|
HC PRO EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER
|
Professional
|
Both
|
$5,068.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
9832621001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$5,068.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,966.64
|
| Rate for Payer: Aetna of WY Medicare |
$442.58
|
| Rate for Payer: Beech Street Commercial |
$4,814.60
|
| Rate for Payer: Cash Price |
$3,547.60
|
| Rate for Payer: Cash Price |
$3,547.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,915.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,966.64
|
| Rate for Payer: First Choice Health Commercial |
$4,561.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,814.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$442.58
|
| Rate for Payer: HealthUtah PPO |
$5,068.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,915.96
|
| Rate for Payer: Multiplan Medicare/VA |
$376.19
|
| Rate for Payer: One Health Plan of WY PPO |
$4,966.64
|
| Rate for Payer: PacificSource Commercial |
$4,561.20
|
| Rate for Payer: PHCS PPO |
$4,814.60
|
| Rate for Payer: Three Rivers PPO |
$3,801.00
|
| Rate for Payer: TriWest Veterans Administration |
$442.58
|
| Rate for Payer: United Healthcare Commercial |
$4,409.16
|
| Rate for Payer: United Healthcare Medicare |
$442.58
|
| Rate for Payer: WINHealth Partners Commercial |
$4,307.80
|
|
|
HC PRO EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA
|
Professional
|
Both
|
$1,762.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
9832512001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$419.55 |
| Max. Negotiated Rate |
$1,762.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,726.76
|
| Rate for Payer: Aetna of WY Medicare |
$493.59
|
| Rate for Payer: Beech Street Commercial |
$1,673.90
|
| Rate for Payer: Cash Price |
$1,233.40
|
| Rate for Payer: Cash Price |
$1,233.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,709.14
|
| Rate for Payer: Cigna of WY Commercial |
$1,726.76
|
| Rate for Payer: First Choice Health Commercial |
$1,585.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,673.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$493.59
|
| Rate for Payer: HealthUtah PPO |
$1,762.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,709.14
|
| Rate for Payer: Multiplan Medicare/VA |
$419.55
|
| Rate for Payer: One Health Plan of WY PPO |
$1,726.76
|
| Rate for Payer: PacificSource Commercial |
$1,585.80
|
| Rate for Payer: PHCS PPO |
$1,673.90
|
| Rate for Payer: Three Rivers PPO |
$1,321.50
|
| Rate for Payer: TriWest Veterans Administration |
$493.59
|
| Rate for Payer: United Healthcare Commercial |
$1,532.94
|
| Rate for Payer: United Healthcare Medicare |
$493.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1,497.70
|
|
|
HC PRO EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$6,178.00
|
|
|
Service Code
|
HCPCS 49203
|
| Hospital Charge Code |
9834920301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$965.47 |
| Max. Negotiated Rate |
$6,178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,054.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,135.85
|
| Rate for Payer: Beech Street Commercial |
$5,869.10
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: Cash Price |
$4,324.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,992.66
|
| Rate for Payer: Cigna of WY Commercial |
$6,054.44
|
| Rate for Payer: First Choice Health Commercial |
$5,560.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,869.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,135.85
|
| Rate for Payer: HealthUtah PPO |
$6,178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,992.66
|
| Rate for Payer: Multiplan Medicare/VA |
$965.47
|
| Rate for Payer: One Health Plan of WY PPO |
$6,054.44
|
| Rate for Payer: PacificSource Commercial |
$5,560.20
|
| Rate for Payer: PHCS PPO |
$5,869.10
|
| Rate for Payer: Three Rivers PPO |
$4,633.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,135.85
|
| Rate for Payer: United Healthcare Commercial |
$5,374.86
|
| Rate for Payer: United Healthcare Medicare |
$1,135.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,251.30
|
|
|
HC PRO EXCISION DISTAL ULNA PARTIAL/COMPLETE
|
Professional
|
Both
|
$3,549.00
|
|
|
Service Code
|
HCPCS 25240
|
| Hospital Charge Code |
9832524001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$360.82 |
| Max. Negotiated Rate |
$3,549.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,478.02
|
| Rate for Payer: Aetna of WY Medicare |
$424.49
|
| Rate for Payer: Beech Street Commercial |
$3,371.55
|
| Rate for Payer: Cash Price |
$2,484.30
|
| Rate for Payer: Cash Price |
$2,484.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,442.53
|
| Rate for Payer: Cigna of WY Commercial |
$3,478.02
|
| Rate for Payer: First Choice Health Commercial |
$3,194.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,371.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$424.49
|
| Rate for Payer: HealthUtah PPO |
$3,549.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,442.53
|
| Rate for Payer: Multiplan Medicare/VA |
$360.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3,478.02
|
| Rate for Payer: PacificSource Commercial |
$3,194.10
|
| Rate for Payer: PHCS PPO |
$3,371.55
|
| Rate for Payer: Three Rivers PPO |
$2,661.75
|
| Rate for Payer: TriWest Veterans Administration |
$424.49
|
| Rate for Payer: United Healthcare Commercial |
$3,087.63
|
| Rate for Payer: United Healthcare Medicare |
$424.49
|
| Rate for Payer: WINHealth Partners Commercial |
$3,016.65
|
|
|
HC PRO EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR
|
Professional
|
Both
|
$1,334.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
9836911001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$272.04 |
| Max. Negotiated Rate |
$1,334.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,307.32
|
| Rate for Payer: Aetna of WY Medicare |
$320.05
|
| Rate for Payer: Beech Street Commercial |
$1,267.30
|
| Rate for Payer: Cash Price |
$933.80
|
| Rate for Payer: Cash Price |
$933.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,293.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,307.32
|
| Rate for Payer: First Choice Health Commercial |
$1,200.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,267.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.05
|
| Rate for Payer: HealthUtah PPO |
$1,334.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,293.98
|
| Rate for Payer: Multiplan Medicare/VA |
$272.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,307.32
|
| Rate for Payer: PacificSource Commercial |
$1,200.60
|
| Rate for Payer: PHCS PPO |
$1,267.30
|
| Rate for Payer: Three Rivers PPO |
$1,000.50
|
| Rate for Payer: TriWest Veterans Administration |
$320.05
|
| Rate for Payer: United Healthcare Commercial |
$1,160.58
|
| Rate for Payer: United Healthcare Medicare |
$320.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,133.90
|
|
|
HC PRO EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 69110 NONPBBPAYER
|
| Hospital Charge Code |
9836911001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$272.04 |
| Max. Negotiated Rate |
$1,668.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,634.64
|
| Rate for Payer: Aetna of WY Medicare |
$320.05
|
| Rate for Payer: Beech Street Commercial |
$1,584.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: Cash Price |
$1,167.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,617.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,634.64
|
| Rate for Payer: First Choice Health Commercial |
$1,501.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,584.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.05
|
| Rate for Payer: HealthUtah PPO |
$1,668.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,617.96
|
| Rate for Payer: Multiplan Medicare/VA |
$272.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,634.64
|
| Rate for Payer: PacificSource Commercial |
$1,501.20
|
| Rate for Payer: PHCS PPO |
$1,584.60
|
| Rate for Payer: Three Rivers PPO |
$1,251.00
|
| Rate for Payer: TriWest Veterans Administration |
$320.05
|
| Rate for Payer: United Healthcare Commercial |
$1,451.16
|
| Rate for Payer: United Healthcare Medicare |
$320.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,417.80
|
|
|
HC PRO EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
9832511101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$1,659.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,625.82
|
| Rate for Payer: Aetna of WY Medicare |
$322.94
|
| Rate for Payer: Beech Street Commercial |
$1,576.05
|
| Rate for Payer: Cash Price |
$1,161.30
|
| Rate for Payer: Cash Price |
$1,161.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,609.23
|
| Rate for Payer: Cigna of WY Commercial |
$1,625.82
|
| Rate for Payer: First Choice Health Commercial |
$1,493.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,576.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$322.94
|
| Rate for Payer: HealthUtah PPO |
$1,659.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,609.23
|
| Rate for Payer: Multiplan Medicare/VA |
$274.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,625.82
|
| Rate for Payer: PacificSource Commercial |
$1,493.10
|
| Rate for Payer: PHCS PPO |
$1,576.05
|
| Rate for Payer: Three Rivers PPO |
$1,244.25
|
| Rate for Payer: TriWest Veterans Administration |
$322.94
|
| Rate for Payer: United Healthcare Commercial |
$1,443.33
|
| Rate for Payer: United Healthcare Medicare |
$322.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1,410.15
|
|
|
HC PRO EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
Both
|
$1,023.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
9831145001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$215.61 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,002.54
|
| Rate for Payer: Aetna of WY Medicare |
$253.66
|
| Rate for Payer: Beech Street Commercial |
$971.85
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: Cash Price |
$716.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$992.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,002.54
|
| Rate for Payer: First Choice Health Commercial |
$920.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$971.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.66
|
| Rate for Payer: HealthUtah PPO |
$1,023.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$992.31
|
| Rate for Payer: Multiplan Medicare/VA |
$215.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,002.54
|
| Rate for Payer: PacificSource Commercial |
$920.70
|
| Rate for Payer: PHCS PPO |
$971.85
|
| Rate for Payer: Three Rivers PPO |
$767.25
|
| Rate for Payer: TriWest Veterans Administration |
$253.66
|
| Rate for Payer: United Healthcare Commercial |
$890.01
|
| Rate for Payer: United Healthcare Medicare |
$253.66
|
| Rate for Payer: WINHealth Partners Commercial |
$869.55
|
|
|
HC PRO EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR
|
Professional
|
Both
|
$1,279.00
|
|
|
Service Code
|
HCPCS 11450 NONPBBPAYER
|
| Hospital Charge Code |
9831145001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$215.61 |
| Max. Negotiated Rate |
$1,279.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,253.42
|
| Rate for Payer: Aetna of WY Medicare |
$253.66
|
| Rate for Payer: Beech Street Commercial |
$1,215.05
|
| Rate for Payer: Cash Price |
$895.30
|
| Rate for Payer: Cash Price |
$895.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,240.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,253.42
|
| Rate for Payer: First Choice Health Commercial |
$1,151.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,215.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.66
|
| Rate for Payer: HealthUtah PPO |
$1,279.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,240.63
|
| Rate for Payer: Multiplan Medicare/VA |
$215.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,253.42
|
| Rate for Payer: PacificSource Commercial |
$1,151.10
|
| Rate for Payer: PHCS PPO |
$1,215.05
|
| Rate for Payer: Three Rivers PPO |
$959.25
|
| Rate for Payer: TriWest Veterans Administration |
$253.66
|
| Rate for Payer: United Healthcare Commercial |
$1,112.73
|
| Rate for Payer: United Healthcare Medicare |
$253.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,087.15
|
|
|
HC PRO EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
Both
|
$1,128.00
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
9821147001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$235.92 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,105.44
|
| Rate for Payer: Aetna of WY Medicare |
$277.55
|
| Rate for Payer: Beech Street Commercial |
$1,071.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,094.16
|
| Rate for Payer: Cigna of WY Commercial |
$1,105.44
|
| Rate for Payer: First Choice Health Commercial |
$1,015.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,071.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.55
|
| Rate for Payer: HealthUtah PPO |
$1,128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,094.16
|
| Rate for Payer: Multiplan Medicare/VA |
$235.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,105.44
|
| Rate for Payer: PacificSource Commercial |
$1,015.20
|
| Rate for Payer: PHCS PPO |
$1,071.60
|
| Rate for Payer: Three Rivers PPO |
$846.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.55
|
| Rate for Payer: United Healthcare Commercial |
$981.36
|
| Rate for Payer: United Healthcare Medicare |
$277.55
|
| Rate for Payer: WINHealth Partners Commercial |
$958.80
|
|
|
HC PRO EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 11470 NONPBBPAYER
|
| Hospital Charge Code |
9821147001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$235.92 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,381.80
|
| Rate for Payer: Aetna of WY Medicare |
$277.55
|
| Rate for Payer: Beech Street Commercial |
$1,339.50
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: Cash Price |
$987.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,367.70
|
| Rate for Payer: Cigna of WY Commercial |
$1,381.80
|
| Rate for Payer: First Choice Health Commercial |
$1,269.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,339.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.55
|
| Rate for Payer: HealthUtah PPO |
$1,410.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,367.70
|
| Rate for Payer: Multiplan Medicare/VA |
$235.92
|
| Rate for Payer: One Health Plan of WY PPO |
$1,381.80
|
| Rate for Payer: PacificSource Commercial |
$1,269.00
|
| Rate for Payer: PHCS PPO |
$1,339.50
|
| Rate for Payer: Three Rivers PPO |
$1,057.50
|
| Rate for Payer: TriWest Veterans Administration |
$277.55
|
| Rate for Payer: United Healthcare Commercial |
$1,226.70
|
| Rate for Payer: United Healthcare Medicare |
$277.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,198.50
|
|
|
HC PRO EXCISION HYDROCELE UNILATERAL
|
Professional
|
Both
|
$1,633.00
|
|
|
Service Code
|
HCPCS 55040
|
| Hospital Charge Code |
9835504001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$279.09 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,600.34
|
| Rate for Payer: Aetna of WY Medicare |
$328.34
|
| Rate for Payer: Beech Street Commercial |
$1,551.35
|
| Rate for Payer: Cash Price |
$1,143.10
|
| Rate for Payer: Cash Price |
$1,143.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,584.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,600.34
|
| Rate for Payer: First Choice Health Commercial |
$1,469.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,551.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.34
|
| Rate for Payer: HealthUtah PPO |
$1,633.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,584.01
|
| Rate for Payer: Multiplan Medicare/VA |
$279.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,600.34
|
| Rate for Payer: PacificSource Commercial |
$1,469.70
|
| Rate for Payer: PHCS PPO |
$1,551.35
|
| Rate for Payer: Three Rivers PPO |
$1,224.75
|
| Rate for Payer: TriWest Veterans Administration |
$328.34
|
| Rate for Payer: United Healthcare Commercial |
$1,420.71
|
| Rate for Payer: United Healthcare Medicare |
$328.34
|
| Rate for Payer: WINHealth Partners Commercial |
$1,388.05
|
|
|
HC PRO EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
HCPCS 30130 50
|
| Hospital Charge Code |
9833013001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$2,916.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,857.68
|
| Rate for Payer: Aetna of WY Medicare |
$408.39
|
| Rate for Payer: Beech Street Commercial |
$2,770.20
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,828.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,857.68
|
| Rate for Payer: First Choice Health Commercial |
$2,624.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,770.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.39
|
| Rate for Payer: HealthUtah PPO |
$2,916.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,828.52
|
| Rate for Payer: Multiplan Medicare/VA |
$347.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,857.68
|
| Rate for Payer: PacificSource Commercial |
$2,624.40
|
| Rate for Payer: PHCS PPO |
$2,770.20
|
| Rate for Payer: Three Rivers PPO |
$2,187.00
|
| Rate for Payer: TriWest Veterans Administration |
$408.39
|
| Rate for Payer: United Healthcare Commercial |
$2,536.92
|
| Rate for Payer: United Healthcare Medicare |
$408.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,478.60
|
|
|
HC PRO EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE
|
Professional
|
Both
|
$1,458.00
|
|
|
Service Code
|
HCPCS 30130
|
| Hospital Charge Code |
9833013001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,428.84
|
| Rate for Payer: Aetna of WY Medicare |
$408.39
|
| Rate for Payer: Beech Street Commercial |
$1,385.10
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,414.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,428.84
|
| Rate for Payer: First Choice Health Commercial |
$1,312.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,385.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.39
|
| Rate for Payer: HealthUtah PPO |
$1,458.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,414.26
|
| Rate for Payer: Multiplan Medicare/VA |
$347.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,428.84
|
| Rate for Payer: PacificSource Commercial |
$1,312.20
|
| Rate for Payer: PHCS PPO |
$1,385.10
|
| Rate for Payer: Three Rivers PPO |
$1,093.50
|
| Rate for Payer: TriWest Veterans Administration |
$408.39
|
| Rate for Payer: United Healthcare Commercial |
$1,268.46
|
| Rate for Payer: United Healthcare Medicare |
$408.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,239.30
|
|
|
HC PRO EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
9832808001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$316.09 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,872.78
|
| Rate for Payer: Aetna of WY Medicare |
$371.87
|
| Rate for Payer: Beech Street Commercial |
$1,815.45
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,853.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,872.78
|
| Rate for Payer: First Choice Health Commercial |
$1,719.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,815.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.87
|
| Rate for Payer: HealthUtah PPO |
$1,911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,853.67
|
| Rate for Payer: Multiplan Medicare/VA |
$316.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,872.78
|
| Rate for Payer: PacificSource Commercial |
$1,719.90
|
| Rate for Payer: PHCS PPO |
$1,815.45
|
| Rate for Payer: Three Rivers PPO |
$1,433.25
|
| Rate for Payer: TriWest Veterans Administration |
$371.87
|
| Rate for Payer: United Healthcare Commercial |
$1,662.57
|
| Rate for Payer: United Healthcare Medicare |
$371.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.35
|
|
|
HC PRO EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
HCPCS 27630
|
| Hospital Charge Code |
9832763001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$297.66 |
| Max. Negotiated Rate |
$1,858.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,820.84
|
| Rate for Payer: Aetna of WY Medicare |
$350.19
|
| Rate for Payer: Beech Street Commercial |
$1,765.10
|
| Rate for Payer: Cash Price |
$1,300.60
|
| Rate for Payer: Cash Price |
$1,300.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,802.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,820.84
|
| Rate for Payer: First Choice Health Commercial |
$1,672.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,765.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$350.19
|
| Rate for Payer: HealthUtah PPO |
$1,858.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,802.26
|
| Rate for Payer: Multiplan Medicare/VA |
$297.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,820.84
|
| Rate for Payer: PacificSource Commercial |
$1,672.20
|
| Rate for Payer: PHCS PPO |
$1,765.10
|
| Rate for Payer: Three Rivers PPO |
$1,393.50
|
| Rate for Payer: TriWest Veterans Administration |
$350.19
|
| Rate for Payer: United Healthcare Commercial |
$1,616.46
|
| Rate for Payer: United Healthcare Medicare |
$350.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1,579.30
|
|
|
HC PRO EXCISION LESION TENDON SHEATH FOREARM/WRIST
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
9832511001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$291.10 |
| Max. Negotiated Rate |
$1,223.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,198.54
|
| Rate for Payer: Aetna of WY Medicare |
$342.47
|
| Rate for Payer: Beech Street Commercial |
$1,161.85
|
| Rate for Payer: Cash Price |
$856.10
|
| Rate for Payer: Cash Price |
$856.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,186.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,198.54
|
| Rate for Payer: First Choice Health Commercial |
$1,100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,161.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$342.47
|
| Rate for Payer: HealthUtah PPO |
$1,223.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,186.31
|
| Rate for Payer: Multiplan Medicare/VA |
$291.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,198.54
|
| Rate for Payer: PacificSource Commercial |
$1,100.70
|
| Rate for Payer: PHCS PPO |
$1,161.85
|
| Rate for Payer: Three Rivers PPO |
$917.25
|
| Rate for Payer: TriWest Veterans Administration |
$342.47
|
| Rate for Payer: United Healthcare Commercial |
$1,064.01
|
| Rate for Payer: United Healthcare Medicare |
$342.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,039.55
|
|
|
HC PRO EXCISION LINGUAL FRENUM FRENECTOMY
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 41115
|
| Hospital Charge Code |
9834111501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$730.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$715.40
|
| Rate for Payer: Aetna of WY Medicare |
$142.59
|
| Rate for Payer: Beech Street Commercial |
$693.50
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: Cash Price |
$511.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$708.10
|
| Rate for Payer: Cigna of WY Commercial |
$715.40
|
| Rate for Payer: First Choice Health Commercial |
$657.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$693.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.59
|
| Rate for Payer: HealthUtah PPO |
$730.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$708.10
|
| Rate for Payer: Multiplan Medicare/VA |
$121.20
|
| Rate for Payer: One Health Plan of WY PPO |
$715.40
|
| Rate for Payer: PacificSource Commercial |
$657.00
|
| Rate for Payer: PHCS PPO |
$693.50
|
| Rate for Payer: Three Rivers PPO |
$547.50
|
| Rate for Payer: TriWest Veterans Administration |
$142.59
|
| Rate for Payer: United Healthcare Commercial |
$635.10
|
| Rate for Payer: United Healthcare Medicare |
$142.59
|
| Rate for Payer: WINHealth Partners Commercial |
$620.50
|
|
|
HC PRO EXCISION LINGUAL FRENUM FRENECTOMY
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 41115 NONPBBPAYER
|
| Hospital Charge Code |
9834111501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$894.74
|
| Rate for Payer: Aetna of WY Medicare |
$142.59
|
| Rate for Payer: Beech Street Commercial |
$867.35
|
| Rate for Payer: Cash Price |
$639.10
|
| Rate for Payer: Cash Price |
$639.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$885.61
|
| Rate for Payer: Cigna of WY Commercial |
$894.74
|
| Rate for Payer: First Choice Health Commercial |
$821.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$867.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.59
|
| Rate for Payer: HealthUtah PPO |
$913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$885.61
|
| Rate for Payer: Multiplan Medicare/VA |
$121.20
|
| Rate for Payer: One Health Plan of WY PPO |
$894.74
|
| Rate for Payer: PacificSource Commercial |
$821.70
|
| Rate for Payer: PHCS PPO |
$867.35
|
| Rate for Payer: Three Rivers PPO |
$684.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.59
|
| Rate for Payer: United Healthcare Commercial |
$794.31
|
| Rate for Payer: United Healthcare Medicare |
$142.59
|
| Rate for Payer: WINHealth Partners Commercial |
$776.05
|
|
|
HC PRO EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$1,919.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
9831164601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$315.94 |
| Max. Negotiated Rate |
$1,919.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,880.62
|
| Rate for Payer: Aetna of WY Medicare |
$371.70
|
| Rate for Payer: Beech Street Commercial |
$1,823.05
|
| Rate for Payer: Cash Price |
$1,343.30
|
| Rate for Payer: Cash Price |
$1,343.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,861.43
|
| Rate for Payer: Cigna of WY Commercial |
$1,880.62
|
| Rate for Payer: First Choice Health Commercial |
$1,727.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,823.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.70
|
| Rate for Payer: HealthUtah PPO |
$1,919.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,861.43
|
| Rate for Payer: Multiplan Medicare/VA |
$315.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,880.62
|
| Rate for Payer: PacificSource Commercial |
$1,727.10
|
| Rate for Payer: PHCS PPO |
$1,823.05
|
| Rate for Payer: Three Rivers PPO |
$1,439.25
|
| Rate for Payer: TriWest Veterans Administration |
$371.70
|
| Rate for Payer: United Healthcare Commercial |
$1,669.53
|
| Rate for Payer: United Healthcare Medicare |
$371.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,631.15
|
|
|
HC PRO EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$2,399.00
|
|
|
Service Code
|
HCPCS 11646 NONPBBPAYER
|
| Hospital Charge Code |
9831164601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$315.94 |
| Max. Negotiated Rate |
$2,399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,351.02
|
| Rate for Payer: Aetna of WY Medicare |
$371.70
|
| Rate for Payer: Beech Street Commercial |
$2,279.05
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,327.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,351.02
|
| Rate for Payer: First Choice Health Commercial |
$2,159.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,279.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.70
|
| Rate for Payer: HealthUtah PPO |
$2,399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,327.03
|
| Rate for Payer: Multiplan Medicare/VA |
$315.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,351.02
|
| Rate for Payer: PacificSource Commercial |
$2,159.10
|
| Rate for Payer: PHCS PPO |
$2,279.05
|
| Rate for Payer: Three Rivers PPO |
$1,799.25
|
| Rate for Payer: TriWest Veterans Administration |
$371.70
|
| Rate for Payer: United Healthcare Commercial |
$2,087.13
|
| Rate for Payer: United Healthcare Medicare |
$371.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,039.15
|
|
|
HC PRO EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 11620 NONPBBPAYER
|
| Hospital Charge Code |
9831162001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$599.76
|
| Rate for Payer: Aetna of WY Medicare |
$119.52
|
| Rate for Payer: Beech Street Commercial |
$581.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$593.64
|
| Rate for Payer: Cigna of WY Commercial |
$599.76
|
| Rate for Payer: First Choice Health Commercial |
$550.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.52
|
| Rate for Payer: HealthUtah PPO |
$612.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$593.64
|
| Rate for Payer: Multiplan Medicare/VA |
$101.59
|
| Rate for Payer: One Health Plan of WY PPO |
$599.76
|
| Rate for Payer: PacificSource Commercial |
$550.80
|
| Rate for Payer: PHCS PPO |
$581.40
|
| Rate for Payer: Three Rivers PPO |
$459.00
|
| Rate for Payer: TriWest Veterans Administration |
$119.52
|
| Rate for Payer: United Healthcare Commercial |
$532.44
|
| Rate for Payer: United Healthcare Medicare |
$119.52
|
| Rate for Payer: WINHealth Partners Commercial |
$520.20
|
|
|
HC PRO EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 11620
|
| Hospital Charge Code |
9831162001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$480.20
|
| Rate for Payer: Aetna of WY Medicare |
$119.52
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$475.30
|
| Rate for Payer: Cigna of WY Commercial |
$480.20
|
| Rate for Payer: First Choice Health Commercial |
$441.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$465.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.52
|
| Rate for Payer: HealthUtah PPO |
$490.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$475.30
|
| Rate for Payer: Multiplan Medicare/VA |
$101.59
|
| Rate for Payer: One Health Plan of WY PPO |
$480.20
|
| Rate for Payer: PacificSource Commercial |
$441.00
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$367.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.52
|
| Rate for Payer: United Healthcare Commercial |
$426.30
|
| Rate for Payer: United Healthcare Medicare |
$119.52
|
| Rate for Payer: WINHealth Partners Commercial |
$416.50
|
|
|
HC PRO EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 11623 NONPBBPAYER
|
| Hospital Charge Code |
9831162301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$171.05 |
| Max. Negotiated Rate |
$1,052.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,030.96
|
| Rate for Payer: Aetna of WY Medicare |
$201.23
|
| Rate for Payer: Beech Street Commercial |
$999.40
|
| Rate for Payer: Cash Price |
$736.40
|
| Rate for Payer: Cash Price |
$736.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,020.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,030.96
|
| Rate for Payer: First Choice Health Commercial |
$946.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$999.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.23
|
| Rate for Payer: HealthUtah PPO |
$1,052.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,020.44
|
| Rate for Payer: Multiplan Medicare/VA |
$171.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,030.96
|
| Rate for Payer: PacificSource Commercial |
$946.80
|
| Rate for Payer: PHCS PPO |
$999.40
|
| Rate for Payer: Three Rivers PPO |
$789.00
|
| Rate for Payer: TriWest Veterans Administration |
$201.23
|
| Rate for Payer: United Healthcare Commercial |
$915.24
|
| Rate for Payer: United Healthcare Medicare |
$201.23
|
| Rate for Payer: WINHealth Partners Commercial |
$894.20
|
|
|
HC PRO EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
9831162301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$171.05 |
| Max. Negotiated Rate |
$842.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$825.16
|
| Rate for Payer: Aetna of WY Medicare |
$201.23
|
| Rate for Payer: Beech Street Commercial |
$799.90
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$816.74
|
| Rate for Payer: Cigna of WY Commercial |
$825.16
|
| Rate for Payer: First Choice Health Commercial |
$757.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$799.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$201.23
|
| Rate for Payer: HealthUtah PPO |
$842.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$816.74
|
| Rate for Payer: Multiplan Medicare/VA |
$171.05
|
| Rate for Payer: One Health Plan of WY PPO |
$825.16
|
| Rate for Payer: PacificSource Commercial |
$757.80
|
| Rate for Payer: PHCS PPO |
$799.90
|
| Rate for Payer: Three Rivers PPO |
$631.50
|
| Rate for Payer: TriWest Veterans Administration |
$201.23
|
| Rate for Payer: United Healthcare Commercial |
$732.54
|
| Rate for Payer: United Healthcare Medicare |
$201.23
|
| Rate for Payer: WINHealth Partners Commercial |
$715.70
|
|
