|
HC PRO EXCISION TUMOR SOFT TISS HAND / FINGER
|
Professional
|
Both
|
$2,823.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
9832611301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$455.34 |
| Max. Negotiated Rate |
$2,823.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,766.54
|
| Rate for Payer: Aetna of WY Medicare |
$535.70
|
| Rate for Payer: Beech Street Commercial |
$2,681.85
|
| Rate for Payer: Cash Price |
$1,976.10
|
| Rate for Payer: Cash Price |
$1,976.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,738.31
|
| Rate for Payer: Cigna of WY Commercial |
$2,766.54
|
| Rate for Payer: First Choice Health Commercial |
$2,540.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,681.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$535.70
|
| Rate for Payer: HealthUtah PPO |
$2,823.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,738.31
|
| Rate for Payer: Multiplan Medicare/VA |
$455.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2,766.54
|
| Rate for Payer: PacificSource Commercial |
$2,540.70
|
| Rate for Payer: PHCS PPO |
$2,681.85
|
| Rate for Payer: Three Rivers PPO |
$2,117.25
|
| Rate for Payer: TriWest Veterans Administration |
$535.70
|
| Rate for Payer: United Healthcare Commercial |
$2,456.01
|
| Rate for Payer: United Healthcare Medicare |
$535.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,399.55
|
|
|
HC PRO EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM
|
Professional
|
Both
|
$2,428.00
|
|
|
Service Code
|
HCPCS 21931
|
| Hospital Charge Code |
9832193101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$384.42 |
| Max. Negotiated Rate |
$2,428.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,379.44
|
| Rate for Payer: Aetna of WY Medicare |
$452.26
|
| Rate for Payer: Beech Street Commercial |
$2,306.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: Cash Price |
$1,699.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,355.16
|
| Rate for Payer: Cigna of WY Commercial |
$2,379.44
|
| Rate for Payer: First Choice Health Commercial |
$2,185.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,306.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$452.26
|
| Rate for Payer: HealthUtah PPO |
$2,428.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,355.16
|
| Rate for Payer: Multiplan Medicare/VA |
$384.42
|
| Rate for Payer: One Health Plan of WY PPO |
$2,379.44
|
| Rate for Payer: PacificSource Commercial |
$2,185.20
|
| Rate for Payer: PHCS PPO |
$2,306.60
|
| Rate for Payer: Three Rivers PPO |
$1,821.00
|
| Rate for Payer: TriWest Veterans Administration |
$452.26
|
| Rate for Payer: United Healthcare Commercial |
$2,112.36
|
| Rate for Payer: United Healthcare Medicare |
$452.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2,063.80
|
|
|
HC PRO EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>
|
Professional
|
Both
|
$7,926.00
|
|
|
Service Code
|
HCPCS 27632
|
| Hospital Charge Code |
9822763201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$335.91 |
| Max. Negotiated Rate |
$7,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,767.48
|
| Rate for Payer: Aetna of WY Medicare |
$395.19
|
| Rate for Payer: Beech Street Commercial |
$7,529.70
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: Cash Price |
$5,548.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,688.22
|
| Rate for Payer: Cigna of WY Commercial |
$7,767.48
|
| Rate for Payer: First Choice Health Commercial |
$7,133.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,529.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$395.19
|
| Rate for Payer: HealthUtah PPO |
$7,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,688.22
|
| Rate for Payer: Multiplan Medicare/VA |
$335.91
|
| Rate for Payer: One Health Plan of WY PPO |
$7,767.48
|
| Rate for Payer: PacificSource Commercial |
$7,133.40
|
| Rate for Payer: PHCS PPO |
$7,529.70
|
| Rate for Payer: Three Rivers PPO |
$5,944.50
|
| Rate for Payer: TriWest Veterans Administration |
$395.19
|
| Rate for Payer: United Healthcare Commercial |
$6,895.62
|
| Rate for Payer: United Healthcare Medicare |
$395.19
|
| Rate for Payer: WINHealth Partners Commercial |
$6,737.10
|
|
|
HC PRO EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>
|
Professional
|
Both
|
$4,145.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
9832704301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$384.07 |
| Max. Negotiated Rate |
$4,145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,062.10
|
| Rate for Payer: Aetna of WY Medicare |
$451.85
|
| Rate for Payer: Beech Street Commercial |
$3,937.75
|
| Rate for Payer: Cash Price |
$2,901.50
|
| Rate for Payer: Cash Price |
$2,901.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,020.65
|
| Rate for Payer: Cigna of WY Commercial |
$4,062.10
|
| Rate for Payer: First Choice Health Commercial |
$3,730.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,937.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$451.85
|
| Rate for Payer: HealthUtah PPO |
$4,145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,020.65
|
| Rate for Payer: Multiplan Medicare/VA |
$384.07
|
| Rate for Payer: One Health Plan of WY PPO |
$4,062.10
|
| Rate for Payer: PacificSource Commercial |
$3,730.50
|
| Rate for Payer: PHCS PPO |
$3,937.75
|
| Rate for Payer: Three Rivers PPO |
$3,108.75
|
| Rate for Payer: TriWest Veterans Administration |
$451.85
|
| Rate for Payer: United Healthcare Commercial |
$3,606.15
|
| Rate for Payer: United Healthcare Medicare |
$451.85
|
| Rate for Payer: WINHealth Partners Commercial |
$3,523.25
|
|
|
HC PRO EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
9832307101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$345.12 |
| Max. Negotiated Rate |
$1,722.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,687.56
|
| Rate for Payer: Aetna of WY Medicare |
$406.02
|
| Rate for Payer: Beech Street Commercial |
$1,635.90
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,670.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,687.56
|
| Rate for Payer: First Choice Health Commercial |
$1,549.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,635.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.02
|
| Rate for Payer: HealthUtah PPO |
$1,722.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,670.34
|
| Rate for Payer: Multiplan Medicare/VA |
$345.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,687.56
|
| Rate for Payer: PacificSource Commercial |
$1,549.80
|
| Rate for Payer: PHCS PPO |
$1,635.90
|
| Rate for Payer: Three Rivers PPO |
$1,291.50
|
| Rate for Payer: TriWest Veterans Administration |
$406.02
|
| Rate for Payer: United Healthcare Commercial |
$1,498.14
|
| Rate for Payer: United Healthcare Medicare |
$406.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,463.70
|
|
|
HC PRO EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 23071 NONPBBPAYER
|
| Hospital Charge Code |
9832307101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$345.12 |
| Max. Negotiated Rate |
$2,153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,109.94
|
| Rate for Payer: Aetna of WY Medicare |
$406.02
|
| Rate for Payer: Beech Street Commercial |
$2,045.35
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: Cash Price |
$1,507.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,088.41
|
| Rate for Payer: Cigna of WY Commercial |
$2,109.94
|
| Rate for Payer: First Choice Health Commercial |
$1,937.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,045.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$406.02
|
| Rate for Payer: HealthUtah PPO |
$2,153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,088.41
|
| Rate for Payer: Multiplan Medicare/VA |
$345.12
|
| Rate for Payer: One Health Plan of WY PPO |
$2,109.94
|
| Rate for Payer: PacificSource Commercial |
$1,937.70
|
| Rate for Payer: PHCS PPO |
$2,045.35
|
| Rate for Payer: Three Rivers PPO |
$1,614.75
|
| Rate for Payer: TriWest Veterans Administration |
$406.02
|
| Rate for Payer: United Healthcare Commercial |
$1,873.11
|
| Rate for Payer: United Healthcare Medicare |
$406.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,830.05
|
|
|
HC PRO EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23075 NONPBBPAYER
|
| Hospital Charge Code |
9832307501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$272.82 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,641.50
|
| Rate for Payer: Aetna of WY Medicare |
$320.97
|
| Rate for Payer: Beech Street Commercial |
$1,591.25
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,624.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,641.50
|
| Rate for Payer: First Choice Health Commercial |
$1,507.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,591.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.97
|
| Rate for Payer: HealthUtah PPO |
$1,675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,624.75
|
| Rate for Payer: Multiplan Medicare/VA |
$272.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,641.50
|
| Rate for Payer: PacificSource Commercial |
$1,507.50
|
| Rate for Payer: PHCS PPO |
$1,591.25
|
| Rate for Payer: Three Rivers PPO |
$1,256.25
|
| Rate for Payer: TriWest Veterans Administration |
$320.97
|
| Rate for Payer: United Healthcare Commercial |
$1,457.25
|
| Rate for Payer: United Healthcare Medicare |
$320.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,423.75
|
|
|
HC PRO EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 23075
|
| Hospital Charge Code |
9832307501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$272.82 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,313.20
|
| Rate for Payer: Aetna of WY Medicare |
$320.97
|
| Rate for Payer: Beech Street Commercial |
$1,273.00
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: Cash Price |
$938.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,299.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,313.20
|
| Rate for Payer: First Choice Health Commercial |
$1,206.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,273.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.97
|
| Rate for Payer: HealthUtah PPO |
$1,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,299.80
|
| Rate for Payer: Multiplan Medicare/VA |
$272.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,313.20
|
| Rate for Payer: PacificSource Commercial |
$1,206.00
|
| Rate for Payer: PHCS PPO |
$1,273.00
|
| Rate for Payer: Three Rivers PPO |
$1,005.00
|
| Rate for Payer: TriWest Veterans Administration |
$320.97
|
| Rate for Payer: United Healthcare Commercial |
$1,165.80
|
| Rate for Payer: United Healthcare Medicare |
$320.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,139.00
|
|
|
HC PRO EXCISION VAGINAL CYST/TUMOR
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 57135 NONPBBPAYER
|
| Hospital Charge Code |
9835713501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$155.17 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,164.24
|
| Rate for Payer: Aetna of WY Medicare |
$182.55
|
| Rate for Payer: Beech Street Commercial |
$1,128.60
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,152.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,164.24
|
| Rate for Payer: First Choice Health Commercial |
$1,069.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,128.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.55
|
| Rate for Payer: HealthUtah PPO |
$1,188.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,152.36
|
| Rate for Payer: Multiplan Medicare/VA |
$155.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,164.24
|
| Rate for Payer: PacificSource Commercial |
$1,069.20
|
| Rate for Payer: PHCS PPO |
$1,128.60
|
| Rate for Payer: Three Rivers PPO |
$891.00
|
| Rate for Payer: TriWest Veterans Administration |
$182.55
|
| Rate for Payer: United Healthcare Commercial |
$1,033.56
|
| Rate for Payer: United Healthcare Medicare |
$182.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,009.80
|
|
|
HC PRO EXCISION VAGINAL CYST/TUMOR
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 57135
|
| Hospital Charge Code |
9835713501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$155.17 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$931.00
|
| Rate for Payer: Aetna of WY Medicare |
$182.55
|
| Rate for Payer: Beech Street Commercial |
$902.50
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$921.50
|
| Rate for Payer: Cigna of WY Commercial |
$931.00
|
| Rate for Payer: First Choice Health Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$902.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.55
|
| Rate for Payer: HealthUtah PPO |
$950.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$921.50
|
| Rate for Payer: Multiplan Medicare/VA |
$155.17
|
| Rate for Payer: One Health Plan of WY PPO |
$931.00
|
| Rate for Payer: PacificSource Commercial |
$855.00
|
| Rate for Payer: PHCS PPO |
$902.50
|
| Rate for Payer: Three Rivers PPO |
$712.50
|
| Rate for Payer: TriWest Veterans Administration |
$182.55
|
| Rate for Payer: United Healthcare Commercial |
$826.50
|
| Rate for Payer: United Healthcare Medicare |
$182.55
|
| Rate for Payer: WINHealth Partners Commercial |
$807.50
|
|
|
HC PRO EXCISION VAGINAL SEPTUM
|
Professional
|
Both
|
$4,015.00
|
|
|
Service Code
|
HCPCS 57130
|
| Hospital Charge Code |
9825713001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$142.87 |
| Max. Negotiated Rate |
$4,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,934.70
|
| Rate for Payer: Aetna of WY Medicare |
$168.08
|
| Rate for Payer: Beech Street Commercial |
$3,814.25
|
| Rate for Payer: Cash Price |
$2,810.50
|
| Rate for Payer: Cash Price |
$2,810.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,894.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,934.70
|
| Rate for Payer: First Choice Health Commercial |
$3,613.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,814.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.08
|
| Rate for Payer: HealthUtah PPO |
$4,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,894.55
|
| Rate for Payer: Multiplan Medicare/VA |
$142.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3,934.70
|
| Rate for Payer: PacificSource Commercial |
$3,613.50
|
| Rate for Payer: PHCS PPO |
$3,814.25
|
| Rate for Payer: Three Rivers PPO |
$3,011.25
|
| Rate for Payer: TriWest Veterans Administration |
$168.08
|
| Rate for Payer: United Healthcare Commercial |
$3,493.05
|
| Rate for Payer: United Healthcare Medicare |
$168.08
|
| Rate for Payer: WINHealth Partners Commercial |
$3,412.75
|
|
|
HC PRO EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM
|
Professional
|
Both
|
$2,987.00
|
|
|
Service Code
|
HCPCS 27337
|
| Hospital Charge Code |
9832733701
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$344.56 |
| Max. Negotiated Rate |
$2,987.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,927.26
|
| Rate for Payer: Aetna of WY Medicare |
$405.37
|
| Rate for Payer: Beech Street Commercial |
$2,837.65
|
| Rate for Payer: Cash Price |
$2,090.90
|
| Rate for Payer: Cash Price |
$2,090.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,897.39
|
| Rate for Payer: Cigna of WY Commercial |
$2,927.26
|
| Rate for Payer: First Choice Health Commercial |
$2,688.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,837.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.37
|
| Rate for Payer: HealthUtah PPO |
$2,987.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,897.39
|
| Rate for Payer: Multiplan Medicare/VA |
$344.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,927.26
|
| Rate for Payer: PacificSource Commercial |
$2,688.30
|
| Rate for Payer: PHCS PPO |
$2,837.65
|
| Rate for Payer: Three Rivers PPO |
$2,240.25
|
| Rate for Payer: TriWest Veterans Administration |
$405.37
|
| Rate for Payer: United Healthcare Commercial |
$2,598.69
|
| Rate for Payer: United Healthcare Medicare |
$405.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,538.95
|
|
|
HC PRO EXCIS TUMOR BACK >5CM
|
Professional
|
Both
|
$3,810.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
9832193301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$601.36 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,733.80
|
| Rate for Payer: Aetna of WY Medicare |
$707.48
|
| Rate for Payer: Beech Street Commercial |
$3,619.50
|
| Rate for Payer: Cash Price |
$2,667.00
|
| Rate for Payer: Cash Price |
$2,667.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,695.70
|
| Rate for Payer: Cigna of WY Commercial |
$3,733.80
|
| Rate for Payer: First Choice Health Commercial |
$3,429.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,619.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$707.48
|
| Rate for Payer: HealthUtah PPO |
$3,810.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,695.70
|
| Rate for Payer: Multiplan Medicare/VA |
$601.36
|
| Rate for Payer: One Health Plan of WY PPO |
$3,733.80
|
| Rate for Payer: PacificSource Commercial |
$3,429.00
|
| Rate for Payer: PHCS PPO |
$3,619.50
|
| Rate for Payer: Three Rivers PPO |
$2,857.50
|
| Rate for Payer: TriWest Veterans Administration |
$707.48
|
| Rate for Payer: United Healthcare Commercial |
$3,314.70
|
| Rate for Payer: United Healthcare Medicare |
$707.48
|
| Rate for Payer: WINHealth Partners Commercial |
$3,238.50
|
|
|
HC PRO EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
HCPCS 42104
|
| Hospital Charge Code |
9834210401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$111.89 |
| Max. Negotiated Rate |
$1,117.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,094.66
|
| Rate for Payer: Aetna of WY Medicare |
$131.63
|
| Rate for Payer: Beech Street Commercial |
$1,061.15
|
| Rate for Payer: Cash Price |
$781.90
|
| Rate for Payer: Cash Price |
$781.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,083.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,094.66
|
| Rate for Payer: First Choice Health Commercial |
$1,005.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,061.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.63
|
| Rate for Payer: HealthUtah PPO |
$1,117.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,083.49
|
| Rate for Payer: Multiplan Medicare/VA |
$111.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,094.66
|
| Rate for Payer: PacificSource Commercial |
$1,005.30
|
| Rate for Payer: PHCS PPO |
$1,061.15
|
| Rate for Payer: Three Rivers PPO |
$837.75
|
| Rate for Payer: TriWest Veterans Administration |
$131.63
|
| Rate for Payer: United Healthcare Commercial |
$971.79
|
| Rate for Payer: United Healthcare Medicare |
$131.63
|
| Rate for Payer: WINHealth Partners Commercial |
$949.45
|
|
|
HC PRO EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
9835552001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$374.54 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,540.56
|
| Rate for Payer: Aetna of WY Medicare |
$440.64
|
| Rate for Payer: Beech Street Commercial |
$1,493.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,524.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,540.56
|
| Rate for Payer: First Choice Health Commercial |
$1,414.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,493.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$440.64
|
| Rate for Payer: HealthUtah PPO |
$1,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,524.84
|
| Rate for Payer: Multiplan Medicare/VA |
$374.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,540.56
|
| Rate for Payer: PacificSource Commercial |
$1,414.80
|
| Rate for Payer: PHCS PPO |
$1,493.40
|
| Rate for Payer: Three Rivers PPO |
$1,179.00
|
| Rate for Payer: TriWest Veterans Administration |
$440.64
|
| Rate for Payer: United Healthcare Commercial |
$1,367.64
|
| Rate for Payer: United Healthcare Medicare |
$440.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,336.20
|
|
|
HC PRO EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
9832809201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$227.62 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.56
|
| Rate for Payer: Aetna of WY Medicare |
$267.79
|
| Rate for Payer: Beech Street Commercial |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: Cash Price |
$1,030.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.56
|
| Rate for Payer: First Choice Health Commercial |
$1,324.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$267.79
|
| Rate for Payer: HealthUtah PPO |
$1,472.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Medicare/VA |
$227.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.56
|
| Rate for Payer: PacificSource Commercial |
$1,324.80
|
| Rate for Payer: PHCS PPO |
$1,398.40
|
| Rate for Payer: Three Rivers PPO |
$1,104.00
|
| Rate for Payer: TriWest Veterans Administration |
$267.79
|
| Rate for Payer: United Healthcare Commercial |
$1,280.64
|
| Rate for Payer: United Healthcare Medicare |
$267.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1,251.20
|
|
|
HC PRO EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 40810 NONPBBPAYER
|
| Hospital Charge Code |
9834081001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$101.74 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$623.28
|
| Rate for Payer: Aetna of WY Medicare |
$119.70
|
| Rate for Payer: Beech Street Commercial |
$604.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$616.92
|
| Rate for Payer: Cigna of WY Commercial |
$623.28
|
| Rate for Payer: First Choice Health Commercial |
$572.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$604.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.70
|
| Rate for Payer: HealthUtah PPO |
$636.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$616.92
|
| Rate for Payer: Multiplan Medicare/VA |
$101.74
|
| Rate for Payer: One Health Plan of WY PPO |
$623.28
|
| Rate for Payer: PacificSource Commercial |
$572.40
|
| Rate for Payer: PHCS PPO |
$604.20
|
| Rate for Payer: Three Rivers PPO |
$477.00
|
| Rate for Payer: TriWest Veterans Administration |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$553.32
|
| Rate for Payer: United Healthcare Medicare |
$119.70
|
| Rate for Payer: WINHealth Partners Commercial |
$540.60
|
|
|
HC PRO EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
HCPCS 40810
|
| Hospital Charge Code |
9834081001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$101.74 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$498.82
|
| Rate for Payer: Aetna of WY Medicare |
$119.70
|
| Rate for Payer: Beech Street Commercial |
$483.55
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$493.73
|
| Rate for Payer: Cigna of WY Commercial |
$498.82
|
| Rate for Payer: First Choice Health Commercial |
$458.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.70
|
| Rate for Payer: HealthUtah PPO |
$509.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$493.73
|
| Rate for Payer: Multiplan Medicare/VA |
$101.74
|
| Rate for Payer: One Health Plan of WY PPO |
$498.82
|
| Rate for Payer: PacificSource Commercial |
$458.10
|
| Rate for Payer: PHCS PPO |
$483.55
|
| Rate for Payer: Three Rivers PPO |
$381.75
|
| Rate for Payer: TriWest Veterans Administration |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$442.83
|
| Rate for Payer: United Healthcare Medicare |
$119.70
|
| Rate for Payer: WINHealth Partners Commercial |
$432.65
|
|
|
HC PRO EXC MAL LESION TRUNK, ARM, LEG <0.5 CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 11600
|
| Hospital Charge Code |
9831160001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$471.38
|
| Rate for Payer: Aetna of WY Medicare |
$118.62
|
| Rate for Payer: Beech Street Commercial |
$456.95
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$466.57
|
| Rate for Payer: Cigna of WY Commercial |
$471.38
|
| Rate for Payer: First Choice Health Commercial |
$432.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.62
|
| Rate for Payer: HealthUtah PPO |
$481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$466.57
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$471.38
|
| Rate for Payer: PacificSource Commercial |
$432.90
|
| Rate for Payer: PHCS PPO |
$456.95
|
| Rate for Payer: Three Rivers PPO |
$360.75
|
| Rate for Payer: TriWest Veterans Administration |
$118.62
|
| Rate for Payer: United Healthcare Commercial |
$418.47
|
| Rate for Payer: United Healthcare Medicare |
$118.62
|
| Rate for Payer: WINHealth Partners Commercial |
$408.85
|
|
|
HC PRO EXC MAL LESION TRUNK, ARM, LEG <0.5 CM
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 11600 NONPBBPAYER
|
| Hospital Charge Code |
9831160001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$100.83 |
| Max. Negotiated Rate |
$601.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.98
|
| Rate for Payer: Aetna of WY Medicare |
$118.62
|
| Rate for Payer: Beech Street Commercial |
$570.95
|
| Rate for Payer: Cash Price |
$420.70
|
| Rate for Payer: Cash Price |
$420.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$582.97
|
| Rate for Payer: Cigna of WY Commercial |
$588.98
|
| Rate for Payer: First Choice Health Commercial |
$540.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.62
|
| Rate for Payer: HealthUtah PPO |
$601.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.97
|
| Rate for Payer: Multiplan Medicare/VA |
$100.83
|
| Rate for Payer: One Health Plan of WY PPO |
$588.98
|
| Rate for Payer: PacificSource Commercial |
$540.90
|
| Rate for Payer: PHCS PPO |
$570.95
|
| Rate for Payer: Three Rivers PPO |
$450.75
|
| Rate for Payer: TriWest Veterans Administration |
$118.62
|
| Rate for Payer: United Healthcare Commercial |
$522.87
|
| Rate for Payer: United Healthcare Medicare |
$118.62
|
| Rate for Payer: WINHealth Partners Commercial |
$510.85
|
|
|
HC PRO EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 64782
|
| Hospital Charge Code |
9826478201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$376.76 |
| Max. Negotiated Rate |
$2,143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,100.14
|
| Rate for Payer: Aetna of WY Medicare |
$443.25
|
| Rate for Payer: Beech Street Commercial |
$2,035.85
|
| Rate for Payer: Cash Price |
$1,500.10
|
| Rate for Payer: Cash Price |
$1,500.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,078.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,100.14
|
| Rate for Payer: First Choice Health Commercial |
$1,928.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,035.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.25
|
| Rate for Payer: HealthUtah PPO |
$2,143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,078.71
|
| Rate for Payer: Multiplan Medicare/VA |
$376.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,100.14
|
| Rate for Payer: PacificSource Commercial |
$1,928.70
|
| Rate for Payer: PHCS PPO |
$2,035.85
|
| Rate for Payer: Three Rivers PPO |
$1,607.25
|
| Rate for Payer: TriWest Veterans Administration |
$443.25
|
| Rate for Payer: United Healthcare Commercial |
$1,864.41
|
| Rate for Payer: United Healthcare Medicare |
$443.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,821.55
|
|
|
HC PRO EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$5,790.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
9826478401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$594.14 |
| Max. Negotiated Rate |
$5,790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,674.20
|
| Rate for Payer: Aetna of WY Medicare |
$698.99
|
| Rate for Payer: Beech Street Commercial |
$5,500.50
|
| Rate for Payer: Cash Price |
$4,053.00
|
| Rate for Payer: Cash Price |
$4,053.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,616.30
|
| Rate for Payer: Cigna of WY Commercial |
$5,674.20
|
| Rate for Payer: First Choice Health Commercial |
$5,211.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,500.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.99
|
| Rate for Payer: HealthUtah PPO |
$5,790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,616.30
|
| Rate for Payer: Multiplan Medicare/VA |
$594.14
|
| Rate for Payer: One Health Plan of WY PPO |
$5,674.20
|
| Rate for Payer: PacificSource Commercial |
$5,211.00
|
| Rate for Payer: PHCS PPO |
$5,500.50
|
| Rate for Payer: Three Rivers PPO |
$4,342.50
|
| Rate for Payer: TriWest Veterans Administration |
$698.99
|
| Rate for Payer: United Healthcare Commercial |
$5,037.30
|
| Rate for Payer: United Healthcare Medicare |
$698.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,921.50
|
|
|
HC PRO EXC PAROTID TUM/GLAND,TOTAL,DISSECT 5TH NERV
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 42420
|
| Hospital Charge Code |
9834242001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$971.80 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,998.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.29
|
| Rate for Payer: Beech Street Commercial |
$3,876.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,957.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,998.40
|
| Rate for Payer: First Choice Health Commercial |
$3,672.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,876.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,143.29
|
| Rate for Payer: HealthUtah PPO |
$4,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,957.60
|
| Rate for Payer: Multiplan Medicare/VA |
$971.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,998.40
|
| Rate for Payer: PacificSource Commercial |
$3,672.00
|
| Rate for Payer: PHCS PPO |
$3,876.00
|
| Rate for Payer: Three Rivers PPO |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,143.29
|
| Rate for Payer: United Healthcare Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare Medicare |
$1,143.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,468.00
|
|
|
HC PRO EXCSION AURAL POLYP
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 69540
|
| Hospital Charge Code |
9836954001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$726.18
|
| Rate for Payer: Aetna of WY Medicare |
$127.72
|
| Rate for Payer: Beech Street Commercial |
$703.95
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$718.77
|
| Rate for Payer: Cigna of WY Commercial |
$726.18
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$703.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.72
|
| Rate for Payer: HealthUtah PPO |
$741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$718.77
|
| Rate for Payer: Multiplan Medicare/VA |
$108.56
|
| Rate for Payer: One Health Plan of WY PPO |
$726.18
|
| Rate for Payer: PacificSource Commercial |
$666.90
|
| Rate for Payer: PHCS PPO |
$703.95
|
| Rate for Payer: Three Rivers PPO |
$555.75
|
| Rate for Payer: TriWest Veterans Administration |
$127.72
|
| Rate for Payer: United Healthcare Commercial |
$644.67
|
| Rate for Payer: United Healthcare Medicare |
$127.72
|
| Rate for Payer: WINHealth Partners Commercial |
$629.85
|
|
|
HC PRO EXC SKIN BENIG <0.5 CM FACE,FACIAL
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 11440 NONPBBPAYER
|
| Hospital Charge Code |
9831144001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$515.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$504.70
|
| Rate for Payer: Aetna of WY Medicare |
$105.15
|
| Rate for Payer: Beech Street Commercial |
$489.25
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: Cash Price |
$360.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$499.55
|
| Rate for Payer: Cigna of WY Commercial |
$504.70
|
| Rate for Payer: First Choice Health Commercial |
$463.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$489.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.15
|
| Rate for Payer: HealthUtah PPO |
$515.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$499.55
|
| Rate for Payer: Multiplan Medicare/VA |
$89.38
|
| Rate for Payer: One Health Plan of WY PPO |
$504.70
|
| Rate for Payer: PacificSource Commercial |
$463.50
|
| Rate for Payer: PHCS PPO |
$489.25
|
| Rate for Payer: Three Rivers PPO |
$386.25
|
| Rate for Payer: TriWest Veterans Administration |
$105.15
|
| Rate for Payer: United Healthcare Commercial |
$448.05
|
| Rate for Payer: United Healthcare Medicare |
$105.15
|
| Rate for Payer: WINHealth Partners Commercial |
$437.75
|
|
