan Medicare/VA |
$447.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4,643.24
|
| Rate for Payer: PacificSource Commercial |
$4,264.20
|
| Rate for Payer: PHCS PPO |
$4,501.10
|
| Rate for Payer: Three Rivers PPO |
$3,553.50
|
| Rate for Payer: TriWest Veterans Administration |
$526.59
|
| Rate for Payer: United Healthcare Commercial |
$4,501.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,027.30
|
|
|
EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 22900 80
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.64
|
| Rate for Payer: Beech Street Commercial |
$349.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.96
|
| Rate for Payer: Cigna of WY Commercial |
$360.64
|
| Rate for Payer: First Choice Health Commercial |
$331.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.60
|
| Rate for Payer: HealthUtah PPO |
$368.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.96
|
| Rate for Payer: One Health Plan of WY PPO |
$360.64
|
| Rate for Payer: PacificSource Commercial |
$331.20
|
| Rate for Payer: PHCS PPO |
$349.60
|
| Rate for Payer: Three Rivers PPO |
$276.00
|
| Rate for Payer: United Healthcare Commercial |
$349.60
|
| Rate for Payer: WINHealth Partners Commercial |
$312.80
|
|
|
EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 22900
|
| Min. Negotiated Rate |
$463.16 |
| Max. Negotiated Rate |
$1,829.00 |
| Rate for Payer: Three Rivers PPO |
$1,371.75
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,792.42
|
| Rate for Payer: Aetna of WY Medicare |
$544.90
|
| Rate for Payer: Beech Street Commercial |
$1,737.55
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,774.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,792.42
|
| Rate for Payer: First Choice Health Commercial |
$1,646.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,737.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$544.90
|
| Rate for Payer: HealthUtah PPO |
$1,829.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,774.13
|
| Rate for Payer: Multiplan Medicare/VA |
$463.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1,792.42
|
| Rate for Payer: PacificSource Commercial |
$1,646.10
|
| Rate for Payer: PHCS PPO |
$1,737.55
|
| Rate for Payer: TriWest Veterans Administration |
$544.90
|
| Rate for Payer: United Healthcare Commercial |
$1,737.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,554.65
|
|
|
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Professional
|
Both
|
$1,772.00
|
|
|
Service Code
|
HCPCS 22903
|
| Min. Negotiated Rate |
$360.23 |
| Max. Negotiated Rate |
$1,772.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,736.56
|
| Rate for Payer: Aetna of WY Medicare |
$423.80
|
| Rate for Payer: Beech Street Commercial |
$1,683.40
|
| Rate for Payer: Cash Price |
$1,240.40
|
| Rate for Payer: Cash Price |
$1,240.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,718.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,736.56
|
| Rate for Payer: First Choice Health Commercial |
$1,594.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,683.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.80
|
| Rate for Payer: HealthUtah PPO |
$1,772.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,718.84
|
| Rate for Payer: Multiplan Medicare/VA |
$360.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,736.56
|
| Rate for Payer: PacificSource Commercial |
$1,594.80
|
| Rate for Payer: PHCS PPO |
$1,683.40
|
| Rate for Payer: Three Rivers PPO |
$1,329.00
|
| Rate for Payer: TriWest Veterans Administration |
$423.80
|
| Rate for Payer: United Healthcare Commercial |
$1,683.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,506.20
|
|
|
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
|
Professional
|
Both
|
$4,681.00
|
|
|
Service Code
|
HCPCS 22902
|
| Min. Negotiated Rate |
$275.08 |
| Max. Negotiated Rate |
$4,681.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,587.38
|
| Rate for Payer: Aetna of WY Medicare |
$323.62
|
| Rate for Payer: Beech Street Commercial |
$4,446.95
|
| Rate for Payer: Cash Price |
$3,276.70
|
| Rate for Payer: Cash Price |
$3,276.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,540.57
|
| Rate for Payer: Cigna of WY Commercial |
$4,587.38
|
| Rate for Payer: First Choice Health Commercial |
$4,212.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,446.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.62
|
| Rate for Payer: HealthUtah PPO |
$4,681.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,540.57
|
| Rate for Payer: Multiplan Medicare/VA |
$275.08
|
| Rate for Payer: One Health Plan of WY PPO |
$4,587.38
|
| Rate for Payer: PacificSource Commercial |
$4,212.90
|
| Rate for Payer: PHCS PPO |
$4,446.95
|
| Rate for Payer: Three Rivers PPO |
$3,510.75
|
| Rate for Payer: TriWest Veterans Administration |
$323.62
|
| Rate for Payer: United Healthcare Commercial |
$4,446.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,978.85
|
|
|
EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
|
Professional
|
Both
|
$4,681.00
|
|
|
Service Code
|
HCPCS 22902 80
|
| Min. Negotiated Rate |
$275.08 |
| Max. Negotiated Rate |
$4,681.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,587.38
|
| Rate for Payer: Beech Street Commercial |
$4,446.95
|
| Rate for Payer: Cash Price |
$3,276.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,540.57
|
| Rate for Payer: Cigna of WY Commercial |
$4,587.38
|
| Rate for Payer: First Choice Health Commercial |
$4,212.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,446.95
|
| Rate for Payer: HealthUtah PPO |
$4,681.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,540.57
|
| Rate for Payer: One Health Plan of WY PPO |
$4,587.38
|
| Rate for Payer: PacificSource Commercial |
$4,212.90
|
| Rate for Payer: PHCS PPO |
$4,446.95
|
| Rate for Payer: Three Rivers PPO |
$3,510.75
|
| Rate for Payer: United Healthcare Commercial |
$4,446.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3,978.85
|
|
|
EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$4,215.00
|
|
|
Service Code
|
HCPCS 28041
|
| Min. Negotiated Rate |
$373.18 |
| Max. Negotiated Rate |
$4,215.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,130.70
|
| Rate for Payer: Aetna of WY Medicare |
$439.04
|
| Rate for Payer: Beech Street Commercial |
$4,004.25
|
| Rate for Payer: Cash Price |
$2,950.50
|
| Rate for Payer: Cash Price |
$2,950.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,088.55
|
| Rate for Payer: Cigna of WY Commercial |
$4,130.70
|
| Rate for Payer: First Choice Health Commercial |
$3,793.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,004.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$439.04
|
| Rate for Payer: HealthUtah PPO |
$4,215.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,088.55
|
| Rate for Payer: Multiplan Medicare/VA |
$373.18
|
| Rate for Payer: One Health Plan of WY PPO |
$4,130.70
|
| Rate for Payer: PacificSource Commercial |
$3,793.50
|
| Rate for Payer: PHCS PPO |
$4,004.25
|
| Rate for Payer: Three Rivers PPO |
$3,161.25
|
| Rate for Payer: TriWest Veterans Administration |
$439.04
|
| Rate for Payer: United Healthcare Commercial |
$4,004.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,582.75
|
|
|
EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 28041 80
|
| Min. Negotiated Rate |
$633.00 |
| Max. Negotiated Rate |
$844.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$827.12
|
| Rate for Payer: Beech Street Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$590.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$818.68
|
| Rate for Payer: Cigna of WY Commercial |
$827.12
|
| Rate for Payer: First Choice Health Commercial |
$759.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$801.80
|
| Rate for Payer: HealthUtah PPO |
$844.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$818.68
|
| Rate for Payer: One Health Plan of WY PPO |
$827.12
|
| Rate for Payer: PacificSource Commercial |
$759.60
|
| Rate for Payer: PHCS PPO |
$801.80
|
| Rate for Payer: Three Rivers PPO |
$633.00
|
| Rate for Payer: United Healthcare Commercial |
$801.80
|
| Rate for Payer: WINHealth Partners Commercial |
$717.40
|
|
|
EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
HCPCS 25075
|
| Min. Negotiated Rate |
$262.85 |
| Max. Negotiated Rate |
$1,389.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,361.22
|
| Rate for Payer: Aetna of WY Medicare |
$309.23
|
| Rate for Payer: Beech Street Commercial |
$1,319.55
|
| Rate for Payer: Cash Price |
$972.30
|
| Rate for Payer: Cash Price |
$972.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,347.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,361.22
|
| Rate for Payer: First Choice Health Commercial |
$1,250.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,319.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.23
|
| Rate for Payer: HealthUtah PPO |
$1,389.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,347.33
|
| Rate for Payer: Multiplan Medicare/VA |
$262.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,361.22
|
| Rate for Payer: PacificSource Commercial |
$1,250.10
|
| Rate for Payer: PHCS PPO |
$1,319.55
|
| Rate for Payer: Three Rivers PPO |
$1,041.75
|
| Rate for Payer: TriWest Veterans Administration |
$309.23
|
| Rate for Payer: United Healthcare Commercial |
$1,319.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,180.65
|
|
|
EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,038.00
|
|
|
Service Code
|
HCPCS 27619
|
| Min. Negotiated Rate |
$389.08 |
| Max. Negotiated Rate |
$2,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,997.24
|
| Rate for Payer: Aetna of WY Medicare |
$457.74
|
| Rate for Payer: Beech Street Commercial |
$1,936.10
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: Cash Price |
$1,426.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,976.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,997.24
|
| Rate for Payer: First Choice Health Commercial |
$1,834.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,936.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$457.74
|
| Rate for Payer: HealthUtah PPO |
$2,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,976.86
|
| Rate for Payer: Multiplan Medicare/VA |
$389.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1,997.24
|
| Rate for Payer: PacificSource Commercial |
$1,834.20
|
| Rate for Payer: PHCS PPO |
$1,936.10
|
| Rate for Payer: Three Rivers PPO |
$1,528.50
|
| Rate for Payer: TriWest Veterans Administration |
$457.74
|
| Rate for Payer: United Healthcare Commercial |
$1,936.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1,732.30
|
|
|
EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM
|
Professional
|
Both
|
$10,164.00
|
|
|
Service Code
|
HCPCS 27618
|
| Min. Negotiated Rate |
$253.88 |
| Max. Negotiated Rate |
$10,164.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,960.72
|
| Rate for Payer: Aetna of WY Medicare |
$298.68
|
| Rate for Payer: Beech Street Commercial |
$9,655.80
|
| Rate for Payer: Cash Price |
$7,114.80
|
| Rate for Payer: Cash Price |
$7,114.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,859.08
|
| Rate for Payer: Cigna of WY Commercial |
$9,960.72
|
| Rate for Payer: First Choice Health Commercial |
$9,147.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,655.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.68
|
| Rate for Payer: HealthUtah PPO |
$10,164.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,859.08
|
| Rate for Payer: Multiplan Medicare/VA |
$253.88
|
| Rate for Payer: One Health Plan of WY PPO |
$9,960.72
|
| Rate for Payer: PacificSource Commercial |
$9,147.60
|
| Rate for Payer: PHCS PPO |
$9,655.80
|
| Rate for Payer: Three Rivers PPO |
$7,623.00
|
| Rate for Payer: TriWest Veterans Administration |
$298.68
|
| Rate for Payer: United Healthcare Commercial |
$9,655.80
|
| Rate for Payer: WINHealth Partners Commercial |
$8,639.40
|
|
|
EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 21555
|
| Min. Negotiated Rate |
$254.07 |
| Max. Negotiated Rate |
$1,346.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,319.08
|
| Rate for Payer: Aetna of WY Medicare |
$298.91
|
| Rate for Payer: Beech Street Commercial |
$1,278.70
|
| Rate for Payer: Cash Price |
$942.20
|
| Rate for Payer: Cash Price |
$942.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,305.62
|
| Rate for Payer: Cigna of WY Commercial |
$1,319.08
|
| Rate for Payer: First Choice Health Commercial |
$1,211.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,278.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.91
|
| Rate for Payer: HealthUtah PPO |
$1,346.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,305.62
|
| Rate for Payer: Multiplan Medicare/VA |
$254.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,319.08
|
| Rate for Payer: PacificSource Commercial |
$1,211.40
|
| Rate for Payer: PHCS PPO |
$1,278.70
|
| Rate for Payer: Three Rivers PPO |
$1,009.50
|
| Rate for Payer: TriWest Veterans Administration |
$298.91
|
| Rate for Payer: United Healthcare Commercial |
$1,278.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,144.10
|
|
|
EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>
|
Professional
|
Both
|
$3,221.00
|
|
|
Service Code
|
HCPCS 21554
|
| Min. Negotiated Rate |
$597.74 |
| Max. Negotiated Rate |
$3,221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,156.58
|
| Rate for Payer: Aetna of WY Medicare |
$703.22
|
| Rate for Payer: Beech Street Commercial |
$3,059.95
|
| Rate for Payer: Cash Price |
$2,254.70
|
| Rate for Payer: Cash Price |
$2,254.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,124.37
|
| Rate for Payer: Cigna of WY Commercial |
$3,156.58
|
| Rate for Payer: First Choice Health Commercial |
$2,898.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,059.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$703.22
|
| Rate for Payer: HealthUtah PPO |
$3,221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,124.37
|
| Rate for Payer: Multiplan Medicare/VA |
$597.74
|
| Rate for Payer: One Health Plan of WY PPO |
$3,156.58
|
| Rate for Payer: PacificSource Commercial |
$2,898.90
|
| Rate for Payer: PHCS PPO |
$3,059.95
|
| Rate for Payer: Three Rivers PPO |
$2,415.75
|
| Rate for Payer: TriWest Veterans Administration |
$703.22
|
| Rate for Payer: United Healthcare Commercial |
$3,059.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2,737.85
|
|
|
EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>
|
Professional
|
Both
|
$8,505.00
|
|
|
Service Code
|
HCPCS 27045
|
| Min. Negotiated Rate |
$599.48 |
| Max. Negotiated Rate |
$8,505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,334.90
|
| Rate for Payer: Aetna of WY Medicare |
$705.27
|
| Rate for Payer: Beech Street Commercial |
$8,079.75
|
| Rate for Payer: Cash Price |
$5,953.50
|
| Rate for Payer: Cash Price |
$5,953.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,249.85
|
| Rate for Payer: Cigna of WY Commercial |
$8,334.90
|
| Rate for Payer: First Choice Health Commercial |
$7,654.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,079.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$705.27
|
| Rate for Payer: HealthUtah PPO |
$8,505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,249.85
|
| Rate for Payer: Multiplan Medicare/VA |
$599.48
|
| Rate for Payer: One Health Plan of WY PPO |
$8,334.90
|
| Rate for Payer: PacificSource Commercial |
$7,654.50
|
| Rate for Payer: PHCS PPO |
$8,079.75
|
| Rate for Payer: Three Rivers PPO |
$6,378.75
|
| Rate for Payer: TriWest Veterans Administration |
$705.27
|
| Rate for Payer: United Healthcare Commercial |
$8,079.75
|
| Rate for Payer: WINHealth Partners Commercial |
$7,229.25
|
|
