|
HC PRO EXC SKIN BENIG <0.5 CM FACE,FACIAL
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
9831144001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$89.38 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$403.76
|
| Rate for Payer: Aetna of WY Medicare |
$105.15
|
| Rate for Payer: Beech Street Commercial |
$391.40
|
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$399.64
|
| Rate for Payer: Cigna of WY Commercial |
$403.76
|
| Rate for Payer: First Choice Health Commercial |
$370.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$391.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.15
|
| Rate for Payer: HealthUtah PPO |
$412.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$399.64
|
| Rate for Payer: Multiplan Medicare/VA |
$89.38
|
| Rate for Payer: One Health Plan of WY PPO |
$403.76
|
| Rate for Payer: PacificSource Commercial |
$370.80
|
| Rate for Payer: PHCS PPO |
$391.40
|
| Rate for Payer: Three Rivers PPO |
$309.00
|
| Rate for Payer: TriWest Veterans Administration |
$105.15
|
| Rate for Payer: United Healthcare Commercial |
$358.44
|
| Rate for Payer: United Healthcare Medicare |
$105.15
|
| Rate for Payer: WINHealth Partners Commercial |
$350.20
|
|
|
HC PRO EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
9831140001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$82.47
|
| Rate for Payer: Beech Street Commercial |
$308.75
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: First Choice Health Commercial |
$292.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.47
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$70.10
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$308.75
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$82.47
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$82.47
|
| Rate for Payer: WINHealth Partners Commercial |
$276.25
|
|
|
HC PRO EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 11400 NONPBBPAYER
|
| Hospital Charge Code |
9831140001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$82.47
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.47
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$70.10
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$82.47
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$82.47
|
| Rate for Payer: WINHealth Partners Commercial |
$345.10
|
|
|
HC PRO EXC SKIN BENIG 0.6-1CM FACE,FACIAL
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 11441 NONPBBPAYER
|
| Hospital Charge Code |
9831144101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.71 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$638.96
|
| Rate for Payer: Aetna of WY Medicare |
$130.25
|
| Rate for Payer: Beech Street Commercial |
$619.40
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: Cash Price |
$456.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$632.44
|
| Rate for Payer: Cigna of WY Commercial |
$638.96
|
| Rate for Payer: First Choice Health Commercial |
$586.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$619.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.25
|
| Rate for Payer: HealthUtah PPO |
$652.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$632.44
|
| Rate for Payer: Multiplan Medicare/VA |
$110.71
|
| Rate for Payer: One Health Plan of WY PPO |
$638.96
|
| Rate for Payer: PacificSource Commercial |
$586.80
|
| Rate for Payer: PHCS PPO |
$619.40
|
| Rate for Payer: Three Rivers PPO |
$489.00
|
| Rate for Payer: TriWest Veterans Administration |
$130.25
|
| Rate for Payer: United Healthcare Commercial |
$567.24
|
| Rate for Payer: United Healthcare Medicare |
$130.25
|
| Rate for Payer: WINHealth Partners Commercial |
$554.20
|
|
|
HC PRO EXC SKIN BENIG 0.6-1CM FACE,FACIAL
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
9831144101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.71 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Aetna of WY Medicare |
$130.25
|
| Rate for Payer: Beech Street Commercial |
$495.90
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.34
|
| Rate for Payer: Cigna of WY Commercial |
$511.56
|
| Rate for Payer: First Choice Health Commercial |
$469.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.25
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: Multiplan Medicare/VA |
$110.71
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$495.90
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: TriWest Veterans Administration |
$130.25
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: United Healthcare Medicare |
$130.25
|
| Rate for Payer: WINHealth Partners Commercial |
$443.70
|
|
|
HC PRO EXC SKIN BENIG 0.6-1 CM REMAINDR BODY
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
9831142101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.34 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.26
|
| Rate for Payer: Aetna of WY Medicare |
$106.28
|
| Rate for Payer: Beech Street Commercial |
$415.15
|
| Rate for Payer: Cash Price |
$305.90
|
| Rate for Payer: Cash Price |
$305.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$423.89
|
| Rate for Payer: Cigna of WY Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$393.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.28
|
| Rate for Payer: HealthUtah PPO |
$437.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$423.89
|
| Rate for Payer: Multiplan Medicare/VA |
$90.34
|
| Rate for Payer: One Health Plan of WY PPO |
$428.26
|
| Rate for Payer: PacificSource Commercial |
$393.30
|
| Rate for Payer: PHCS PPO |
$415.15
|
| Rate for Payer: Three Rivers PPO |
$327.75
|
| Rate for Payer: TriWest Veterans Administration |
$106.28
|
| Rate for Payer: United Healthcare Commercial |
$380.19
|
| Rate for Payer: United Healthcare Medicare |
$106.28
|
| Rate for Payer: WINHealth Partners Commercial |
$371.45
|
|
|
HC PRO EXC SKIN BENIG 0.6-1 CM REMAINDR BODY
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 11421 NONPBBPAYER
|
| Hospital Charge Code |
9831142101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$90.34 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$535.08
|
| Rate for Payer: Aetna of WY Medicare |
$106.28
|
| Rate for Payer: Beech Street Commercial |
$518.70
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$529.62
|
| Rate for Payer: Cigna of WY Commercial |
$535.08
|
| Rate for Payer: First Choice Health Commercial |
$491.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$518.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.28
|
| Rate for Payer: HealthUtah PPO |
$546.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$529.62
|
| Rate for Payer: Multiplan Medicare/VA |
$90.34
|
| Rate for Payer: One Health Plan of WY PPO |
$535.08
|
| Rate for Payer: PacificSource Commercial |
$491.40
|
| Rate for Payer: PHCS PPO |
$518.70
|
| Rate for Payer: Three Rivers PPO |
$409.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.28
|
| Rate for Payer: United Healthcare Commercial |
$475.02
|
| Rate for Payer: United Healthcare Medicare |
$106.28
|
| Rate for Payer: WINHealth Partners Commercial |
$464.10
|
|
|
HC PRO EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 11401 NONPBBPAYER
|
| Hospital Charge Code |
9831140101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$517.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$506.66
|
| Rate for Payer: Aetna of WY Medicare |
$103.09
|
| Rate for Payer: Beech Street Commercial |
$491.15
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$501.49
|
| Rate for Payer: Cigna of WY Commercial |
$506.66
|
| Rate for Payer: First Choice Health Commercial |
$465.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$491.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.09
|
| Rate for Payer: HealthUtah PPO |
$517.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$501.49
|
| Rate for Payer: Multiplan Medicare/VA |
$87.63
|
| Rate for Payer: One Health Plan of WY PPO |
$506.66
|
| Rate for Payer: PacificSource Commercial |
$465.30
|
| Rate for Payer: PHCS PPO |
$491.15
|
| Rate for Payer: Three Rivers PPO |
$387.75
|
| Rate for Payer: TriWest Veterans Administration |
$103.09
|
| Rate for Payer: United Healthcare Commercial |
$449.79
|
| Rate for Payer: United Healthcare Medicare |
$103.09
|
| Rate for Payer: WINHealth Partners Commercial |
$439.45
|
|
|
HC PRO EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
9831140101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$405.72
|
| Rate for Payer: Aetna of WY Medicare |
$103.09
|
| Rate for Payer: Beech Street Commercial |
$393.30
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$401.58
|
| Rate for Payer: Cigna of WY Commercial |
$405.72
|
| Rate for Payer: First Choice Health Commercial |
$372.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$393.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.09
|
| Rate for Payer: HealthUtah PPO |
$414.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$401.58
|
| Rate for Payer: Multiplan Medicare/VA |
$87.63
|
| Rate for Payer: One Health Plan of WY PPO |
$405.72
|
| Rate for Payer: PacificSource Commercial |
$372.60
|
| Rate for Payer: PHCS PPO |
$393.30
|
| Rate for Payer: Three Rivers PPO |
$310.50
|
| Rate for Payer: TriWest Veterans Administration |
$103.09
|
| Rate for Payer: United Healthcare Commercial |
$360.18
|
| Rate for Payer: United Healthcare Medicare |
$103.09
|
| Rate for Payer: WINHealth Partners Commercial |
$351.90
|
|
|
HC PRO EXC SKIN BENIG 1.1-2 CM FACE,FACIAL
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
9831144201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$579.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$567.42
|
| Rate for Payer: Aetna of WY Medicare |
$143.33
|
| Rate for Payer: Beech Street Commercial |
$550.05
|
| Rate for Payer: Cash Price |
$405.30
|
| Rate for Payer: Cash Price |
$405.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$561.63
|
| Rate for Payer: Cigna of WY Commercial |
$567.42
|
| Rate for Payer: First Choice Health Commercial |
$521.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$550.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.33
|
| Rate for Payer: HealthUtah PPO |
$579.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$561.63
|
| Rate for Payer: Multiplan Medicare/VA |
$121.83
|
| Rate for Payer: One Health Plan of WY PPO |
$567.42
|
| Rate for Payer: PacificSource Commercial |
$521.10
|
| Rate for Payer: PHCS PPO |
$550.05
|
| Rate for Payer: Three Rivers PPO |
$434.25
|
| Rate for Payer: TriWest Veterans Administration |
$143.33
|
| Rate for Payer: United Healthcare Commercial |
$503.73
|
| Rate for Payer: United Healthcare Medicare |
$143.33
|
| Rate for Payer: WINHealth Partners Commercial |
$492.15
|
|
|
HC PRO EXC SKIN BENIG 1.1-2 CM FACE,FACIAL
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 11442 NONPBBPAYER
|
| Hospital Charge Code |
9831144201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$724.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$709.52
|
| Rate for Payer: Aetna of WY Medicare |
$143.33
|
| Rate for Payer: Beech Street Commercial |
$687.80
|
| Rate for Payer: Cash Price |
$506.80
|
| Rate for Payer: Cash Price |
$506.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$702.28
|
| Rate for Payer: Cigna of WY Commercial |
$709.52
|
| Rate for Payer: First Choice Health Commercial |
$651.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$687.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.33
|
| Rate for Payer: HealthUtah PPO |
$724.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$702.28
|
| Rate for Payer: Multiplan Medicare/VA |
$121.83
|
| Rate for Payer: One Health Plan of WY PPO |
$709.52
|
| Rate for Payer: PacificSource Commercial |
$651.60
|
| Rate for Payer: PHCS PPO |
$687.80
|
| Rate for Payer: Three Rivers PPO |
$543.00
|
| Rate for Payer: TriWest Veterans Administration |
$143.33
|
| Rate for Payer: United Healthcare Commercial |
$629.88
|
| Rate for Payer: United Healthcare Medicare |
$143.33
|
| Rate for Payer: WINHealth Partners Commercial |
$615.40
|
|
|
HC PRO EXC SKIN BENIG 1.1-2 CM REMAINDR BODY
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 11422 NONPBBPAYER
|
| Hospital Charge Code |
9831142201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$112.59 |
| Max. Negotiated Rate |
$679.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$665.42
|
| Rate for Payer: Aetna of WY Medicare |
$132.46
|
| Rate for Payer: Beech Street Commercial |
$645.05
|
| Rate for Payer: Cash Price |
$475.30
|
| Rate for Payer: Cash Price |
$475.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$658.63
|
| Rate for Payer: Cigna of WY Commercial |
$665.42
|
| Rate for Payer: First Choice Health Commercial |
$611.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$645.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.46
|
| Rate for Payer: HealthUtah PPO |
$679.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$658.63
|
| Rate for Payer: Multiplan Medicare/VA |
$112.59
|
| Rate for Payer: One Health Plan of WY PPO |
$665.42
|
| Rate for Payer: PacificSource Commercial |
$611.10
|
| Rate for Payer: PHCS PPO |
$645.05
|
| Rate for Payer: Three Rivers PPO |
$509.25
|
| Rate for Payer: TriWest Veterans Administration |
$132.46
|
| Rate for Payer: United Healthcare Commercial |
$590.73
|
| Rate for Payer: United Healthcare Medicare |
$132.46
|
| Rate for Payer: WINHealth Partners Commercial |
$577.15
|
|
|
HC PRO EXC SKIN BENIG 1.1-2 CM REMAINDR BODY
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
9831142201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$112.59 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$532.14
|
| Rate for Payer: Aetna of WY Medicare |
$132.46
|
| Rate for Payer: Beech Street Commercial |
$515.85
|
| Rate for Payer: Cash Price |
$380.10
|
| Rate for Payer: Cash Price |
$380.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$526.71
|
| Rate for Payer: Cigna of WY Commercial |
$532.14
|
| Rate for Payer: First Choice Health Commercial |
$488.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$515.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.46
|
| Rate for Payer: HealthUtah PPO |
$543.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$526.71
|
| Rate for Payer: Multiplan Medicare/VA |
$112.59
|
| Rate for Payer: One Health Plan of WY PPO |
$532.14
|
| Rate for Payer: PacificSource Commercial |
$488.70
|
| Rate for Payer: PHCS PPO |
$515.85
|
| Rate for Payer: Three Rivers PPO |
$407.25
|
| Rate for Payer: TriWest Veterans Administration |
$132.46
|
| Rate for Payer: United Healthcare Commercial |
$472.41
|
| Rate for Payer: United Healthcare Medicare |
$132.46
|
| Rate for Payer: WINHealth Partners Commercial |
$461.55
|
|
|
HC PRO EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
9831140201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$447.86
|
| Rate for Payer: Aetna of WY Medicare |
$112.65
|
| Rate for Payer: Beech Street Commercial |
$434.15
|
| Rate for Payer: Cash Price |
$319.90
|
| Rate for Payer: Cash Price |
$319.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$443.29
|
| Rate for Payer: Cigna of WY Commercial |
$447.86
|
| Rate for Payer: First Choice Health Commercial |
$411.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$434.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.65
|
| Rate for Payer: HealthUtah PPO |
$457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$443.29
|
| Rate for Payer: Multiplan Medicare/VA |
$95.75
|
| Rate for Payer: One Health Plan of WY PPO |
$447.86
|
| Rate for Payer: PacificSource Commercial |
$411.30
|
| Rate for Payer: PHCS PPO |
$434.15
|
| Rate for Payer: Three Rivers PPO |
$342.75
|
| Rate for Payer: TriWest Veterans Administration |
$112.65
|
| Rate for Payer: United Healthcare Commercial |
$397.59
|
| Rate for Payer: United Healthcare Medicare |
$112.65
|
| Rate for Payer: WINHealth Partners Commercial |
$388.45
|
|
|
HC PRO EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 11402 NONPBBPAYER
|
| Hospital Charge Code |
9831140201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$559.58
|
| Rate for Payer: Aetna of WY Medicare |
$112.65
|
| Rate for Payer: Beech Street Commercial |
$542.45
|
| Rate for Payer: Cash Price |
$399.70
|
| Rate for Payer: Cash Price |
$399.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$553.87
|
| Rate for Payer: Cigna of WY Commercial |
$559.58
|
| Rate for Payer: First Choice Health Commercial |
$513.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$542.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.65
|
| Rate for Payer: HealthUtah PPO |
$571.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$553.87
|
| Rate for Payer: Multiplan Medicare/VA |
$95.75
|
| Rate for Payer: One Health Plan of WY PPO |
$559.58
|
| Rate for Payer: PacificSource Commercial |
$513.90
|
| Rate for Payer: PHCS PPO |
$542.45
|
| Rate for Payer: Three Rivers PPO |
$428.25
|
| Rate for Payer: TriWest Veterans Administration |
$112.65
|
| Rate for Payer: United Healthcare Commercial |
$496.77
|
| Rate for Payer: United Healthcare Medicare |
$112.65
|
| Rate for Payer: WINHealth Partners Commercial |
$485.35
|
|
|
HC PRO EXC SKIN BENIG 2.1-3 CM REMAINDR BODY
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 11423 NONPBBPAYER
|
| Hospital Charge Code |
9831142301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$762.44
|
| Rate for Payer: Aetna of WY Medicare |
$152.90
|
| Rate for Payer: Beech Street Commercial |
$739.10
|
| Rate for Payer: Cash Price |
$544.60
|
| Rate for Payer: Cash Price |
$544.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$754.66
|
| Rate for Payer: Cigna of WY Commercial |
$762.44
|
| Rate for Payer: First Choice Health Commercial |
$700.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$739.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.90
|
| Rate for Payer: HealthUtah PPO |
$778.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$754.66
|
| Rate for Payer: Multiplan Medicare/VA |
$129.96
|
| Rate for Payer: One Health Plan of WY PPO |
$762.44
|
| Rate for Payer: PacificSource Commercial |
$700.20
|
| Rate for Payer: PHCS PPO |
$739.10
|
| Rate for Payer: Three Rivers PPO |
$583.50
|
| Rate for Payer: TriWest Veterans Administration |
$152.90
|
| Rate for Payer: United Healthcare Commercial |
$676.86
|
| Rate for Payer: United Healthcare Medicare |
$152.90
|
| Rate for Payer: WINHealth Partners Commercial |
$661.30
|
|
|
HC PRO EXC SKIN BENIG 2.1-3 CM REMAINDR BODY
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
9831142301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$622.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$609.56
|
| Rate for Payer: Aetna of WY Medicare |
$152.90
|
| Rate for Payer: Beech Street Commercial |
$590.90
|
| Rate for Payer: Cash Price |
$435.40
|
| Rate for Payer: Cash Price |
$435.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$603.34
|
| Rate for Payer: Cigna of WY Commercial |
$609.56
|
| Rate for Payer: First Choice Health Commercial |
$559.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$590.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.90
|
| Rate for Payer: HealthUtah PPO |
$622.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$603.34
|
| Rate for Payer: Multiplan Medicare/VA |
$129.96
|
| Rate for Payer: One Health Plan of WY PPO |
$609.56
|
| Rate for Payer: PacificSource Commercial |
$559.80
|
| Rate for Payer: PHCS PPO |
$590.90
|
| Rate for Payer: Three Rivers PPO |
$466.50
|
| Rate for Payer: TriWest Veterans Administration |
$152.90
|
| Rate for Payer: United Healthcare Commercial |
$541.14
|
| Rate for Payer: United Healthcare Medicare |
$152.90
|
| Rate for Payer: WINHealth Partners Commercial |
$528.70
|
|
|
HC PRO EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
9831140301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$123.84 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$578.20
|
| Rate for Payer: Aetna of WY Medicare |
$145.70
|
| Rate for Payer: Beech Street Commercial |
$560.50
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: Cash Price |
$413.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$572.30
|
| Rate for Payer: Cigna of WY Commercial |
$578.20
|
| Rate for Payer: First Choice Health Commercial |
$531.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$560.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.70
|
| Rate for Payer: HealthUtah PPO |
$590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$572.30
|
| Rate for Payer: Multiplan Medicare/VA |
$123.84
|
| Rate for Payer: One Health Plan of WY PPO |
$578.20
|
| Rate for Payer: PacificSource Commercial |
$531.00
|
| Rate for Payer: PHCS PPO |
$560.50
|
| Rate for Payer: Three Rivers PPO |
$442.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.70
|
| Rate for Payer: United Healthcare Commercial |
$513.30
|
| Rate for Payer: United Healthcare Medicare |
$145.70
|
| Rate for Payer: WINHealth Partners Commercial |
$501.50
|
|
|
HC PRO EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 11403 NONPBBPAYER
|
| Hospital Charge Code |
9831140301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$123.84 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$723.24
|
| Rate for Payer: Aetna of WY Medicare |
$145.70
|
| Rate for Payer: Beech Street Commercial |
$701.10
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$715.86
|
| Rate for Payer: Cigna of WY Commercial |
$723.24
|
| Rate for Payer: First Choice Health Commercial |
$664.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$701.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.70
|
| Rate for Payer: HealthUtah PPO |
$738.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$715.86
|
| Rate for Payer: Multiplan Medicare/VA |
$123.84
|
| Rate for Payer: One Health Plan of WY PPO |
$723.24
|
| Rate for Payer: PacificSource Commercial |
$664.20
|
| Rate for Payer: PHCS PPO |
$701.10
|
| Rate for Payer: Three Rivers PPO |
$553.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.70
|
| Rate for Payer: United Healthcare Commercial |
$642.06
|
| Rate for Payer: United Healthcare Medicare |
$145.70
|
| Rate for Payer: WINHealth Partners Commercial |
$627.30
|
|
|
HC PRO EXC SKIN BENIG 3.1- 4 CM FACE,FACIAL
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 11444 NONPBBPAYER
|
| Hospital Charge Code |
9831144401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$185.78 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$964.32
|
| Rate for Payer: Aetna of WY Medicare |
$218.57
|
| Rate for Payer: Beech Street Commercial |
$934.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$954.48
|
| Rate for Payer: Cigna of WY Commercial |
$964.32
|
| Rate for Payer: First Choice Health Commercial |
$885.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$934.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.57
|
| Rate for Payer: HealthUtah PPO |
$984.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$954.48
|
| Rate for Payer: Multiplan Medicare/VA |
$185.78
|
| Rate for Payer: One Health Plan of WY PPO |
$964.32
|
| Rate for Payer: PacificSource Commercial |
$885.60
|
| Rate for Payer: PHCS PPO |
$934.80
|
| Rate for Payer: Three Rivers PPO |
$738.00
|
| Rate for Payer: TriWest Veterans Administration |
$218.57
|
| Rate for Payer: United Healthcare Commercial |
$856.08
|
| Rate for Payer: United Healthcare Medicare |
$218.57
|
| Rate for Payer: WINHealth Partners Commercial |
$836.40
|
|
|
HC PRO EXC SKIN BENIG 3.1- 4 CM FACE,FACIAL
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
9831144401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$185.78 |
| Max. Negotiated Rate |
$787.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$771.26
|
| Rate for Payer: Aetna of WY Medicare |
$218.57
|
| Rate for Payer: Beech Street Commercial |
$747.65
|
| Rate for Payer: Cash Price |
$550.90
|
| Rate for Payer: Cash Price |
$550.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$763.39
|
| Rate for Payer: Cigna of WY Commercial |
$771.26
|
| Rate for Payer: First Choice Health Commercial |
$708.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$747.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.57
|
| Rate for Payer: HealthUtah PPO |
$787.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$763.39
|
| Rate for Payer: Multiplan Medicare/VA |
$185.78
|
| Rate for Payer: One Health Plan of WY PPO |
$771.26
|
| Rate for Payer: PacificSource Commercial |
$708.30
|
| Rate for Payer: PHCS PPO |
$747.65
|
| Rate for Payer: Three Rivers PPO |
$590.25
|
| Rate for Payer: TriWest Veterans Administration |
$218.57
|
| Rate for Payer: United Healthcare Commercial |
$684.69
|
| Rate for Payer: United Healthcare Medicare |
$218.57
|
| Rate for Payer: WINHealth Partners Commercial |
$668.95
|
|
|
HC PRO EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 11404 NONPBBPAYER
|
| Hospital Charge Code |
9831140401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$135.79 |
| Max. Negotiated Rate |
$811.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$794.78
|
| Rate for Payer: Aetna of WY Medicare |
$159.75
|
| Rate for Payer: Beech Street Commercial |
$770.45
|
| Rate for Payer: Cash Price |
$567.70
|
| Rate for Payer: Cash Price |
$567.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$786.67
|
| Rate for Payer: Cigna of WY Commercial |
$794.78
|
| Rate for Payer: First Choice Health Commercial |
$729.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$770.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.75
|
| Rate for Payer: HealthUtah PPO |
$811.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$786.67
|
| Rate for Payer: Multiplan Medicare/VA |
$135.79
|
| Rate for Payer: One Health Plan of WY PPO |
$794.78
|
| Rate for Payer: PacificSource Commercial |
$729.90
|
| Rate for Payer: PHCS PPO |
$770.45
|
| Rate for Payer: Three Rivers PPO |
$608.25
|
| Rate for Payer: TriWest Veterans Administration |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$705.57
|
| Rate for Payer: United Healthcare Medicare |
$159.75
|
| Rate for Payer: WINHealth Partners Commercial |
$689.35
|
|
|
HC PRO EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
9831140401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$135.79 |
| Max. Negotiated Rate |
$649.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$636.02
|
| Rate for Payer: Aetna of WY Medicare |
$159.75
|
| Rate for Payer: Beech Street Commercial |
$616.55
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$629.53
|
| Rate for Payer: Cigna of WY Commercial |
$636.02
|
| Rate for Payer: First Choice Health Commercial |
$584.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$616.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.75
|
| Rate for Payer: HealthUtah PPO |
$649.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$629.53
|
| Rate for Payer: Multiplan Medicare/VA |
$135.79
|
| Rate for Payer: One Health Plan of WY PPO |
$636.02
|
| Rate for Payer: PacificSource Commercial |
$584.10
|
| Rate for Payer: PHCS PPO |
$616.55
|
| Rate for Payer: Three Rivers PPO |
$486.75
|
| Rate for Payer: TriWest Veterans Administration |
$159.75
|
| Rate for Payer: United Healthcare Commercial |
$564.63
|
| Rate for Payer: United Healthcare Medicare |
$159.75
|
| Rate for Payer: WINHealth Partners Commercial |
$551.65
|
|
|
HC PRO EXC SKIN BENIG >4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 11406 NONPBBPAYER
|
| Hospital Charge Code |
9831140601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$203.67 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,206.38
|
| Rate for Payer: Aetna of WY Medicare |
$239.61
|
| Rate for Payer: Beech Street Commercial |
$1,169.45
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,194.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,206.38
|
| Rate for Payer: First Choice Health Commercial |
$1,107.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,169.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.61
|
| Rate for Payer: HealthUtah PPO |
$1,231.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,194.07
|
| Rate for Payer: Multiplan Medicare/VA |
$203.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,206.38
|
| Rate for Payer: PacificSource Commercial |
$1,107.90
|
| Rate for Payer: PHCS PPO |
$1,169.45
|
| Rate for Payer: Three Rivers PPO |
$923.25
|
| Rate for Payer: TriWest Veterans Administration |
$239.61
|
| Rate for Payer: United Healthcare Commercial |
$1,070.97
|
| Rate for Payer: United Healthcare Medicare |
$239.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,046.35
|
|
|
HC PRO EXC SKIN BENIG >4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
9831140601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$203.67 |
| Max. Negotiated Rate |
$985.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$965.30
|
| Rate for Payer: Aetna of WY Medicare |
$239.61
|
| Rate for Payer: Beech Street Commercial |
$935.75
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$955.45
|
| Rate for Payer: Cigna of WY Commercial |
$965.30
|
| Rate for Payer: First Choice Health Commercial |
$886.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$935.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$239.61
|
| Rate for Payer: HealthUtah PPO |
$985.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$955.45
|
| Rate for Payer: Multiplan Medicare/VA |
$203.67
|
| Rate for Payer: One Health Plan of WY PPO |
$965.30
|
| Rate for Payer: PacificSource Commercial |
$886.50
|
| Rate for Payer: PHCS PPO |
$935.75
|
| Rate for Payer: Three Rivers PPO |
$738.75
|
| Rate for Payer: TriWest Veterans Administration |
$239.61
|
| Rate for Payer: United Healthcare Commercial |
$856.95
|
| Rate for Payer: United Healthcare Medicare |
$239.61
|
| Rate for Payer: WINHealth Partners Commercial |
$837.25
|
|
