|
HC PRO EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
9831160401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$173.69 |
| Max. Negotiated Rate |
$853.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$835.94
|
| Rate for Payer: Aetna of WY Medicare |
$204.34
|
| Rate for Payer: Beech Street Commercial |
$810.35
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$827.41
|
| Rate for Payer: Cigna of WY Commercial |
$835.94
|
| Rate for Payer: First Choice Health Commercial |
$767.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.34
|
| Rate for Payer: HealthUtah PPO |
$853.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$827.41
|
| Rate for Payer: Multiplan Medicare/VA |
$173.69
|
| Rate for Payer: One Health Plan of WY PPO |
$835.94
|
| Rate for Payer: PacificSource Commercial |
$767.70
|
| Rate for Payer: PHCS PPO |
$810.35
|
| Rate for Payer: Three Rivers PPO |
$639.75
|
| Rate for Payer: TriWest Veterans Administration |
$204.34
|
| Rate for Payer: United Healthcare Commercial |
$742.11
|
| Rate for Payer: United Healthcare Medicare |
$204.34
|
| Rate for Payer: WINHealth Partners Commercial |
$725.05
|
|
|
HC PRO EXC SKIN MALIG >4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$1,273.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
9831160601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$256.97 |
| Max. Negotiated Rate |
$1,273.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,247.54
|
| Rate for Payer: Aetna of WY Medicare |
$302.32
|
| Rate for Payer: Beech Street Commercial |
$1,209.35
|
| Rate for Payer: Cash Price |
$891.10
|
| Rate for Payer: Cash Price |
$891.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,234.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,247.54
|
| Rate for Payer: First Choice Health Commercial |
$1,145.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,209.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.32
|
| Rate for Payer: HealthUtah PPO |
$1,273.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,234.81
|
| Rate for Payer: Multiplan Medicare/VA |
$256.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,247.54
|
| Rate for Payer: PacificSource Commercial |
$1,145.70
|
| Rate for Payer: PHCS PPO |
$1,209.35
|
| Rate for Payer: Three Rivers PPO |
$954.75
|
| Rate for Payer: TriWest Veterans Administration |
$302.32
|
| Rate for Payer: United Healthcare Commercial |
$1,107.51
|
| Rate for Payer: United Healthcare Medicare |
$302.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,082.05
|
|
|
HC PRO EXC SKIN MALIG >4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 11606 NONPBBPAYER
|
| Hospital Charge Code |
9831160601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$256.97 |
| Max. Negotiated Rate |
$1,591.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,559.18
|
| Rate for Payer: Aetna of WY Medicare |
$302.32
|
| Rate for Payer: Beech Street Commercial |
$1,511.45
|
| Rate for Payer: Cash Price |
$1,113.70
|
| Rate for Payer: Cash Price |
$1,113.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,543.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,559.18
|
| Rate for Payer: First Choice Health Commercial |
$1,431.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,511.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.32
|
| Rate for Payer: HealthUtah PPO |
$1,591.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,543.27
|
| Rate for Payer: Multiplan Medicare/VA |
$256.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,559.18
|
| Rate for Payer: PacificSource Commercial |
$1,431.90
|
| Rate for Payer: PHCS PPO |
$1,511.45
|
| Rate for Payer: Three Rivers PPO |
$1,193.25
|
| Rate for Payer: TriWest Veterans Administration |
$302.32
|
| Rate for Payer: United Healthcare Commercial |
$1,384.17
|
| Rate for Payer: United Healthcare Medicare |
$302.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,352.35
|
|
|
HC PRO EXC TUM,LEG/ANKLE SUBC<3CM
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 27618
|
| Hospital Charge Code |
9832761801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$253.88 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,660.12
|
| Rate for Payer: Aetna of WY Medicare |
$298.68
|
| Rate for Payer: Beech Street Commercial |
$1,609.30
|
| Rate for Payer: Cash Price |
$1,185.80
|
| Rate for Payer: Cash Price |
$1,185.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,643.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,660.12
|
| Rate for Payer: First Choice Health Commercial |
$1,524.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,609.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.68
|
| Rate for Payer: HealthUtah PPO |
$1,694.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,643.18
|
| Rate for Payer: Multiplan Medicare/VA |
$253.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,660.12
|
| Rate for Payer: PacificSource Commercial |
$1,524.60
|
| Rate for Payer: PHCS PPO |
$1,609.30
|
| Rate for Payer: Three Rivers PPO |
$1,270.50
|
| Rate for Payer: TriWest Veterans Administration |
$298.68
|
| Rate for Payer: United Healthcare Commercial |
$1,473.78
|
| Rate for Payer: United Healthcare Medicare |
$298.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,439.90
|
|
|
HC PRO EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
9832155201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$366.44 |
| Max. Negotiated Rate |
$2,298.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,252.04
|
| Rate for Payer: Aetna of WY Medicare |
$431.11
|
| Rate for Payer: Beech Street Commercial |
$2,183.10
|
| Rate for Payer: Cash Price |
$1,608.60
|
| Rate for Payer: Cash Price |
$1,608.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,229.06
|
| Rate for Payer: Cigna of WY Commercial |
$2,252.04
|
| Rate for Payer: First Choice Health Commercial |
$2,068.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,183.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.11
|
| Rate for Payer: HealthUtah PPO |
$2,298.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,229.06
|
| Rate for Payer: Multiplan Medicare/VA |
$366.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,252.04
|
| Rate for Payer: PacificSource Commercial |
$2,068.20
|
| Rate for Payer: PHCS PPO |
$2,183.10
|
| Rate for Payer: Three Rivers PPO |
$1,723.50
|
| Rate for Payer: TriWest Veterans Administration |
$431.11
|
| Rate for Payer: United Healthcare Commercial |
$1,999.26
|
| Rate for Payer: United Healthcare Medicare |
$431.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1,953.30
|
|
|
HC PRO EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3+CM
|
Professional
|
Both
|
$2,187.00
|
|
|
Service Code
|
HCPCS 25071
|
| Hospital Charge Code |
9832507101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$350.09 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,143.26
|
| Rate for Payer: Aetna of WY Medicare |
$411.87
|
| Rate for Payer: Beech Street Commercial |
$2,077.65
|
| Rate for Payer: Cash Price |
$1,530.90
|
| Rate for Payer: Cash Price |
$1,530.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,121.39
|
| Rate for Payer: Cigna of WY Commercial |
$2,143.26
|
| Rate for Payer: First Choice Health Commercial |
$1,968.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,077.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$411.87
|
| Rate for Payer: HealthUtah PPO |
$2,187.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,121.39
|
| Rate for Payer: Multiplan Medicare/VA |
$350.09
|
| Rate for Payer: One Health Plan of WY PPO |
$2,143.26
|
| Rate for Payer: PacificSource Commercial |
$1,968.30
|
| Rate for Payer: PHCS PPO |
$2,077.65
|
| Rate for Payer: Three Rivers PPO |
$1,640.25
|
| Rate for Payer: TriWest Veterans Administration |
$411.87
|
| Rate for Payer: United Healthcare Commercial |
$1,902.69
|
| Rate for Payer: United Healthcare Medicare |
$411.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,858.95
|
|
|
HC PRO EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
9832507501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$262.85 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,592.50
|
| Rate for Payer: Aetna of WY Medicare |
$309.23
|
| Rate for Payer: Beech Street Commercial |
$1,543.75
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: Cash Price |
$1,137.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,576.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,592.50
|
| Rate for Payer: First Choice Health Commercial |
$1,462.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,543.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$309.23
|
| Rate for Payer: HealthUtah PPO |
$1,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,576.25
|
| Rate for Payer: Multiplan Medicare/VA |
$262.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,592.50
|
| Rate for Payer: PacificSource Commercial |
$1,462.50
|
| Rate for Payer: PHCS PPO |
$1,543.75
|
| Rate for Payer: Three Rivers PPO |
$1,218.75
|
| Rate for Payer: TriWest Veterans Administration |
$309.23
|
| Rate for Payer: United Healthcare Commercial |
$1,413.75
|
| Rate for Payer: United Healthcare Medicare |
$309.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,381.25
|
|
|
HC PRO EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,140.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
9832290001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$463.16 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,097.20
|
| Rate for Payer: Aetna of WY Medicare |
$544.90
|
| Rate for Payer: Beech Street Commercial |
$2,033.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: Cash Price |
$1,498.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,075.80
|
| Rate for Payer: Cigna of WY Commercial |
$2,097.20
|
| Rate for Payer: First Choice Health Commercial |
$1,926.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,033.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$544.90
|
| Rate for Payer: HealthUtah PPO |
$2,140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,075.80
|
| Rate for Payer: Multiplan Medicare/VA |
$463.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,097.20
|
| Rate for Payer: PacificSource Commercial |
$1,926.00
|
| Rate for Payer: PHCS PPO |
$2,033.00
|
| Rate for Payer: Three Rivers PPO |
$1,605.00
|
| Rate for Payer: TriWest Veterans Administration |
$544.90
|
| Rate for Payer: United Healthcare Commercial |
$1,861.80
|
| Rate for Payer: United Healthcare Medicare |
$544.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,819.00
|
|
|
HC PRO EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 22903
|
| Hospital Charge Code |
9832290301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$360.23 |
| Max. Negotiated Rate |
$2,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,031.54
|
| Rate for Payer: Aetna of WY Medicare |
$423.80
|
| Rate for Payer: Beech Street Commercial |
$1,969.35
|
| Rate for Payer: Cash Price |
$1,451.10
|
| Rate for Payer: Cash Price |
$1,451.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,010.81
|
| Rate for Payer: Cigna of WY Commercial |
$2,031.54
|
| Rate for Payer: First Choice Health Commercial |
$1,865.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,969.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.80
|
| Rate for Payer: HealthUtah PPO |
$2,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,010.81
|
| Rate for Payer: Multiplan Medicare/VA |
$360.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2,031.54
|
| Rate for Payer: PacificSource Commercial |
$1,865.70
|
| Rate for Payer: PHCS PPO |
$1,969.35
|
| Rate for Payer: Three Rivers PPO |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration |
$423.80
|
| Rate for Payer: United Healthcare Commercial |
$1,803.51
|
| Rate for Payer: United Healthcare Medicare |
$423.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,762.05
|
|
|
HC PRO EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
|
Professional
|
Both
|
$5,477.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
9832290201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$275.08 |
| Max. Negotiated Rate |
$5,477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,367.46
|
| Rate for Payer: Aetna of WY Medicare |
$323.62
|
| Rate for Payer: Beech Street Commercial |
$5,203.15
|
| Rate for Payer: Cash Price |
$3,833.90
|
| Rate for Payer: Cash Price |
$3,833.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,312.69
|
| Rate for Payer: Cigna of WY Commercial |
$5,367.46
|
| Rate for Payer: First Choice Health Commercial |
$4,929.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,203.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$323.62
|
| Rate for Payer: HealthUtah PPO |
$5,477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,312.69
|
| Rate for Payer: Multiplan Medicare/VA |
$275.08
|
| Rate for Payer: One Health Plan of WY PPO |
$5,367.46
|
| Rate for Payer: PacificSource Commercial |
$4,929.30
|
| Rate for Payer: PHCS PPO |
$5,203.15
|
| Rate for Payer: Three Rivers PPO |
$4,107.75
|
| Rate for Payer: TriWest Veterans Administration |
$323.62
|
| Rate for Payer: United Healthcare Commercial |
$4,764.99
|
| Rate for Payer: United Healthcare Medicare |
$323.62
|
| Rate for Payer: WINHealth Partners Commercial |
$4,655.45
|
|
|
HC PRO EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 28041
|
| Hospital Charge Code |
9832804101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$373.18 |
| Max. Negotiated Rate |
$1,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,537.62
|
| Rate for Payer: Aetna of WY Medicare |
$439.04
|
| Rate for Payer: Beech Street Commercial |
$1,490.55
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: Cash Price |
$1,098.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,521.93
|
| Rate for Payer: Cigna of WY Commercial |
$1,537.62
|
| Rate for Payer: First Choice Health Commercial |
$1,412.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,490.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$439.04
|
| Rate for Payer: HealthUtah PPO |
$1,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,521.93
|
| Rate for Payer: Multiplan Medicare/VA |
$373.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,537.62
|
| Rate for Payer: PacificSource Commercial |
$1,412.10
|
| Rate for Payer: PHCS PPO |
$1,490.55
|
| Rate for Payer: Three Rivers PPO |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration |
$439.04
|
| Rate for Payer: United Healthcare Commercial |
$1,365.03
|
| Rate for Payer: United Healthcare Medicare |
$439.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,333.65
|
|
|
HC PRO EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,384.00
|
|
|
Service Code
|
HCPCS 27619
|
| Hospital Charge Code |
9832761901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$389.08 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,336.32
|
| Rate for Payer: Aetna of WY Medicare |
$457.74
|
| Rate for Payer: Beech Street Commercial |
$2,264.80
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,312.48
|
| Rate for Payer: Cigna of WY Commercial |
$2,336.32
|
| Rate for Payer: First Choice Health Commercial |
$2,145.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,264.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$457.74
|
| Rate for Payer: HealthUtah PPO |
$2,384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,312.48
|
| Rate for Payer: Multiplan Medicare/VA |
$389.08
|
| Rate for Payer: One Health Plan of WY PPO |
$2,336.32
|
| Rate for Payer: PacificSource Commercial |
$2,145.60
|
| Rate for Payer: PHCS PPO |
$2,264.80
|
| Rate for Payer: Three Rivers PPO |
$1,788.00
|
| Rate for Payer: TriWest Veterans Administration |
$457.74
|
| Rate for Payer: United Healthcare Commercial |
$2,074.08
|
| Rate for Payer: United Healthcare Medicare |
$457.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2,026.40
|
|
|
HC PRO EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>
|
Professional
|
Both
|
$3,769.00
|
|
|
Service Code
|
HCPCS 21554
|
| Hospital Charge Code |
9832155401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$597.74 |
| Max. Negotiated Rate |
$3,769.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,693.62
|
| Rate for Payer: Aetna of WY Medicare |
$703.22
|
| Rate for Payer: Beech Street Commercial |
$3,580.55
|
| Rate for Payer: Cash Price |
$2,638.30
|
| Rate for Payer: Cash Price |
$2,638.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,655.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,693.62
|
| Rate for Payer: First Choice Health Commercial |
$3,392.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,580.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$703.22
|
| Rate for Payer: HealthUtah PPO |
$3,769.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,655.93
|
| Rate for Payer: Multiplan Medicare/VA |
$597.74
|
| Rate for Payer: One Health Plan of WY PPO |
$3,693.62
|
| Rate for Payer: PacificSource Commercial |
$3,392.10
|
| Rate for Payer: PHCS PPO |
$3,580.55
|
| Rate for Payer: Three Rivers PPO |
$2,826.75
|
| Rate for Payer: TriWest Veterans Administration |
$703.22
|
| Rate for Payer: United Healthcare Commercial |
$3,279.03
|
| Rate for Payer: United Healthcare Medicare |
$703.22
|
| Rate for Payer: WINHealth Partners Commercial |
$3,203.65
|
|
|
HC PRO EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5+CM
|
Professional
|
Both
|
$2,517.00
|
|
|
Service Code
|
HCPCS 27045
|
| Hospital Charge Code |
9832704501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$599.48 |
| Max. Negotiated Rate |
$2,517.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,466.66
|
| Rate for Payer: Aetna of WY Medicare |
$705.27
|
| Rate for Payer: Beech Street Commercial |
$2,391.15
|
| Rate for Payer: Cash Price |
$1,761.90
|
| Rate for Payer: Cash Price |
$1,761.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,441.49
|
| Rate for Payer: Cigna of WY Commercial |
$2,466.66
|
| Rate for Payer: First Choice Health Commercial |
$2,265.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,391.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$705.27
|
| Rate for Payer: HealthUtah PPO |
$2,517.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,441.49
|
| Rate for Payer: Multiplan Medicare/VA |
$599.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,466.66
|
| Rate for Payer: PacificSource Commercial |
$2,265.30
|
| Rate for Payer: PHCS PPO |
$2,391.15
|
| Rate for Payer: Three Rivers PPO |
$1,887.75
|
| Rate for Payer: TriWest Veterans Administration |
$705.27
|
| Rate for Payer: United Healthcare Commercial |
$2,189.79
|
| Rate for Payer: United Healthcare Medicare |
$705.27
|
| Rate for Payer: WINHealth Partners Commercial |
$2,139.45
|
|
|
HC PRO EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 27328
|
| Hospital Charge Code |
9832732801
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$512.76 |
| 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 |
$603.25
|
| 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 |
$603.25
|
| Rate for Payer: HealthUtah PPO |
$2,153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,088.41
|
| Rate for Payer: Multiplan Medicare/VA |
$512.76
|
| 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 |
$603.25
|
| Rate for Payer: United Healthcare Commercial |
$1,873.11
|
| Rate for Payer: United Healthcare Medicare |
$603.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,830.05
|
|
|
HC PRO EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM
|
Professional
|
Both
|
$844.00
|
|
|
Service Code
|
HCPCS 24071 NONPBBPAYER
|
| Hospital Charge Code |
9832407101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$333.52 |
| Max. Negotiated Rate |
$844.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$827.12
|
| Rate for Payer: Aetna of WY Medicare |
$392.38
|
| Rate for Payer: Beech Street Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$590.80
|
| Rate for Payer: Cash Price |
$590.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$818.68
|
| Rate for Payer: Cigna of WY Commercial |
$827.12
|
| Rate for Payer: First Choice Health Commercial |
$759.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$801.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$392.38
|
| Rate for Payer: HealthUtah PPO |
$844.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$818.68
|
| Rate for Payer: Multiplan Medicare/VA |
$333.52
|
| Rate for Payer: One Health Plan of WY PPO |
$827.12
|
| Rate for Payer: PacificSource Commercial |
$759.60
|
| Rate for Payer: PHCS PPO |
$801.80
|
| Rate for Payer: Three Rivers PPO |
$633.00
|
| Rate for Payer: TriWest Veterans Administration |
$392.38
|
| Rate for Payer: United Healthcare Commercial |
$734.28
|
| Rate for Payer: United Healthcare Medicare |
$392.38
|
| Rate for Payer: WINHealth Partners Commercial |
$717.40
|
|
|
HC PRO EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 24071
|
| Hospital Charge Code |
9832407101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$333.52 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$661.50
|
| Rate for Payer: Aetna of WY Medicare |
$392.38
|
| Rate for Payer: Beech Street Commercial |
$641.25
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$654.75
|
| Rate for Payer: Cigna of WY Commercial |
$661.50
|
| Rate for Payer: First Choice Health Commercial |
$607.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$641.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$392.38
|
| Rate for Payer: HealthUtah PPO |
$675.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$654.75
|
| Rate for Payer: Multiplan Medicare/VA |
$333.52
|
| Rate for Payer: One Health Plan of WY PPO |
$661.50
|
| Rate for Payer: PacificSource Commercial |
$607.50
|
| Rate for Payer: PHCS PPO |
$641.25
|
| Rate for Payer: Three Rivers PPO |
$506.25
|
| Rate for Payer: TriWest Veterans Administration |
$392.38
|
| Rate for Payer: United Healthcare Commercial |
$587.25
|
| Rate for Payer: United Healthcare Medicare |
$392.38
|
| Rate for Payer: WINHealth Partners Commercial |
$573.75
|
|
|
HC PRO EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
Both
|
$990.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
9832407501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$273.18 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$970.20
|
| Rate for Payer: Aetna of WY Medicare |
$321.39
|
| Rate for Payer: Beech Street Commercial |
$940.50
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$960.30
|
| Rate for Payer: Cigna of WY Commercial |
$970.20
|
| Rate for Payer: First Choice Health Commercial |
$891.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$940.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.39
|
| Rate for Payer: HealthUtah PPO |
$990.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$960.30
|
| Rate for Payer: Multiplan Medicare/VA |
$273.18
|
| Rate for Payer: One Health Plan of WY PPO |
$970.20
|
| Rate for Payer: PacificSource Commercial |
$891.00
|
| Rate for Payer: PHCS PPO |
$940.50
|
| Rate for Payer: Three Rivers PPO |
$742.50
|
| Rate for Payer: TriWest Veterans Administration |
$321.39
|
| Rate for Payer: United Healthcare Commercial |
$861.30
|
| Rate for Payer: United Healthcare Medicare |
$321.39
|
| Rate for Payer: WINHealth Partners Commercial |
$841.50
|
|
|
HC PRO EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 24075 NONPBBPAYER
|
| Hospital Charge Code |
9832407501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$273.18 |
| Max. Negotiated Rate |
$1,238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,213.24
|
| Rate for Payer: Aetna of WY Medicare |
$321.39
|
| Rate for Payer: Beech Street Commercial |
$1,176.10
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: Cash Price |
$866.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,200.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,213.24
|
| Rate for Payer: First Choice Health Commercial |
$1,114.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,176.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$321.39
|
| Rate for Payer: HealthUtah PPO |
$1,238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,200.86
|
| Rate for Payer: Multiplan Medicare/VA |
$273.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,213.24
|
| Rate for Payer: PacificSource Commercial |
$1,114.20
|
| Rate for Payer: PHCS PPO |
$1,176.10
|
| Rate for Payer: Three Rivers PPO |
$928.50
|
| Rate for Payer: TriWest Veterans Administration |
$321.39
|
| Rate for Payer: United Healthcare Commercial |
$1,077.06
|
| Rate for Payer: United Healthcare Medicare |
$321.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,052.30
|
|
|
HC PRO EXC TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$2,147.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
9832611101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$346.13 |
| Max. Negotiated Rate |
$2,147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,104.06
|
| Rate for Payer: Aetna of WY Medicare |
$407.21
|
| Rate for Payer: Beech Street Commercial |
$2,039.65
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: Cash Price |
$1,502.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,082.59
|
| Rate for Payer: Cigna of WY Commercial |
$2,104.06
|
| Rate for Payer: First Choice Health Commercial |
$1,932.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,039.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.21
|
| Rate for Payer: HealthUtah PPO |
$2,147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,082.59
|
| Rate for Payer: Multiplan Medicare/VA |
$346.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,104.06
|
| Rate for Payer: PacificSource Commercial |
$1,932.30
|
| Rate for Payer: PHCS PPO |
$2,039.65
|
| Rate for Payer: Three Rivers PPO |
$1,610.25
|
| Rate for Payer: TriWest Veterans Administration |
$407.21
|
| Rate for Payer: United Healthcare Commercial |
$1,867.89
|
| Rate for Payer: United Healthcare Medicare |
$407.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,824.95
|
|
|
HC PRO EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
9832611501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$278.44 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,669.92
|
| Rate for Payer: Aetna of WY Medicare |
$327.58
|
| Rate for Payer: Beech Street Commercial |
$1,618.80
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,652.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,669.92
|
| Rate for Payer: First Choice Health Commercial |
$1,533.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,618.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$327.58
|
| Rate for Payer: HealthUtah PPO |
$1,704.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,652.88
|
| Rate for Payer: Multiplan Medicare/VA |
$278.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,669.92
|
| Rate for Payer: PacificSource Commercial |
$1,533.60
|
| Rate for Payer: PHCS PPO |
$1,618.80
|
| Rate for Payer: Three Rivers PPO |
$1,278.00
|
| Rate for Payer: TriWest Veterans Administration |
$327.58
|
| Rate for Payer: United Healthcare Commercial |
$1,482.48
|
| Rate for Payer: United Healthcare Medicare |
$327.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,448.40
|
|
|
HC PRO EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 42450
|
| Hospital Charge Code |
9834245001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,813.00
|
| Rate for Payer: Aetna of WY Medicare |
$355.76
|
| Rate for Payer: Beech Street Commercial |
$1,757.50
|
| Rate for Payer: Cash Price |
$1,295.00
|
| Rate for Payer: Cash Price |
$1,295.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,794.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,813.00
|
| Rate for Payer: First Choice Health Commercial |
$1,665.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,757.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$355.76
|
| Rate for Payer: HealthUtah PPO |
$1,850.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,794.50
|
| Rate for Payer: Multiplan Medicare/VA |
$302.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,813.00
|
| Rate for Payer: PacificSource Commercial |
$1,665.00
|
| Rate for Payer: PHCS PPO |
$1,757.50
|
| Rate for Payer: Three Rivers PPO |
$1,387.50
|
| Rate for Payer: TriWest Veterans Administration |
$355.76
|
| Rate for Payer: United Healthcare Commercial |
$1,609.50
|
| Rate for Payer: United Healthcare Medicare |
$355.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,572.50
|
|
|
HC PRO EXPLORATION OF KNEE JOINT
|
Professional
|
Both
|
$6,316.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
9832731001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$605.57 |
| Max. Negotiated Rate |
$6,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,189.68
|
| Rate for Payer: Aetna of WY Medicare |
$712.43
|
| Rate for Payer: Beech Street Commercial |
$6,000.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: Cash Price |
$4,421.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,126.52
|
| Rate for Payer: Cigna of WY Commercial |
$6,189.68
|
| Rate for Payer: First Choice Health Commercial |
$5,684.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,000.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$712.43
|
| Rate for Payer: HealthUtah PPO |
$6,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,126.52
|
| Rate for Payer: Multiplan Medicare/VA |
$605.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,189.68
|
| Rate for Payer: PacificSource Commercial |
$5,684.40
|
| Rate for Payer: PHCS PPO |
$6,000.20
|
| Rate for Payer: Three Rivers PPO |
$4,737.00
|
| Rate for Payer: TriWest Veterans Administration |
$712.43
|
| Rate for Payer: United Healthcare Commercial |
$5,494.92
|
| Rate for Payer: United Healthcare Medicare |
$712.43
|
| Rate for Payer: WINHealth Partners Commercial |
$5,368.60
|
|
|
HC PRO EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$1,661.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
9754900001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$621.50 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,627.78
|
| Rate for Payer: Aetna of WY Medicare |
$731.18
|
| Rate for Payer: Beech Street Commercial |
$1,577.95
|
| Rate for Payer: Cash Price |
$1,162.70
|
| Rate for Payer: Cash Price |
$1,162.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,611.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,627.78
|
| Rate for Payer: First Choice Health Commercial |
$1,494.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,577.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.18
|
| Rate for Payer: HealthUtah PPO |
$1,661.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,611.17
|
| Rate for Payer: Multiplan Medicare/VA |
$621.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,627.78
|
| Rate for Payer: PacificSource Commercial |
$1,494.90
|
| Rate for Payer: PHCS PPO |
$1,577.95
|
| Rate for Payer: Three Rivers PPO |
$1,245.75
|
| Rate for Payer: TriWest Veterans Administration |
$731.18
|
| Rate for Payer: United Healthcare Commercial |
$1,445.07
|
| Rate for Payer: United Healthcare Medicare |
$731.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,411.85
|
|
|
HC PRO EXPLORE PARATHYROID GLANDS
|
Professional
|
Both
|
$4,985.00
|
|
|
Service Code
|
HCPCS 60500
|
| Hospital Charge Code |
9836050001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$787.94 |
| Max. Negotiated Rate |
$4,985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,885.30
|
| Rate for Payer: Aetna of WY Medicare |
$926.99
|
| Rate for Payer: Beech Street Commercial |
$4,735.75
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: Cash Price |
$3,489.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,835.45
|
| Rate for Payer: Cigna of WY Commercial |
$4,885.30
|
| Rate for Payer: First Choice Health Commercial |
$4,486.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,735.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$926.99
|
| Rate for Payer: HealthUtah PPO |
$4,985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,835.45
|
| Rate for Payer: Multiplan Medicare/VA |
$787.94
|
| Rate for Payer: One Health Plan of WY PPO |
$4,885.30
|
| Rate for Payer: PacificSource Commercial |
$4,486.50
|
| Rate for Payer: PHCS PPO |
$4,735.75
|
| Rate for Payer: Three Rivers PPO |
$3,738.75
|
| Rate for Payer: TriWest Veterans Administration |
$926.99
|
| Rate for Payer: United Healthcare Commercial |
$4,336.95
|
| Rate for Payer: United Healthcare Medicare |
$926.99
|
| Rate for Payer: WINHealth Partners Commercial |
$4,237.25
|
|
