|
HC EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
5101160101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$145.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$142.08
|
| Rate for Payer: Altius Commercial |
$142.08
|
| Rate for Payer: Beech Street Commercial |
$145.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$121.51
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$143.56
|
| Rate for Payer: Cigna of WY Commercial |
$145.04
|
| Rate for Payer: Entrust Commercial |
$140.60
|
| Rate for Payer: First Choice Health Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.68
|
| Rate for Payer: HealthUtah PPO |
$148.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$143.56
|
| Rate for Payer: Multiplan Medicare/VA |
$92.80
|
| Rate for Payer: One Health Plan of WY PPO |
$145.04
|
| Rate for Payer: PacificSource Commercial |
$133.20
|
| Rate for Payer: PHCS PPO |
$145.04
|
| Rate for Payer: Three Rivers PPO |
$111.00
|
| Rate for Payer: TriWest Veterans Administration |
$97.68
|
| Rate for Payer: United Healthcare Commercial |
$128.76
|
| Rate for Payer: United Healthcare Medicare |
$97.68
|
| Rate for Payer: WINHealth Partners Commercial |
$140.60
|
| Rate for Payer: Wise Provider Network Commercial |
$140.60
|
|
|
HC EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
5101160101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$145.04
|
| Rate for Payer: Aetna of WY Medicare |
$97.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$142.08
|
| Rate for Payer: Altius Commercial |
$142.08
|
| Rate for Payer: Beech Street Commercial |
$145.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$121.51
|
| Rate for Payer: Cash Price |
$103.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$143.56
|
| Rate for Payer: Cigna of WY Commercial |
$145.04
|
| Rate for Payer: Entrust Commercial |
$140.60
|
| Rate for Payer: First Choice Health Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$140.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.84
|
| Rate for Payer: HealthUtah PPO |
$148.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$143.56
|
| Rate for Payer: Multiplan Medicare/VA |
$81.55
|
| Rate for Payer: One Health Plan of WY PPO |
$145.04
|
| Rate for Payer: PacificSource Commercial |
$133.20
|
| Rate for Payer: PHCS PPO |
$145.04
|
| Rate for Payer: Three Rivers PPO |
$111.00
|
| Rate for Payer: TriWest Veterans Administration |
$85.84
|
| Rate for Payer: United Healthcare Commercial |
$128.76
|
| Rate for Payer: United Healthcare Medicare |
$85.84
|
| Rate for Payer: WINHealth Partners Commercial |
$145.04
|
| Rate for Payer: Wise Provider Network Commercial |
$140.60
|
|
|
HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 11642
|
| Hospital Charge Code |
5101164201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$174.72
|
| Rate for Payer: Altius Commercial |
$174.72
|
| Rate for Payer: Beech Street Commercial |
$178.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.42
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$176.54
|
| Rate for Payer: Cigna of WY Commercial |
$178.36
|
| Rate for Payer: Entrust Commercial |
$172.90
|
| Rate for Payer: First Choice Health Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.12
|
| Rate for Payer: HealthUtah PPO |
$182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$176.54
|
| Rate for Payer: Multiplan Medicare/VA |
$114.11
|
| Rate for Payer: One Health Plan of WY PPO |
$178.36
|
| Rate for Payer: PacificSource Commercial |
$163.80
|
| Rate for Payer: PHCS PPO |
$178.36
|
| Rate for Payer: Three Rivers PPO |
$136.50
|
| Rate for Payer: TriWest Veterans Administration |
$120.12
|
| Rate for Payer: United Healthcare Commercial |
$158.34
|
| Rate for Payer: United Healthcare Medicare |
$120.12
|
| Rate for Payer: WINHealth Partners Commercial |
$172.90
|
| Rate for Payer: Wise Provider Network Commercial |
$172.90
|
|
|
HC EXC SKIN MALIG 1.1-2 CM FACE,FACIAL
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 11642
|
| Hospital Charge Code |
5101164201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.28 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$178.36
|
| Rate for Payer: Aetna of WY Medicare |
$120.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$174.72
|
| Rate for Payer: Altius Commercial |
$174.72
|
| Rate for Payer: Beech Street Commercial |
$178.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.42
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$176.54
|
| Rate for Payer: Cigna of WY Commercial |
$178.36
|
| Rate for Payer: Entrust Commercial |
$172.90
|
| Rate for Payer: First Choice Health Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.56
|
| Rate for Payer: HealthUtah PPO |
$182.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$176.54
|
| Rate for Payer: Multiplan Medicare/VA |
$100.28
|
| Rate for Payer: One Health Plan of WY PPO |
$178.36
|
| Rate for Payer: PacificSource Commercial |
$163.80
|
| Rate for Payer: PHCS PPO |
$178.36
|
| Rate for Payer: Three Rivers PPO |
$136.50
|
| Rate for Payer: TriWest Veterans Administration |
$105.56
|
| Rate for Payer: United Healthcare Commercial |
$158.34
|
| Rate for Payer: United Healthcare Medicare |
$105.56
|
| Rate for Payer: WINHealth Partners Commercial |
$178.36
|
| Rate for Payer: Wise Provider Network Commercial |
$172.90
|
|
|
HC EXC SKIN MALIG 1.1-2 CM REMAINDR BODY
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
5101162201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.24
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.75
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.54
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$105.96
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$111.54
|
| Rate for Payer: United Healthcare Commercial |
$147.03
|
| Rate for Payer: United Healthcare Medicare |
$111.54
|
| Rate for Payer: WINHealth Partners Commercial |
$160.55
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
|
HC EXC SKIN MALIG 1.1-2 CM REMAINDR BODY
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
5101162201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Aetna of WY Medicare |
$111.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.24
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.75
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.02
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$93.12
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.02
|
| Rate for Payer: United Healthcare Commercial |
$147.03
|
| Rate for Payer: United Healthcare Medicare |
$98.02
|
| Rate for Payer: WINHealth Partners Commercial |
$165.62
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
|
HC EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
5101160201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.56
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.18
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.26
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$100.95
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$106.26
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$106.26
|
| Rate for Payer: WINHealth Partners Commercial |
$152.95
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
HC EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
5101160201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.71 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$106.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.56
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.18
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.38
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$88.71
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$93.38
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$93.38
|
| Rate for Payer: WINHealth Partners Commercial |
$157.78
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
HC EXC SKIN MALIG 2.1-3 CM FACE,FACIAL
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
5101164301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.63 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$218.88
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.19
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.24
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$125.63
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$132.24
|
| Rate for Payer: United Healthcare Commercial |
$198.36
|
| Rate for Payer: United Healthcare Medicare |
$132.24
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC EXC SKIN MALIG 2.1-3 CM FACE,FACIAL
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
5101164301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$223.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$218.88
|
| Rate for Payer: Altius Commercial |
$218.88
|
| Rate for Payer: Beech Street Commercial |
$223.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.19
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$221.16
|
| Rate for Payer: Cigna of WY Commercial |
$223.44
|
| Rate for Payer: Entrust Commercial |
$216.60
|
| Rate for Payer: First Choice Health Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.48
|
| Rate for Payer: HealthUtah PPO |
$228.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$221.16
|
| Rate for Payer: Multiplan Medicare/VA |
$142.96
|
| Rate for Payer: One Health Plan of WY PPO |
$223.44
|
| Rate for Payer: PacificSource Commercial |
$205.20
|
| Rate for Payer: PHCS PPO |
$223.44
|
| Rate for Payer: Three Rivers PPO |
$171.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.48
|
| Rate for Payer: United Healthcare Commercial |
$198.36
|
| Rate for Payer: United Healthcare Medicare |
$150.48
|
| Rate for Payer: WINHealth Partners Commercial |
$216.60
|
| Rate for Payer: Wise Provider Network Commercial |
$216.60
|
|
|
HC EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
5101160301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.89 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$128.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$186.24
|
| Rate for Payer: Altius Commercial |
$186.24
|
| Rate for Payer: Beech Street Commercial |
$190.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.27
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Entrust Commercial |
$184.30
|
| Rate for Payer: First Choice Health Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.52
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$106.89
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$190.12
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$112.52
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$112.52
|
| Rate for Payer: WINHealth Partners Commercial |
$190.12
|
| Rate for Payer: Wise Provider Network Commercial |
$184.30
|
|
|
HC EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
5101160301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.64 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$186.24
|
| Rate for Payer: Altius Commercial |
$186.24
|
| Rate for Payer: Beech Street Commercial |
$190.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.27
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: Entrust Commercial |
$184.30
|
| Rate for Payer: First Choice Health Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.04
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$121.64
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$190.12
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$128.04
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$128.04
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
| Rate for Payer: Wise Provider Network Commercial |
$184.30
|
|
|
HC EXC SKIN MALIG 3.1-4 CM REMAINDR BODY
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
5101162401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.69 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Aetna of WY Medicare |
$157.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$229.44
|
| Rate for Payer: Altius Commercial |
$229.44
|
| Rate for Payer: Beech Street Commercial |
$234.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.22
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: Entrust Commercial |
$227.05
|
| Rate for Payer: First Choice Health Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.62
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$131.69
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$234.22
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$138.62
|
| Rate for Payer: United Healthcare Commercial |
$207.93
|
| Rate for Payer: United Healthcare Medicare |
$138.62
|
| Rate for Payer: WINHealth Partners Commercial |
$234.22
|
| Rate for Payer: Wise Provider Network Commercial |
$227.05
|
|
|
HC EXC SKIN MALIG 3.1-4 CM REMAINDR BODY
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
5101162401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$229.44
|
| Rate for Payer: Altius Commercial |
$229.44
|
| Rate for Payer: Beech Street Commercial |
$234.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.22
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: Entrust Commercial |
$227.05
|
| Rate for Payer: First Choice Health Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.74
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$149.85
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$234.22
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$157.74
|
| Rate for Payer: United Healthcare Commercial |
$207.93
|
| Rate for Payer: United Healthcare Medicare |
$157.74
|
| Rate for Payer: WINHealth Partners Commercial |
$227.05
|
| Rate for Payer: Wise Provider Network Commercial |
$227.05
|
|
|
HC EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
5101160401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.36 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$208.74
|
| Rate for Payer: Aetna of WY Medicare |
$140.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$204.48
|
| Rate for Payer: Altius Commercial |
$204.48
|
| Rate for Payer: Beech Street Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.87
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$206.61
|
| Rate for Payer: Cigna of WY Commercial |
$208.74
|
| Rate for Payer: Entrust Commercial |
$202.35
|
| Rate for Payer: First Choice Health Commercial |
$202.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$202.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.54
|
| Rate for Payer: HealthUtah PPO |
$213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$206.61
|
| Rate for Payer: Multiplan Medicare/VA |
$117.36
|
| Rate for Payer: One Health Plan of WY PPO |
$208.74
|
| Rate for Payer: PacificSource Commercial |
$191.70
|
| Rate for Payer: PHCS PPO |
$208.74
|
| Rate for Payer: Three Rivers PPO |
$159.75
|
| Rate for Payer: TriWest Veterans Administration |
$123.54
|
| Rate for Payer: United Healthcare Commercial |
$185.31
|
| Rate for Payer: United Healthcare Medicare |
$123.54
|
| Rate for Payer: WINHealth Partners Commercial |
$208.74
|
| Rate for Payer: Wise Provider Network Commercial |
$202.35
|
|
|
HC EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
5101160401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.55 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$208.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$204.48
|
| Rate for Payer: Altius Commercial |
$204.48
|
| Rate for Payer: Beech Street Commercial |
$208.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$174.87
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$206.61
|
| Rate for Payer: Cigna of WY Commercial |
$208.74
|
| Rate for Payer: Entrust Commercial |
$202.35
|
| Rate for Payer: First Choice Health Commercial |
$202.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$202.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.58
|
| Rate for Payer: HealthUtah PPO |
$213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$206.61
|
| Rate for Payer: Multiplan Medicare/VA |
$133.55
|
| Rate for Payer: One Health Plan of WY PPO |
$208.74
|
| Rate for Payer: PacificSource Commercial |
$191.70
|
| Rate for Payer: PHCS PPO |
$208.74
|
| Rate for Payer: Three Rivers PPO |
$159.75
|
| Rate for Payer: TriWest Veterans Administration |
$140.58
|
| Rate for Payer: United Healthcare Commercial |
$185.31
|
| Rate for Payer: United Healthcare Medicare |
$140.58
|
| Rate for Payer: WINHealth Partners Commercial |
$202.35
|
| Rate for Payer: Wise Provider Network Commercial |
$202.35
|
|
|
HC EXC SKIN MALIG >4 CM TRUNK,ARM,LEG
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
5101160601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.39 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$311.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$305.28
|
| Rate for Payer: Altius Commercial |
$305.28
|
| Rate for Payer: Beech Street Commercial |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.08
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$308.46
|
| Rate for Payer: Cigna of WY Commercial |
$311.64
|
| Rate for Payer: Entrust Commercial |
$302.10
|
| Rate for Payer: First Choice Health Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.88
|
| Rate for Payer: HealthUtah PPO |
$318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$308.46
|
| Rate for Payer: Multiplan Medicare/VA |
$199.39
|
| Rate for Payer: One Health Plan of WY PPO |
$311.64
|
| Rate for Payer: PacificSource Commercial |
$286.20
|
| Rate for Payer: PHCS PPO |
$311.64
|
| Rate for Payer: Three Rivers PPO |
$238.50
|
| Rate for Payer: TriWest Veterans Administration |
$209.88
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$209.88
|
| Rate for Payer: WINHealth Partners Commercial |
$302.10
|
| Rate for Payer: Wise Provider Network Commercial |
$302.10
|
|
|
HC EXC SKIN MALIG >4 CM TRUNK,ARM,LEG
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
5101160601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.22 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$311.64
|
| Rate for Payer: Aetna of WY Medicare |
$209.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$305.28
|
| Rate for Payer: Altius Commercial |
$305.28
|
| Rate for Payer: Beech Street Commercial |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$261.08
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$308.46
|
| Rate for Payer: Cigna of WY Commercial |
$311.64
|
| Rate for Payer: Entrust Commercial |
$302.10
|
| Rate for Payer: First Choice Health Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$302.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.44
|
| Rate for Payer: HealthUtah PPO |
$318.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$308.46
|
| Rate for Payer: Multiplan Medicare/VA |
$175.22
|
| Rate for Payer: One Health Plan of WY PPO |
$311.64
|
| Rate for Payer: PacificSource Commercial |
$286.20
|
| Rate for Payer: PHCS PPO |
$311.64
|
| Rate for Payer: Three Rivers PPO |
$238.50
|
| Rate for Payer: TriWest Veterans Administration |
$184.44
|
| Rate for Payer: United Healthcare Commercial |
$276.66
|
| Rate for Payer: United Healthcare Medicare |
$184.44
|
| Rate for Payer: WINHealth Partners Commercial |
$311.64
|
| Rate for Payer: Wise Provider Network Commercial |
$302.10
|
|
|
HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
5102307601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$611.06 |
| Max. Negotiated Rate |
$1,109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,086.82
|
| Rate for Payer: Aetna of WY Medicare |
$731.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,064.64
|
| Rate for Payer: Altius Commercial |
$1,064.64
|
| Rate for Payer: Beech Street Commercial |
$1,086.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$910.49
|
| Rate for Payer: Cash Price |
$776.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,075.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,086.82
|
| Rate for Payer: Entrust Commercial |
$1,053.55
|
| Rate for Payer: First Choice Health Commercial |
$1,053.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,053.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$643.22
|
| Rate for Payer: HealthUtah PPO |
$1,109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,075.73
|
| Rate for Payer: Multiplan Medicare/VA |
$611.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,086.82
|
| Rate for Payer: PacificSource Commercial |
$998.10
|
| Rate for Payer: PHCS PPO |
$1,086.82
|
| Rate for Payer: Three Rivers PPO |
$831.75
|
| Rate for Payer: TriWest Veterans Administration |
$643.22
|
| Rate for Payer: United Healthcare Commercial |
$964.83
|
| Rate for Payer: United Healthcare Medicare |
$643.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,086.82
|
| Rate for Payer: Wise Provider Network Commercial |
$1,053.55
|
|
|
HC EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
5102307601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$695.34 |
| Max. Negotiated Rate |
$1,109.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,086.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,064.64
|
| Rate for Payer: Altius Commercial |
$1,064.64
|
| Rate for Payer: Beech Street Commercial |
$1,086.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$910.49
|
| Rate for Payer: Cash Price |
$776.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,075.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,086.82
|
| Rate for Payer: Entrust Commercial |
$1,053.55
|
| Rate for Payer: First Choice Health Commercial |
$1,053.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,053.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$731.94
|
| Rate for Payer: HealthUtah PPO |
$1,109.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,075.73
|
| Rate for Payer: Multiplan Medicare/VA |
$695.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,086.82
|
| Rate for Payer: PacificSource Commercial |
$998.10
|
| Rate for Payer: PHCS PPO |
$1,086.82
|
| Rate for Payer: Three Rivers PPO |
$831.75
|
| Rate for Payer: TriWest Veterans Administration |
$731.94
|
| Rate for Payer: United Healthcare Commercial |
$964.83
|
| Rate for Payer: United Healthcare Medicare |
$731.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1,053.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,053.55
|
|
|
HC EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
5102155501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$987.52 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,543.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,512.00
|
| Rate for Payer: Altius Commercial |
$1,512.00
|
| Rate for Payer: Beech Street Commercial |
$1,543.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,293.08
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,527.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,543.50
|
| Rate for Payer: Entrust Commercial |
$1,496.25
|
| Rate for Payer: First Choice Health Commercial |
$1,496.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,496.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,039.50
|
| Rate for Payer: HealthUtah PPO |
$1,575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,527.75
|
| Rate for Payer: Multiplan Medicare/VA |
$987.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,543.50
|
| Rate for Payer: PacificSource Commercial |
$1,417.50
|
| Rate for Payer: PHCS PPO |
$1,543.50
|
| Rate for Payer: Three Rivers PPO |
$1,181.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,039.50
|
| Rate for Payer: United Healthcare Commercial |
$1,370.25
|
| Rate for Payer: United Healthcare Medicare |
$1,039.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,496.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,496.25
|
|
|
HC EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
HCPCS 21555
|
| Hospital Charge Code |
5102155501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$867.82 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,543.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,039.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,512.00
|
| Rate for Payer: Altius Commercial |
$1,512.00
|
| Rate for Payer: Beech Street Commercial |
$1,543.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,293.08
|
| Rate for Payer: Cash Price |
$1,102.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,527.75
|
| Rate for Payer: Cigna of WY Commercial |
$1,543.50
|
| Rate for Payer: Entrust Commercial |
$1,496.25
|
| Rate for Payer: First Choice Health Commercial |
$1,496.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,496.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$913.50
|
| Rate for Payer: HealthUtah PPO |
$1,575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,527.75
|
| Rate for Payer: Multiplan Medicare/VA |
$867.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,543.50
|
| Rate for Payer: PacificSource Commercial |
$1,417.50
|
| Rate for Payer: PHCS PPO |
$1,543.50
|
| Rate for Payer: Three Rivers PPO |
$1,181.25
|
| Rate for Payer: TriWest Veterans Administration |
$913.50
|
| Rate for Payer: United Healthcare Commercial |
$1,370.25
|
| Rate for Payer: United Healthcare Medicare |
$913.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,543.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,496.25
|
|
|
HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
5102307301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$392.31 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$697.76
|
| Rate for Payer: Aetna of WY Medicare |
$469.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$683.52
|
| Rate for Payer: Altius Commercial |
$683.52
|
| Rate for Payer: Beech Street Commercial |
$697.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$584.55
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$690.64
|
| Rate for Payer: Cigna of WY Commercial |
$697.76
|
| Rate for Payer: Entrust Commercial |
$676.40
|
| Rate for Payer: First Choice Health Commercial |
$676.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$676.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$412.96
|
| Rate for Payer: HealthUtah PPO |
$712.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$690.64
|
| Rate for Payer: Multiplan Medicare/VA |
$392.31
|
| Rate for Payer: One Health Plan of WY PPO |
$697.76
|
| Rate for Payer: PacificSource Commercial |
$640.80
|
| Rate for Payer: PHCS PPO |
$697.76
|
| Rate for Payer: Three Rivers PPO |
$534.00
|
| Rate for Payer: TriWest Veterans Administration |
$412.96
|
| Rate for Payer: United Healthcare Commercial |
$619.44
|
| Rate for Payer: United Healthcare Medicare |
$412.96
|
| Rate for Payer: WINHealth Partners Commercial |
$697.76
|
| Rate for Payer: Wise Provider Network Commercial |
$676.40
|
|
|
HC EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
5102307301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$446.42 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$697.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$683.52
|
| Rate for Payer: Altius Commercial |
$683.52
|
| Rate for Payer: Beech Street Commercial |
$697.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$584.55
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$690.64
|
| Rate for Payer: Cigna of WY Commercial |
$697.76
|
| Rate for Payer: Entrust Commercial |
$676.40
|
| Rate for Payer: First Choice Health Commercial |
$676.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$676.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$469.92
|
| Rate for Payer: HealthUtah PPO |
$712.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$690.64
|
| Rate for Payer: Multiplan Medicare/VA |
$446.42
|
| Rate for Payer: One Health Plan of WY PPO |
$697.76
|
| Rate for Payer: PacificSource Commercial |
$640.80
|
| Rate for Payer: PHCS PPO |
$697.76
|
| Rate for Payer: Three Rivers PPO |
$534.00
|
| Rate for Payer: TriWest Veterans Administration |
$469.92
|
| Rate for Payer: United Healthcare Commercial |
$619.44
|
| Rate for Payer: United Healthcare Medicare |
$469.92
|
| Rate for Payer: WINHealth Partners Commercial |
$676.40
|
| Rate for Payer: Wise Provider Network Commercial |
$676.40
|
|
|
HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 24071
|
| Hospital Charge Code |
5102407101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.62
|
| Rate for Payer: Aetna of WY Medicare |
$111.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.24
|
| Rate for Payer: Altius Commercial |
$162.24
|
| Rate for Payer: Beech Street Commercial |
$165.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.75
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.93
|
| Rate for Payer: Cigna of WY Commercial |
$165.62
|
| Rate for Payer: Entrust Commercial |
$160.55
|
| Rate for Payer: First Choice Health Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.02
|
| Rate for Payer: HealthUtah PPO |
$169.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.93
|
| Rate for Payer: Multiplan Medicare/VA |
$93.12
|
| Rate for Payer: One Health Plan of WY PPO |
$165.62
|
| Rate for Payer: PacificSource Commercial |
$152.10
|
| Rate for Payer: PHCS PPO |
$165.62
|
| Rate for Payer: Three Rivers PPO |
$126.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.02
|
| Rate for Payer: United Healthcare Commercial |
$147.03
|
| Rate for Payer: United Healthcare Medicare |
$98.02
|
| Rate for Payer: WINHealth Partners Commercial |
$165.62
|
| Rate for Payer: Wise Provider Network Commercial |
$160.55
|
|
