|
HC EXC SKIN BENIG <0.5 CM FACE,FACIAL
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
5101144001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.74
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$56.75
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$59.74
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$59.74
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
5101140001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.46
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$50.79
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$53.46
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$53.46
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
5101140001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.63 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$53.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.76
|
| Rate for Payer: Altius Commercial |
$77.76
|
| Rate for Payer: Beech Street Commercial |
$79.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: Entrust Commercial |
$76.95
|
| Rate for Payer: First Choice Health Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.98
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$44.63
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$79.38
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.98
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$46.98
|
| Rate for Payer: WINHealth Partners Commercial |
$79.38
|
| Rate for Payer: Wise Provider Network Commercial |
$76.95
|
|
|
HC EXC SKIN BENIG 0.6-1 CM FACE,FACIAL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
5101144101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Aetna of WY Medicare |
$85.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.40
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$71.63
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.40
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$75.40
|
| Rate for Payer: WINHealth Partners Commercial |
$127.40
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC EXC SKIN BENIG 0.6-1 CM FACE,FACIAL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
5101144101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.80
|
| Rate for Payer: Altius Commercial |
$124.80
|
| Rate for Payer: Beech Street Commercial |
$127.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.10
|
| Rate for Payer: Cigna of WY Commercial |
$127.40
|
| Rate for Payer: Entrust Commercial |
$123.50
|
| Rate for Payer: First Choice Health Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.80
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.10
|
| Rate for Payer: Multiplan Medicare/VA |
$81.51
|
| Rate for Payer: One Health Plan of WY PPO |
$127.40
|
| Rate for Payer: PacificSource Commercial |
$117.00
|
| Rate for Payer: PHCS PPO |
$127.40
|
| Rate for Payer: Three Rivers PPO |
$97.50
|
| Rate for Payer: TriWest Veterans Administration |
$85.80
|
| Rate for Payer: United Healthcare Commercial |
$113.10
|
| Rate for Payer: United Healthcare Medicare |
$85.80
|
| Rate for Payer: WINHealth Partners Commercial |
$123.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.50
|
|
|
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
5101142101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Aetna of WY Medicare |
$71.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.22
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$60.06
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.22
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$63.22
|
| Rate for Payer: WINHealth Partners Commercial |
$106.82
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
5101142101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.64
|
| Rate for Payer: Altius Commercial |
$104.64
|
| Rate for Payer: Beech Street Commercial |
$106.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.73
|
| Rate for Payer: Cigna of WY Commercial |
$106.82
|
| Rate for Payer: Entrust Commercial |
$103.55
|
| Rate for Payer: First Choice Health Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.94
|
| Rate for Payer: HealthUtah PPO |
$109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.73
|
| Rate for Payer: Multiplan Medicare/VA |
$68.34
|
| Rate for Payer: One Health Plan of WY PPO |
$106.82
|
| Rate for Payer: PacificSource Commercial |
$98.10
|
| Rate for Payer: PHCS PPO |
$106.82
|
| Rate for Payer: Three Rivers PPO |
$81.75
|
| Rate for Payer: TriWest Veterans Administration |
$71.94
|
| Rate for Payer: United Healthcare Commercial |
$94.83
|
| Rate for Payer: United Healthcare Medicare |
$71.94
|
| Rate for Payer: WINHealth Partners Commercial |
$103.55
|
| Rate for Payer: Wise Provider Network Commercial |
$103.55
|
|
|
HC EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
5101140101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.98
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$64.58
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.98
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$67.98
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
5101140101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.75 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.88
|
| Rate for Payer: Altius Commercial |
$98.88
|
| Rate for Payer: Beech Street Commercial |
$100.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.56
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: Entrust Commercial |
$97.85
|
| Rate for Payer: First Choice Health Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.74
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$56.75
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$100.94
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$59.74
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$59.74
|
| Rate for Payer: WINHealth Partners Commercial |
$100.94
|
| Rate for Payer: Wise Provider Network Commercial |
$97.85
|
|
|
HC EXC SKIN BENIG 1.1-2 CM FACE,FACIAL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
5101144201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$95.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.10
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$79.90
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.10
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$84.10
|
| Rate for Payer: WINHealth Partners Commercial |
$142.10
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC EXC SKIN BENIG 1.1-2 CM FACE,FACIAL
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
5101144201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$139.20
|
| Rate for Payer: Altius Commercial |
$139.20
|
| Rate for Payer: Beech Street Commercial |
$142.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$119.04
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: Entrust Commercial |
$137.75
|
| Rate for Payer: First Choice Health Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.70
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$90.92
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$142.10
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$95.70
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$95.70
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
| Rate for Payer: Wise Provider Network Commercial |
$137.75
|
|
|
HC EXC SKIN BENIG 1.1-2 CM REMAINDR BODY
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
5101142201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$130.56
|
| Rate for Payer: Altius Commercial |
$130.56
|
| Rate for Payer: Beech Street Commercial |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$111.66
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: Entrust Commercial |
$129.20
|
| Rate for Payer: First Choice Health Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.76
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$85.27
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PHCS PPO |
$133.28
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$89.76
|
| Rate for Payer: United Healthcare Commercial |
$118.32
|
| Rate for Payer: United Healthcare Medicare |
$89.76
|
| Rate for Payer: WINHealth Partners Commercial |
$129.20
|
| Rate for Payer: Wise Provider Network Commercial |
$129.20
|
|
|
HC EXC SKIN BENIG 1.1-2 CM REMAINDR BODY
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
5101142201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.28
|
| Rate for Payer: Aetna of WY Medicare |
$89.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$130.56
|
| Rate for Payer: Altius Commercial |
$130.56
|
| Rate for Payer: Beech Street Commercial |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$111.66
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.92
|
| Rate for Payer: Cigna of WY Commercial |
$133.28
|
| Rate for Payer: Entrust Commercial |
$129.20
|
| Rate for Payer: First Choice Health Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.88
|
| Rate for Payer: HealthUtah PPO |
$136.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.92
|
| Rate for Payer: Multiplan Medicare/VA |
$74.94
|
| Rate for Payer: One Health Plan of WY PPO |
$133.28
|
| Rate for Payer: PacificSource Commercial |
$122.40
|
| Rate for Payer: PHCS PPO |
$133.28
|
| Rate for Payer: Three Rivers PPO |
$102.00
|
| Rate for Payer: TriWest Veterans Administration |
$78.88
|
| Rate for Payer: United Healthcare Commercial |
$118.32
|
| Rate for Payer: United Healthcare Medicare |
$78.88
|
| Rate for Payer: WINHealth Partners Commercial |
$133.28
|
| Rate for Payer: Wise Provider Network Commercial |
$129.20
|
|
|
HC EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
5101140201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.48 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$109.44
|
| Rate for Payer: Altius Commercial |
$109.44
|
| Rate for Payer: Beech Street Commercial |
$111.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$93.59
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.58
|
| Rate for Payer: Cigna of WY Commercial |
$111.72
|
| Rate for Payer: Entrust Commercial |
$108.30
|
| Rate for Payer: First Choice Health Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.24
|
| Rate for Payer: HealthUtah PPO |
$114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.58
|
| Rate for Payer: Multiplan Medicare/VA |
$71.48
|
| Rate for Payer: One Health Plan of WY PPO |
$111.72
|
| Rate for Payer: PacificSource Commercial |
$102.60
|
| Rate for Payer: PHCS PPO |
$111.72
|
| Rate for Payer: Three Rivers PPO |
$85.50
|
| Rate for Payer: TriWest Veterans Administration |
$75.24
|
| Rate for Payer: United Healthcare Commercial |
$99.18
|
| Rate for Payer: United Healthcare Medicare |
$75.24
|
| Rate for Payer: WINHealth Partners Commercial |
$108.30
|
| Rate for Payer: Wise Provider Network Commercial |
$108.30
|
|
|
HC EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
5101140201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.72
|
| Rate for Payer: Aetna of WY Medicare |
$75.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$109.44
|
| Rate for Payer: Altius Commercial |
$109.44
|
| Rate for Payer: Beech Street Commercial |
$111.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$93.59
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.58
|
| Rate for Payer: Cigna of WY Commercial |
$111.72
|
| Rate for Payer: Entrust Commercial |
$108.30
|
| Rate for Payer: First Choice Health Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.58
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$111.72
|
| Rate for Payer: PacificSource Commercial |
$102.60
|
| Rate for Payer: PHCS PPO |
$111.72
|
| Rate for Payer: Three Rivers PPO |
$85.50
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$99.18
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$111.72
|
| Rate for Payer: Wise Provider Network Commercial |
$108.30
|
|
|
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
5101142301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.76
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.08
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.96
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$97.81
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.96
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$102.96
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
5101142301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$102.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.76
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.08
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.48
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$85.96
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$90.48
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$90.48
|
| Rate for Payer: WINHealth Partners Commercial |
$152.88
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC EXC SKIN BENIG >4 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
5101140601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Aetna of WY Medicare |
$162.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.68
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$135.55
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$142.68
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$142.68
|
| Rate for Payer: WINHealth Partners Commercial |
$241.08
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC EXC SKIN BENIG >4 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
5101140601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$236.16
|
| Rate for Payer: Altius Commercial |
$236.16
|
| Rate for Payer: Beech Street Commercial |
$241.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.62
|
| Rate for Payer: Cigna of WY Commercial |
$241.08
|
| Rate for Payer: Entrust Commercial |
$233.70
|
| Rate for Payer: First Choice Health Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.36
|
| Rate for Payer: HealthUtah PPO |
$246.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.62
|
| Rate for Payer: Multiplan Medicare/VA |
$154.24
|
| Rate for Payer: One Health Plan of WY PPO |
$241.08
|
| Rate for Payer: PacificSource Commercial |
$221.40
|
| Rate for Payer: PHCS PPO |
$241.08
|
| Rate for Payer: Three Rivers PPO |
$184.50
|
| Rate for Payer: TriWest Veterans Administration |
$162.36
|
| Rate for Payer: United Healthcare Commercial |
$214.02
|
| Rate for Payer: United Healthcare Medicare |
$162.36
|
| Rate for Payer: WINHealth Partners Commercial |
$233.70
|
| Rate for Payer: Wise Provider Network Commercial |
$233.70
|
|
|
HC EXC SKIN BENIG <5MM REMAINDR BODY
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
5101142001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$78.72
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.32
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.12
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$51.41
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$54.12
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$54.12
|
| Rate for Payer: WINHealth Partners Commercial |
$77.90
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC EXC SKIN BENIG <5MM REMAINDR BODY
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
5101142001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$54.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$78.72
|
| Rate for Payer: Altius Commercial |
$78.72
|
| Rate for Payer: Beech Street Commercial |
$80.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.32
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: Entrust Commercial |
$77.90
|
| Rate for Payer: First Choice Health Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.56
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$45.18
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$80.36
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$47.56
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$47.56
|
| Rate for Payer: WINHealth Partners Commercial |
$80.36
|
| Rate for Payer: Wise Provider Network Commercial |
$77.90
|
|
|
HC EXC SKIN MALIG 0.6-1CM FACE,FACIAL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
5101164101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.76
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.08
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.96
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$97.81
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$102.96
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$102.96
|
| Rate for Payer: WINHealth Partners Commercial |
$148.20
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC EXC SKIN MALIG 0.6-1CM FACE,FACIAL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
5101164101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$152.88
|
| Rate for Payer: Aetna of WY Medicare |
$102.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$149.76
|
| Rate for Payer: Altius Commercial |
$149.76
|
| Rate for Payer: Beech Street Commercial |
$152.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.08
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$151.32
|
| Rate for Payer: Cigna of WY Commercial |
$152.88
|
| Rate for Payer: Entrust Commercial |
$148.20
|
| Rate for Payer: First Choice Health Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.48
|
| Rate for Payer: HealthUtah PPO |
$156.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$151.32
|
| Rate for Payer: Multiplan Medicare/VA |
$85.96
|
| Rate for Payer: One Health Plan of WY PPO |
$152.88
|
| Rate for Payer: PacificSource Commercial |
$140.40
|
| Rate for Payer: PHCS PPO |
$152.88
|
| Rate for Payer: Three Rivers PPO |
$117.00
|
| Rate for Payer: TriWest Veterans Administration |
$90.48
|
| Rate for Payer: United Healthcare Commercial |
$135.72
|
| Rate for Payer: United Healthcare Medicare |
$90.48
|
| Rate for Payer: WINHealth Partners Commercial |
$152.88
|
| Rate for Payer: Wise Provider Network Commercial |
$148.20
|
|
|
HC EXC SKIN MALIG 0.6-1 CM REMAINDR BODY
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
5101162101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.34
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$93.42
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.34
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$98.34
|
| Rate for Payer: WINHealth Partners Commercial |
$141.55
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
HC EXC SKIN MALIG 0.6-1 CM REMAINDR BODY
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
5101162101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.10 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$98.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.42
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$82.10
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.42
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$86.42
|
| Rate for Payer: WINHealth Partners Commercial |
$146.02
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
