|
HC PRO DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 11046 NONPBBPAYER
|
| Hospital Charge Code |
9831104601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$51.75
|
| Rate for Payer: Beech Street Commercial |
$266.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: First Choice Health Commercial |
$252.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.75
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$43.99
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$266.00
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$51.75
|
| Rate for Payer: WINHealth Partners Commercial |
$238.00
|
|
|
HC PRO DECOMPRESSION UNSPECIFIED NERVE
|
Professional
|
Both
|
$1,854.00
|
|
|
Service Code
|
HCPCS 64722
|
| Hospital Charge Code |
9826472201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$306.81 |
| Max. Negotiated Rate |
$1,854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,816.92
|
| Rate for Payer: Aetna of WY Medicare |
$360.95
|
| Rate for Payer: Beech Street Commercial |
$1,761.30
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,798.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,816.92
|
| Rate for Payer: First Choice Health Commercial |
$1,668.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,761.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$360.95
|
| Rate for Payer: HealthUtah PPO |
$1,854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,798.38
|
| Rate for Payer: Multiplan Medicare/VA |
$306.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,816.92
|
| Rate for Payer: PacificSource Commercial |
$1,668.60
|
| Rate for Payer: PHCS PPO |
$1,761.30
|
| Rate for Payer: Three Rivers PPO |
$1,390.50
|
| Rate for Payer: TriWest Veterans Administration |
$360.95
|
| Rate for Payer: United Healthcare Commercial |
$1,612.98
|
| Rate for Payer: United Healthcare Medicare |
$360.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,575.90
|
|
|
HC PRO DELIVER PLACENTA
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
9835941401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$72.15 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$84.88
|
| Rate for Payer: Beech Street Commercial |
$261.25
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: First Choice Health Commercial |
$247.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.88
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$72.15
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$261.25
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$84.88
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$84.88
|
| Rate for Payer: WINHealth Partners Commercial |
$233.75
|
|
|
HC PRO DESTRUC BENIGN/PREMAL 2 TO 14 LESIONS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 17003 NONPBBPAYER
|
| Hospital Charge Code |
9831700301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$1.96
|
| Rate for Payer: Beech Street Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: First Choice Health Commercial |
$20.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.96
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$1.67
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$21.85
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.96
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$1.96
|
| Rate for Payer: WINHealth Partners Commercial |
$19.55
|
|
|
HC PRO DESTRUC BENIGN/PREMAL 2 TO 14 LESIONS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
9831700301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.64
|
| Rate for Payer: Aetna of WY Medicare |
$1.96
|
| Rate for Payer: Beech Street Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.46
|
| Rate for Payer: Cigna of WY Commercial |
$17.64
|
| Rate for Payer: First Choice Health Commercial |
$16.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.96
|
| Rate for Payer: HealthUtah PPO |
$18.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1.67
|
| Rate for Payer: One Health Plan of WY PPO |
$17.64
|
| Rate for Payer: PacificSource Commercial |
$16.20
|
| Rate for Payer: PHCS PPO |
$17.10
|
| Rate for Payer: Three Rivers PPO |
$13.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.96
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$1.96
|
| Rate for Payer: WINHealth Partners Commercial |
$15.30
|
|
|
HC PRO DESTRUC BENIGN/PREMAL,FIRST LESION
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 17000 NONPBBPAYER
|
| Hospital Charge Code |
9831700001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.64
|
| Rate for Payer: Aetna of WY Medicare |
$53.84
|
| Rate for Payer: Beech Street Commercial |
$254.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$259.96
|
| Rate for Payer: Cigna of WY Commercial |
$262.64
|
| Rate for Payer: First Choice Health Commercial |
$241.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.84
|
| Rate for Payer: HealthUtah PPO |
$268.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$259.96
|
| Rate for Payer: Multiplan Medicare/VA |
$45.76
|
| Rate for Payer: One Health Plan of WY PPO |
$262.64
|
| Rate for Payer: PacificSource Commercial |
$241.20
|
| Rate for Payer: PHCS PPO |
$254.60
|
| Rate for Payer: Three Rivers PPO |
$201.00
|
| Rate for Payer: TriWest Veterans Administration |
$53.84
|
| Rate for Payer: United Healthcare Commercial |
$233.16
|
| Rate for Payer: United Healthcare Medicare |
$53.84
|
| Rate for Payer: WINHealth Partners Commercial |
$227.80
|
|
|
HC PRO DESTRUC BENIGN/PREMAL,FIRST LESION
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
9831700001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$209.72
|
| Rate for Payer: Aetna of WY Medicare |
$53.84
|
| Rate for Payer: Beech Street Commercial |
$203.30
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: Cash Price |
$149.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$207.58
|
| Rate for Payer: Cigna of WY Commercial |
$209.72
|
| Rate for Payer: First Choice Health Commercial |
$192.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$203.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.84
|
| Rate for Payer: HealthUtah PPO |
$214.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$207.58
|
| Rate for Payer: Multiplan Medicare/VA |
$45.76
|
| Rate for Payer: One Health Plan of WY PPO |
$209.72
|
| Rate for Payer: PacificSource Commercial |
$192.60
|
| Rate for Payer: PHCS PPO |
$203.30
|
| Rate for Payer: Three Rivers PPO |
$160.50
|
| Rate for Payer: TriWest Veterans Administration |
$53.84
|
| Rate for Payer: United Healthcare Commercial |
$186.18
|
| Rate for Payer: United Healthcare Medicare |
$53.84
|
| Rate for Payer: WINHealth Partners Commercial |
$181.90
|
|
|
HC PRO DESTRUCT BENIGN/PREMAL,15+ LESIONS
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 17004 NONPBBPAYER
|
| Hospital Charge Code |
9831700401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.01 |
| Max. Negotiated Rate |
$487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$477.26
|
| Rate for Payer: Aetna of WY Medicare |
$95.31
|
| Rate for Payer: Beech Street Commercial |
$462.65
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$472.39
|
| Rate for Payer: Cigna of WY Commercial |
$477.26
|
| Rate for Payer: First Choice Health Commercial |
$438.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$462.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.31
|
| Rate for Payer: HealthUtah PPO |
$487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$472.39
|
| Rate for Payer: Multiplan Medicare/VA |
$81.01
|
| Rate for Payer: One Health Plan of WY PPO |
$477.26
|
| Rate for Payer: PacificSource Commercial |
$438.30
|
| Rate for Payer: PHCS PPO |
$462.65
|
| Rate for Payer: Three Rivers PPO |
$365.25
|
| Rate for Payer: TriWest Veterans Administration |
$95.31
|
| Rate for Payer: United Healthcare Commercial |
$423.69
|
| Rate for Payer: United Healthcare Medicare |
$95.31
|
| Rate for Payer: WINHealth Partners Commercial |
$413.95
|
|
|
HC PRO DESTRUCT BENIGN/PREMAL,15+ LESIONS
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
9831700401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$81.01 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$382.20
|
| Rate for Payer: Aetna of WY Medicare |
$95.31
|
| Rate for Payer: Beech Street Commercial |
$370.50
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$378.30
|
| Rate for Payer: Cigna of WY Commercial |
$382.20
|
| Rate for Payer: First Choice Health Commercial |
$351.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$370.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.31
|
| Rate for Payer: HealthUtah PPO |
$390.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$378.30
|
| Rate for Payer: Multiplan Medicare/VA |
$81.01
|
| Rate for Payer: One Health Plan of WY PPO |
$382.20
|
| Rate for Payer: PacificSource Commercial |
$351.00
|
| Rate for Payer: PHCS PPO |
$370.50
|
| Rate for Payer: Three Rivers PPO |
$292.50
|
| Rate for Payer: TriWest Veterans Administration |
$95.31
|
| Rate for Payer: United Healthcare Commercial |
$339.30
|
| Rate for Payer: United Healthcare Medicare |
$95.31
|
| Rate for Payer: WINHealth Partners Commercial |
$331.50
|
|
|
HC PRO DESTRUCT BY NEURO AGENT; OTHER PERIPH NERVE
|
Professional
|
Both
|
$1,732.00
|
|
|
Service Code
|
HCPCS 64640 50
|
| Hospital Charge Code |
9836464001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$1,732.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,697.36
|
| Rate for Payer: Aetna of WY Medicare |
$114.77
|
| Rate for Payer: Beech Street Commercial |
$1,645.40
|
| Rate for Payer: Cash Price |
$1,212.40
|
| Rate for Payer: Cash Price |
$1,212.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,680.04
|
| Rate for Payer: Cigna of WY Commercial |
$1,697.36
|
| Rate for Payer: First Choice Health Commercial |
$1,558.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,645.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.77
|
| Rate for Payer: HealthUtah PPO |
$1,732.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,680.04
|
| Rate for Payer: Multiplan Medicare/VA |
$97.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,697.36
|
| Rate for Payer: PacificSource Commercial |
$1,558.80
|
| Rate for Payer: PHCS PPO |
$1,645.40
|
| Rate for Payer: Three Rivers PPO |
$1,299.00
|
| Rate for Payer: TriWest Veterans Administration |
$114.77
|
| Rate for Payer: United Healthcare Commercial |
$1,506.84
|
| Rate for Payer: United Healthcare Medicare |
$114.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1,472.20
|
|
|
HC PRO DESTRUCT BY NEURO AGENT; OTHER PERIPH NERVE
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
9836464001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$866.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$848.68
|
| Rate for Payer: Aetna of WY Medicare |
$114.77
|
| Rate for Payer: Beech Street Commercial |
$822.70
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$840.02
|
| Rate for Payer: Cigna of WY Commercial |
$848.68
|
| Rate for Payer: First Choice Health Commercial |
$779.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$822.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.77
|
| Rate for Payer: HealthUtah PPO |
$866.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$840.02
|
| Rate for Payer: Multiplan Medicare/VA |
$97.55
|
| Rate for Payer: One Health Plan of WY PPO |
$848.68
|
| Rate for Payer: PacificSource Commercial |
$779.40
|
| Rate for Payer: PHCS PPO |
$822.70
|
| Rate for Payer: Three Rivers PPO |
$649.50
|
| Rate for Payer: TriWest Veterans Administration |
$114.77
|
| Rate for Payer: United Healthcare Commercial |
$753.42
|
| Rate for Payer: United Healthcare Medicare |
$114.77
|
| Rate for Payer: WINHealth Partners Commercial |
$736.10
|
|
|
HC PRO DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 17111 NONPBBPAYER
|
| Hospital Charge Code |
9831711101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$466.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$456.68
|
| Rate for Payer: Beech Street Commercial |
$442.70
|
| Rate for Payer: Cash Price |
$326.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.02
|
| Rate for Payer: Cigna of WY Commercial |
$456.68
|
| Rate for Payer: First Choice Health Commercial |
$419.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$442.70
|
| Rate for Payer: HealthUtah PPO |
$466.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.02
|
| Rate for Payer: One Health Plan of WY PPO |
$456.68
|
| Rate for Payer: PacificSource Commercial |
$419.40
|
| Rate for Payer: PHCS PPO |
$442.70
|
| Rate for Payer: Three Rivers PPO |
$349.50
|
| Rate for Payer: United Healthcare Commercial |
$405.42
|
| Rate for Payer: WINHealth Partners Commercial |
$396.10
|
|
|
HC PRO DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
9831711101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$279.75 |
| Max. Negotiated Rate |
$373.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$365.54
|
| Rate for Payer: Beech Street Commercial |
$354.35
|
| Rate for Payer: Cash Price |
$261.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$361.81
|
| Rate for Payer: Cigna of WY Commercial |
$365.54
|
| Rate for Payer: First Choice Health Commercial |
$335.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$354.35
|
| Rate for Payer: HealthUtah PPO |
$373.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$361.81
|
| Rate for Payer: One Health Plan of WY PPO |
$365.54
|
| Rate for Payer: PacificSource Commercial |
$335.70
|
| Rate for Payer: PHCS PPO |
$354.35
|
| Rate for Payer: Three Rivers PPO |
$279.75
|
| Rate for Payer: United Healthcare Commercial |
$324.51
|
| Rate for Payer: WINHealth Partners Commercial |
$317.05
|
|
|
HC PRO DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
HCPCS 17110 NONPBBPAYER
|
| Hospital Charge Code |
9831711001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Medicare |
$67.18
|
| Rate for Payer: Beech Street Commercial |
$379.05
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.18
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$57.10
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$379.05
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.18
|
| Rate for Payer: United Healthcare Commercial |
$347.13
|
| Rate for Payer: United Healthcare Medicare |
$67.18
|
| Rate for Payer: WINHealth Partners Commercial |
$339.15
|
|
|
HC PRO DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
9831711001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$319.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.62
|
| Rate for Payer: Aetna of WY Medicare |
$67.18
|
| Rate for Payer: Beech Street Commercial |
$303.05
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.43
|
| Rate for Payer: Cigna of WY Commercial |
$312.62
|
| Rate for Payer: First Choice Health Commercial |
$287.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.18
|
| Rate for Payer: HealthUtah PPO |
$319.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.43
|
| Rate for Payer: Multiplan Medicare/VA |
$57.10
|
| Rate for Payer: One Health Plan of WY PPO |
$312.62
|
| Rate for Payer: PacificSource Commercial |
$287.10
|
| Rate for Payer: PHCS PPO |
$303.05
|
| Rate for Payer: Three Rivers PPO |
$239.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.18
|
| Rate for Payer: United Healthcare Commercial |
$277.53
|
| Rate for Payer: United Healthcare Medicare |
$67.18
|
| Rate for Payer: WINHealth Partners Commercial |
$271.15
|
|
|
HC PRO DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
9834693001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$777.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$761.46
|
| Rate for Payer: Aetna of WY Medicare |
$148.00
|
| Rate for Payer: Beech Street Commercial |
$738.15
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$753.69
|
| Rate for Payer: Cigna of WY Commercial |
$761.46
|
| Rate for Payer: First Choice Health Commercial |
$699.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$738.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.00
|
| Rate for Payer: HealthUtah PPO |
$777.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$753.69
|
| Rate for Payer: Multiplan Medicare/VA |
$125.80
|
| Rate for Payer: One Health Plan of WY PPO |
$761.46
|
| Rate for Payer: PacificSource Commercial |
$699.30
|
| Rate for Payer: PHCS PPO |
$738.15
|
| Rate for Payer: Three Rivers PPO |
$582.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.00
|
| Rate for Payer: United Healthcare Commercial |
$675.99
|
| Rate for Payer: United Healthcare Medicare |
$148.00
|
| Rate for Payer: WINHealth Partners Commercial |
$660.45
|
|
|
HC PRO DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$1,284.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
9835651501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$175.33 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,258.32
|
| Rate for Payer: Aetna of WY Medicare |
$206.27
|
| Rate for Payer: Beech Street Commercial |
$1,219.80
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,245.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,258.32
|
| Rate for Payer: First Choice Health Commercial |
$1,155.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,219.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.27
|
| Rate for Payer: HealthUtah PPO |
$1,284.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,245.48
|
| Rate for Payer: Multiplan Medicare/VA |
$175.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,258.32
|
| Rate for Payer: PacificSource Commercial |
$1,155.60
|
| Rate for Payer: PHCS PPO |
$1,219.80
|
| Rate for Payer: Three Rivers PPO |
$963.00
|
| Rate for Payer: TriWest Veterans Administration |
$206.27
|
| Rate for Payer: United Healthcare Commercial |
$1,117.08
|
| Rate for Payer: United Healthcare Medicare |
$206.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,091.40
|
|
|
HC PRO DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$1,605.00
|
|
|
Service Code
|
HCPCS 56515 NONPBBPAYER
|
| Hospital Charge Code |
9835651501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$175.33 |
| Max. Negotiated Rate |
$1,605.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,572.90
|
| Rate for Payer: Aetna of WY Medicare |
$206.27
|
| Rate for Payer: Beech Street Commercial |
$1,524.75
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,556.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,572.90
|
| Rate for Payer: First Choice Health Commercial |
$1,444.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,524.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.27
|
| Rate for Payer: HealthUtah PPO |
$1,605.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,556.85
|
| Rate for Payer: Multiplan Medicare/VA |
$175.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,572.90
|
| Rate for Payer: PacificSource Commercial |
$1,444.50
|
| Rate for Payer: PHCS PPO |
$1,524.75
|
| Rate for Payer: Three Rivers PPO |
$1,203.75
|
| Rate for Payer: TriWest Veterans Administration |
$206.27
|
| Rate for Payer: United Healthcare Commercial |
$1,396.35
|
| Rate for Payer: United Healthcare Medicare |
$206.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,364.25
|
|
|
HC PRO DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
9831728001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$339.08
|
| Rate for Payer: Aetna of WY Medicare |
$84.35
|
| Rate for Payer: Beech Street Commercial |
$328.70
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$335.62
|
| Rate for Payer: Cigna of WY Commercial |
$339.08
|
| Rate for Payer: First Choice Health Commercial |
$311.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$328.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.35
|
| Rate for Payer: HealthUtah PPO |
$346.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$335.62
|
| Rate for Payer: Multiplan Medicare/VA |
$71.70
|
| Rate for Payer: One Health Plan of WY PPO |
$339.08
|
| Rate for Payer: PacificSource Commercial |
$311.40
|
| Rate for Payer: PHCS PPO |
$328.70
|
| Rate for Payer: Three Rivers PPO |
$259.50
|
| Rate for Payer: TriWest Veterans Administration |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$301.02
|
| Rate for Payer: United Healthcare Medicare |
$84.35
|
| Rate for Payer: WINHealth Partners Commercial |
$294.10
|
|
|
HC PRO DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 17280 NONPBBPAYER
|
| Hospital Charge Code |
9831728001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$433.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$424.34
|
| Rate for Payer: Aetna of WY Medicare |
$84.35
|
| Rate for Payer: Beech Street Commercial |
$411.35
|
| Rate for Payer: Cash Price |
$303.10
|
| Rate for Payer: Cash Price |
$303.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.01
|
| Rate for Payer: Cigna of WY Commercial |
$424.34
|
| Rate for Payer: First Choice Health Commercial |
$389.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$411.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.35
|
| Rate for Payer: HealthUtah PPO |
$433.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.01
|
| Rate for Payer: Multiplan Medicare/VA |
$71.70
|
| Rate for Payer: One Health Plan of WY PPO |
$424.34
|
| Rate for Payer: PacificSource Commercial |
$389.70
|
| Rate for Payer: PHCS PPO |
$411.35
|
| Rate for Payer: Three Rivers PPO |
$324.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$376.71
|
| Rate for Payer: United Healthcare Medicare |
$84.35
|
| Rate for Payer: WINHealth Partners Commercial |
$368.05
|
|
|
HC PRO DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/>
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
9831727001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$78.79 |
| Max. Negotiated Rate |
$562.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$550.76
|
| Rate for Payer: Aetna of WY Medicare |
$92.69
|
| Rate for Payer: Beech Street Commercial |
$533.90
|
| Rate for Payer: Cash Price |
$393.40
|
| Rate for Payer: Cash Price |
$393.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$545.14
|
| Rate for Payer: Cigna of WY Commercial |
$550.76
|
| Rate for Payer: First Choice Health Commercial |
$505.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$533.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.69
|
| Rate for Payer: HealthUtah PPO |
$562.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$545.14
|
| Rate for Payer: Multiplan Medicare/VA |
$78.79
|
| Rate for Payer: One Health Plan of WY PPO |
$550.76
|
| Rate for Payer: PacificSource Commercial |
$505.80
|
| Rate for Payer: PHCS PPO |
$533.90
|
| Rate for Payer: Three Rivers PPO |
$421.50
|
| Rate for Payer: TriWest Veterans Administration |
$92.69
|
| Rate for Payer: United Healthcare Commercial |
$488.94
|
| Rate for Payer: United Healthcare Medicare |
$92.69
|
| Rate for Payer: WINHealth Partners Commercial |
$477.70
|
|
|
HC PRO DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/>
|
Professional
|
Both
|
$703.00
|
|
|
Service Code
|
HCPCS 17270 NONPBBPAYER
|
| Hospital Charge Code |
9831727001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$78.79 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$688.94
|
| Rate for Payer: Aetna of WY Medicare |
$92.69
|
| Rate for Payer: Beech Street Commercial |
$667.85
|
| Rate for Payer: Cash Price |
$492.10
|
| Rate for Payer: Cash Price |
$492.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$681.91
|
| Rate for Payer: Cigna of WY Commercial |
$688.94
|
| Rate for Payer: First Choice Health Commercial |
$632.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$667.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.69
|
| Rate for Payer: HealthUtah PPO |
$703.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$681.91
|
| Rate for Payer: Multiplan Medicare/VA |
$78.79
|
| Rate for Payer: One Health Plan of WY PPO |
$688.94
|
| Rate for Payer: PacificSource Commercial |
$632.70
|
| Rate for Payer: PHCS PPO |
$667.85
|
| Rate for Payer: Three Rivers PPO |
$527.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.69
|
| Rate for Payer: United Healthcare Commercial |
$611.61
|
| Rate for Payer: United Healthcare Medicare |
$92.69
|
| Rate for Payer: WINHealth Partners Commercial |
$597.55
|
|
|
HC PRO DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 17260 NONPBBPAYER
|
| Hospital Charge Code |
9831726001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$68.56
|
| Rate for Payer: Beech Street Commercial |
$332.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: First Choice Health Commercial |
$315.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.56
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$58.28
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$332.50
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$68.56
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$68.56
|
| Rate for Payer: WINHealth Partners Commercial |
$297.50
|
|
|
HC PRO DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 17260
|
| Hospital Charge Code |
9831726001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$68.56
|
| Rate for Payer: Beech Street Commercial |
$266.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: First Choice Health Commercial |
$252.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.56
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$58.28
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$266.00
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.56
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$68.56
|
| Rate for Payer: WINHealth Partners Commercial |
$238.00
|
|
|
HC PRO DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 17261
|
| Hospital Charge Code |
9831726101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$71.98 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$340.06
|
| Rate for Payer: Aetna of WY Medicare |
$84.68
|
| Rate for Payer: Beech Street Commercial |
$329.65
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: Cash Price |
$242.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.59
|
| Rate for Payer: Cigna of WY Commercial |
$340.06
|
| Rate for Payer: First Choice Health Commercial |
$312.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.68
|
| Rate for Payer: HealthUtah PPO |
$347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.59
|
| Rate for Payer: Multiplan Medicare/VA |
$71.98
|
| Rate for Payer: One Health Plan of WY PPO |
$340.06
|
| Rate for Payer: PacificSource Commercial |
$312.30
|
| Rate for Payer: PHCS PPO |
$329.65
|
| Rate for Payer: Three Rivers PPO |
$260.25
|
| Rate for Payer: TriWest Veterans Administration |
$84.68
|
| Rate for Payer: United Healthcare Commercial |
$301.89
|
| Rate for Payer: United Healthcare Medicare |
$84.68
|
| Rate for Payer: WINHealth Partners Commercial |
$294.95
|
|
