|
HC PRO EXC SKIN BENIG <5MM REMAINDR BODY
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
9831142001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$322.42
|
| Rate for Payer: Aetna of WY Medicare |
$80.35
|
| Rate for Payer: Beech Street Commercial |
$312.55
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: Cash Price |
$230.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$319.13
|
| Rate for Payer: Cigna of WY Commercial |
$322.42
|
| Rate for Payer: First Choice Health Commercial |
$296.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$312.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.35
|
| Rate for Payer: HealthUtah PPO |
$329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$319.13
|
| Rate for Payer: Multiplan Medicare/VA |
$68.30
|
| Rate for Payer: One Health Plan of WY PPO |
$322.42
|
| Rate for Payer: PacificSource Commercial |
$296.10
|
| Rate for Payer: PHCS PPO |
$312.55
|
| Rate for Payer: Three Rivers PPO |
$246.75
|
| Rate for Payer: TriWest Veterans Administration |
$80.35
|
| Rate for Payer: United Healthcare Commercial |
$286.23
|
| Rate for Payer: United Healthcare Medicare |
$80.35
|
| Rate for Payer: WINHealth Partners Commercial |
$279.65
|
|
|
HC PRO EXC SKIN BENIG <5MM REMAINDR BODY
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 11420 NONPBBPAYER
|
| Hospital Charge Code |
9831142001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$402.78
|
| Rate for Payer: Aetna of WY Medicare |
$80.35
|
| Rate for Payer: Beech Street Commercial |
$390.45
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$398.67
|
| Rate for Payer: Cigna of WY Commercial |
$402.78
|
| Rate for Payer: First Choice Health Commercial |
$369.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$390.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.35
|
| Rate for Payer: HealthUtah PPO |
$411.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$398.67
|
| Rate for Payer: Multiplan Medicare/VA |
$68.30
|
| Rate for Payer: One Health Plan of WY PPO |
$402.78
|
| Rate for Payer: PacificSource Commercial |
$369.90
|
| Rate for Payer: PHCS PPO |
$390.45
|
| Rate for Payer: Three Rivers PPO |
$308.25
|
| Rate for Payer: TriWest Veterans Administration |
$80.35
|
| Rate for Payer: United Healthcare Commercial |
$357.57
|
| Rate for Payer: United Healthcare Medicare |
$80.35
|
| Rate for Payer: WINHealth Partners Commercial |
$349.35
|
|
|
HC PRO EXC SKIN MALIG <0.5 CM FACE,FACIAL
|
Professional
|
Both
|
$628.00
|
|
|
Service Code
|
HCPCS 11640 NONPBBPAYER
|
| Hospital Charge Code |
9831164001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$615.44
|
| Rate for Payer: Aetna of WY Medicare |
$122.96
|
| Rate for Payer: Beech Street Commercial |
$596.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: Cash Price |
$439.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.16
|
| Rate for Payer: Cigna of WY Commercial |
$615.44
|
| Rate for Payer: First Choice Health Commercial |
$565.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$596.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.96
|
| Rate for Payer: HealthUtah PPO |
$628.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.16
|
| Rate for Payer: Multiplan Medicare/VA |
$104.52
|
| Rate for Payer: One Health Plan of WY PPO |
$615.44
|
| Rate for Payer: PacificSource Commercial |
$565.20
|
| Rate for Payer: PHCS PPO |
$596.60
|
| Rate for Payer: Three Rivers PPO |
$471.00
|
| Rate for Payer: TriWest Veterans Administration |
$122.96
|
| Rate for Payer: United Healthcare Commercial |
$546.36
|
| Rate for Payer: United Healthcare Medicare |
$122.96
|
| Rate for Payer: WINHealth Partners Commercial |
$533.80
|
|
|
HC PRO EXC SKIN MALIG <0.5 CM FACE,FACIAL
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
9831164001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$491.96
|
| Rate for Payer: Aetna of WY Medicare |
$122.96
|
| Rate for Payer: Beech Street Commercial |
$476.90
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: Cash Price |
$351.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$486.94
|
| Rate for Payer: Cigna of WY Commercial |
$491.96
|
| Rate for Payer: First Choice Health Commercial |
$451.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$476.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.96
|
| Rate for Payer: HealthUtah PPO |
$502.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$486.94
|
| Rate for Payer: Multiplan Medicare/VA |
$104.52
|
| Rate for Payer: One Health Plan of WY PPO |
$491.96
|
| Rate for Payer: PacificSource Commercial |
$451.80
|
| Rate for Payer: PHCS PPO |
$476.90
|
| Rate for Payer: Three Rivers PPO |
$376.50
|
| Rate for Payer: TriWest Veterans Administration |
$122.96
|
| Rate for Payer: United Healthcare Commercial |
$436.74
|
| Rate for Payer: United Healthcare Medicare |
$122.96
|
| Rate for Payer: WINHealth Partners Commercial |
$426.70
|
|
|
HC PRO EXC SKIN MALIG 0.6-1CM FACE,FACIAL
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 11641 NONPBBPAYER
|
| Hospital Charge Code |
9831164101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$127.74 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$762.44
|
| Rate for Payer: Aetna of WY Medicare |
$150.28
|
| 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 |
$150.28
|
| Rate for Payer: HealthUtah PPO |
$778.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$754.66
|
| Rate for Payer: Multiplan Medicare/VA |
$127.74
|
| 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 |
$150.28
|
| Rate for Payer: United Healthcare Commercial |
$676.86
|
| Rate for Payer: United Healthcare Medicare |
$150.28
|
| Rate for Payer: WINHealth Partners Commercial |
$661.30
|
|
|
HC PRO EXC SKIN MALIG 0.6-1CM FACE,FACIAL
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
9831164101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$127.74 |
| Max. Negotiated Rate |
$622.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$609.56
|
| Rate for Payer: Aetna of WY Medicare |
$150.28
|
| 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 |
$150.28
|
| Rate for Payer: HealthUtah PPO |
$622.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$603.34
|
| Rate for Payer: Multiplan Medicare/VA |
$127.74
|
| 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 |
$150.28
|
| Rate for Payer: United Healthcare Commercial |
$541.14
|
| Rate for Payer: United Healthcare Medicare |
$150.28
|
| Rate for Payer: WINHealth Partners Commercial |
$528.70
|
|
|
HC PRO EXC SKIN MALIG 0.6-1 CM REMAINDR BODY
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 11621
|
| Hospital Charge Code |
9831162101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.52 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$583.10
|
| Rate for Payer: Aetna of WY Medicare |
$144.14
|
| Rate for Payer: Beech Street Commercial |
$565.25
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$577.15
|
| Rate for Payer: Cigna of WY Commercial |
$583.10
|
| Rate for Payer: First Choice Health Commercial |
$535.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.14
|
| Rate for Payer: HealthUtah PPO |
$595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$577.15
|
| Rate for Payer: Multiplan Medicare/VA |
$122.52
|
| Rate for Payer: One Health Plan of WY PPO |
$583.10
|
| Rate for Payer: PacificSource Commercial |
$535.50
|
| Rate for Payer: PHCS PPO |
$565.25
|
| Rate for Payer: Three Rivers PPO |
$446.25
|
| Rate for Payer: TriWest Veterans Administration |
$144.14
|
| Rate for Payer: United Healthcare Commercial |
$517.65
|
| Rate for Payer: United Healthcare Medicare |
$144.14
|
| Rate for Payer: WINHealth Partners Commercial |
$505.75
|
|
|
HC PRO EXC SKIN MALIG 0.6-1 CM REMAINDR BODY
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 11621 NONPBBPAYER
|
| Hospital Charge Code |
9831162101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.52 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$729.12
|
| Rate for Payer: Aetna of WY Medicare |
$144.14
|
| Rate for Payer: Beech Street Commercial |
$706.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$721.68
|
| Rate for Payer: Cigna of WY Commercial |
$729.12
|
| Rate for Payer: First Choice Health Commercial |
$669.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$706.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.14
|
| Rate for Payer: HealthUtah PPO |
$744.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$721.68
|
| Rate for Payer: Multiplan Medicare/VA |
$122.52
|
| Rate for Payer: One Health Plan of WY PPO |
$729.12
|
| Rate for Payer: PacificSource Commercial |
$669.60
|
| Rate for Payer: PHCS PPO |
$706.80
|
| Rate for Payer: Three Rivers PPO |
$558.00
|
| Rate for Payer: TriWest Veterans Administration |
$144.14
|
| Rate for Payer: United Healthcare Commercial |
$647.28
|
| Rate for Payer: United Healthcare Medicare |
$144.14
|
| Rate for Payer: WINHealth Partners Commercial |
$632.40
|
|
|
HC PRO EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 11601 NONPBBPAYER
|
| Hospital Charge Code |
9831160101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$726.18
|
| Rate for Payer: Aetna of WY Medicare |
$143.58
|
| Rate for Payer: Beech Street Commercial |
$703.95
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: Cash Price |
$518.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$718.77
|
| Rate for Payer: Cigna of WY Commercial |
$726.18
|
| Rate for Payer: First Choice Health Commercial |
$666.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$703.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.58
|
| Rate for Payer: HealthUtah PPO |
$741.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$718.77
|
| Rate for Payer: Multiplan Medicare/VA |
$122.04
|
| Rate for Payer: One Health Plan of WY PPO |
$726.18
|
| Rate for Payer: PacificSource Commercial |
$666.90
|
| Rate for Payer: PHCS PPO |
$703.95
|
| Rate for Payer: Three Rivers PPO |
$555.75
|
| Rate for Payer: TriWest Veterans Administration |
$143.58
|
| Rate for Payer: United Healthcare Commercial |
$644.67
|
| Rate for Payer: United Healthcare Medicare |
$143.58
|
| Rate for Payer: WINHealth Partners Commercial |
$629.85
|
|
|
HC PRO EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 11601
|
| Hospital Charge Code |
9831160101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$122.04 |
| Max. Negotiated Rate |
$593.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$581.14
|
| Rate for Payer: Aetna of WY Medicare |
$143.58
|
| Rate for Payer: Beech Street Commercial |
$563.35
|
| Rate for Payer: Cash Price |
$415.10
|
| Rate for Payer: Cash Price |
$415.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$575.21
|
| Rate for Payer: Cigna of WY Commercial |
$581.14
|
| Rate for Payer: First Choice Health Commercial |
$533.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$563.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.58
|
| Rate for Payer: HealthUtah PPO |
$593.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$575.21
|
| Rate for Payer: Multiplan Medicare/VA |
$122.04
|
| Rate for Payer: One Health Plan of WY PPO |
$581.14
|
| Rate for Payer: PacificSource Commercial |
$533.70
|
| Rate for Payer: PHCS PPO |
$563.35
|
| Rate for Payer: Three Rivers PPO |
$444.75
|
| Rate for Payer: TriWest Veterans Administration |
$143.58
|
| Rate for Payer: United Healthcare Commercial |
$515.91
|
| Rate for Payer: United Healthcare Medicare |
$143.58
|
| Rate for Payer: WINHealth Partners Commercial |
$504.05
|
|
|
HC PRO EXC SKIN MALIG 1.1-2 CM FACE,FACIAL
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 11642 NONPBBPAYER
|
| Hospital Charge Code |
9831164201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$149.22 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$890.82
|
| Rate for Payer: Aetna of WY Medicare |
$175.55
|
| Rate for Payer: Beech Street Commercial |
$863.55
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$881.73
|
| Rate for Payer: Cigna of WY Commercial |
$890.82
|
| Rate for Payer: First Choice Health Commercial |
$818.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$863.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.55
|
| Rate for Payer: HealthUtah PPO |
$909.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$881.73
|
| Rate for Payer: Multiplan Medicare/VA |
$149.22
|
| Rate for Payer: One Health Plan of WY PPO |
$890.82
|
| Rate for Payer: PacificSource Commercial |
$818.10
|
| Rate for Payer: PHCS PPO |
$863.55
|
| Rate for Payer: Three Rivers PPO |
$681.75
|
| Rate for Payer: TriWest Veterans Administration |
$175.55
|
| Rate for Payer: United Healthcare Commercial |
$790.83
|
| Rate for Payer: United Healthcare Medicare |
$175.55
|
| Rate for Payer: WINHealth Partners Commercial |
$772.65
|
|
|
HC PRO EXC SKIN MALIG 1.1-2 CM FACE,FACIAL
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 11642
|
| Hospital Charge Code |
9831164201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$149.22 |
| Max. Negotiated Rate |
$727.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$712.46
|
| Rate for Payer: Aetna of WY Medicare |
$175.55
|
| Rate for Payer: Beech Street Commercial |
$690.65
|
| Rate for Payer: Cash Price |
$508.90
|
| Rate for Payer: Cash Price |
$508.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$705.19
|
| Rate for Payer: Cigna of WY Commercial |
$712.46
|
| Rate for Payer: First Choice Health Commercial |
$654.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$690.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.55
|
| Rate for Payer: HealthUtah PPO |
$727.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$705.19
|
| Rate for Payer: Multiplan Medicare/VA |
$149.22
|
| Rate for Payer: One Health Plan of WY PPO |
$712.46
|
| Rate for Payer: PacificSource Commercial |
$654.30
|
| Rate for Payer: PHCS PPO |
$690.65
|
| Rate for Payer: Three Rivers PPO |
$545.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.55
|
| Rate for Payer: United Healthcare Commercial |
$632.49
|
| Rate for Payer: United Healthcare Medicare |
$175.55
|
| Rate for Payer: WINHealth Partners Commercial |
$617.95
|
|
|
HC PRO EXC SKIN MALIG 1.1-2 CM REMAINDR BODY
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
HCPCS 11622 NONPBBPAYER
|
| Hospital Charge Code |
9831162201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$829.08
|
| Rate for Payer: Aetna of WY Medicare |
$163.53
|
| Rate for Payer: Beech Street Commercial |
$803.70
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$820.62
|
| Rate for Payer: Cigna of WY Commercial |
$829.08
|
| Rate for Payer: First Choice Health Commercial |
$761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$803.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.53
|
| Rate for Payer: HealthUtah PPO |
$846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$820.62
|
| Rate for Payer: Multiplan Medicare/VA |
$139.00
|
| Rate for Payer: One Health Plan of WY PPO |
$829.08
|
| Rate for Payer: PacificSource Commercial |
$761.40
|
| Rate for Payer: PHCS PPO |
$803.70
|
| Rate for Payer: Three Rivers PPO |
$634.50
|
| Rate for Payer: TriWest Veterans Administration |
$163.53
|
| Rate for Payer: United Healthcare Commercial |
$736.02
|
| Rate for Payer: United Healthcare Medicare |
$163.53
|
| Rate for Payer: WINHealth Partners Commercial |
$719.10
|
|
|
HC PRO EXC SKIN MALIG 1.1-2 CM REMAINDR BODY
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
9831162201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$677.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$663.46
|
| Rate for Payer: Aetna of WY Medicare |
$163.53
|
| Rate for Payer: Beech Street Commercial |
$643.15
|
| Rate for Payer: Cash Price |
$473.90
|
| Rate for Payer: Cash Price |
$473.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$656.69
|
| Rate for Payer: Cigna of WY Commercial |
$663.46
|
| Rate for Payer: First Choice Health Commercial |
$609.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$643.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.53
|
| Rate for Payer: HealthUtah PPO |
$677.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$656.69
|
| Rate for Payer: Multiplan Medicare/VA |
$139.00
|
| Rate for Payer: One Health Plan of WY PPO |
$663.46
|
| Rate for Payer: PacificSource Commercial |
$609.30
|
| Rate for Payer: PHCS PPO |
$643.15
|
| Rate for Payer: Three Rivers PPO |
$507.75
|
| Rate for Payer: TriWest Veterans Administration |
$163.53
|
| Rate for Payer: United Healthcare Commercial |
$588.99
|
| Rate for Payer: United Healthcare Medicare |
$163.53
|
| Rate for Payer: WINHealth Partners Commercial |
$575.45
|
|
|
HC PRO EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
9831160201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$132.62 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$633.08
|
| Rate for Payer: Aetna of WY Medicare |
$156.02
|
| Rate for Payer: Beech Street Commercial |
$613.70
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$626.62
|
| Rate for Payer: Cigna of WY Commercial |
$633.08
|
| Rate for Payer: First Choice Health Commercial |
$581.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$613.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.02
|
| Rate for Payer: HealthUtah PPO |
$646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$626.62
|
| Rate for Payer: Multiplan Medicare/VA |
$132.62
|
| Rate for Payer: One Health Plan of WY PPO |
$633.08
|
| Rate for Payer: PacificSource Commercial |
$581.40
|
| Rate for Payer: PHCS PPO |
$613.70
|
| Rate for Payer: Three Rivers PPO |
$484.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.02
|
| Rate for Payer: United Healthcare Commercial |
$562.02
|
| Rate for Payer: United Healthcare Medicare |
$156.02
|
| Rate for Payer: WINHealth Partners Commercial |
$549.10
|
|
|
HC PRO EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$807.00
|
|
|
Service Code
|
HCPCS 11602 NONPBBPAYER
|
| Hospital Charge Code |
9831160201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$132.62 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$790.86
|
| Rate for Payer: Aetna of WY Medicare |
$156.02
|
| Rate for Payer: Beech Street Commercial |
$766.65
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$782.79
|
| Rate for Payer: Cigna of WY Commercial |
$790.86
|
| Rate for Payer: First Choice Health Commercial |
$726.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$766.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.02
|
| Rate for Payer: HealthUtah PPO |
$807.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$782.79
|
| Rate for Payer: Multiplan Medicare/VA |
$132.62
|
| Rate for Payer: One Health Plan of WY PPO |
$790.86
|
| Rate for Payer: PacificSource Commercial |
$726.30
|
| Rate for Payer: PHCS PPO |
$766.65
|
| Rate for Payer: Three Rivers PPO |
$605.25
|
| Rate for Payer: TriWest Veterans Administration |
$156.02
|
| Rate for Payer: United Healthcare Commercial |
$702.09
|
| Rate for Payer: United Healthcare Medicare |
$156.02
|
| Rate for Payer: WINHealth Partners Commercial |
$685.95
|
|
|
HC PRO EXC SKIN MALIG 2.1-3 CM FACE,FACIAL
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
9831164301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$185.64 |
| Max. Negotiated Rate |
$913.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$894.74
|
| Rate for Payer: Aetna of WY Medicare |
$218.40
|
| Rate for Payer: Beech Street Commercial |
$867.35
|
| Rate for Payer: Cash Price |
$639.10
|
| Rate for Payer: Cash Price |
$639.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$885.61
|
| Rate for Payer: Cigna of WY Commercial |
$894.74
|
| Rate for Payer: First Choice Health Commercial |
$821.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$867.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.40
|
| Rate for Payer: HealthUtah PPO |
$913.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$885.61
|
| Rate for Payer: Multiplan Medicare/VA |
$185.64
|
| Rate for Payer: One Health Plan of WY PPO |
$894.74
|
| Rate for Payer: PacificSource Commercial |
$821.70
|
| Rate for Payer: PHCS PPO |
$867.35
|
| Rate for Payer: Three Rivers PPO |
$684.75
|
| Rate for Payer: TriWest Veterans Administration |
$218.40
|
| Rate for Payer: United Healthcare Commercial |
$794.31
|
| Rate for Payer: United Healthcare Medicare |
$218.40
|
| Rate for Payer: WINHealth Partners Commercial |
$776.05
|
|
|
HC PRO EXC SKIN MALIG 2.1-3 CM FACE,FACIAL
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 11643 NONPBBPAYER
|
| Hospital Charge Code |
9831164301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$185.64 |
| Max. Negotiated Rate |
$1,141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,118.18
|
| Rate for Payer: Aetna of WY Medicare |
$218.40
|
| Rate for Payer: Beech Street Commercial |
$1,083.95
|
| Rate for Payer: Cash Price |
$798.70
|
| Rate for Payer: Cash Price |
$798.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,106.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,118.18
|
| Rate for Payer: First Choice Health Commercial |
$1,026.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,083.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$218.40
|
| Rate for Payer: HealthUtah PPO |
$1,141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,106.77
|
| Rate for Payer: Multiplan Medicare/VA |
$185.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1,118.18
|
| Rate for Payer: PacificSource Commercial |
$1,026.90
|
| Rate for Payer: PHCS PPO |
$1,083.95
|
| Rate for Payer: Three Rivers PPO |
$855.75
|
| Rate for Payer: TriWest Veterans Administration |
$218.40
|
| Rate for Payer: United Healthcare Commercial |
$992.67
|
| Rate for Payer: United Healthcare Medicare |
$218.40
|
| Rate for Payer: WINHealth Partners Commercial |
$969.85
|
|
|
HC PRO EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
HCPCS 11603 NONPBBPAYER
|
| Hospital Charge Code |
9831160301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$158.13 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$948.64
|
| Rate for Payer: Aetna of WY Medicare |
$186.03
|
| Rate for Payer: Beech Street Commercial |
$919.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$938.96
|
| Rate for Payer: Cigna of WY Commercial |
$948.64
|
| Rate for Payer: First Choice Health Commercial |
$871.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$919.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.03
|
| Rate for Payer: HealthUtah PPO |
$968.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$938.96
|
| Rate for Payer: Multiplan Medicare/VA |
$158.13
|
| Rate for Payer: One Health Plan of WY PPO |
$948.64
|
| Rate for Payer: PacificSource Commercial |
$871.20
|
| Rate for Payer: PHCS PPO |
$919.60
|
| Rate for Payer: Three Rivers PPO |
$726.00
|
| Rate for Payer: TriWest Veterans Administration |
$186.03
|
| Rate for Payer: United Healthcare Commercial |
$842.16
|
| Rate for Payer: United Healthcare Medicare |
$186.03
|
| Rate for Payer: WINHealth Partners Commercial |
$822.80
|
|
|
HC PRO EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
9831160301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$158.13 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$758.52
|
| Rate for Payer: Aetna of WY Medicare |
$186.03
|
| Rate for Payer: Beech Street Commercial |
$735.30
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$750.78
|
| Rate for Payer: Cigna of WY Commercial |
$758.52
|
| Rate for Payer: First Choice Health Commercial |
$696.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$735.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$186.03
|
| Rate for Payer: HealthUtah PPO |
$774.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$750.78
|
| Rate for Payer: Multiplan Medicare/VA |
$158.13
|
| Rate for Payer: One Health Plan of WY PPO |
$758.52
|
| Rate for Payer: PacificSource Commercial |
$696.60
|
| Rate for Payer: PHCS PPO |
$735.30
|
| Rate for Payer: Three Rivers PPO |
$580.50
|
| Rate for Payer: TriWest Veterans Administration |
$186.03
|
| Rate for Payer: United Healthcare Commercial |
$673.38
|
| Rate for Payer: United Healthcare Medicare |
$186.03
|
| Rate for Payer: WINHealth Partners Commercial |
$657.90
|
|
|
HC PRO EXC SKIN MALIG 3.1-4 CM FACE,FACIAL
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 11644 NONPBBPAYER
|
| Hospital Charge Code |
9831164401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$229.57 |
| Max. Negotiated Rate |
$1,417.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,388.66
|
| Rate for Payer: Aetna of WY Medicare |
$270.08
|
| Rate for Payer: Beech Street Commercial |
$1,346.15
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: Cash Price |
$991.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,374.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,388.66
|
| Rate for Payer: First Choice Health Commercial |
$1,275.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,346.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.08
|
| Rate for Payer: HealthUtah PPO |
$1,417.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,374.49
|
| Rate for Payer: Multiplan Medicare/VA |
$229.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,388.66
|
| Rate for Payer: PacificSource Commercial |
$1,275.30
|
| Rate for Payer: PHCS PPO |
$1,346.15
|
| Rate for Payer: Three Rivers PPO |
$1,062.75
|
| Rate for Payer: TriWest Veterans Administration |
$270.08
|
| Rate for Payer: United Healthcare Commercial |
$1,232.79
|
| Rate for Payer: United Healthcare Medicare |
$270.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,204.45
|
|
|
HC PRO EXC SKIN MALIG 3.1-4 CM FACE,FACIAL
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
9831164401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$229.57 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,111.32
|
| Rate for Payer: Aetna of WY Medicare |
$270.08
|
| Rate for Payer: Beech Street Commercial |
$1,077.30
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,099.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,111.32
|
| Rate for Payer: First Choice Health Commercial |
$1,020.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.08
|
| Rate for Payer: HealthUtah PPO |
$1,134.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,099.98
|
| Rate for Payer: Multiplan Medicare/VA |
$229.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1,111.32
|
| Rate for Payer: PacificSource Commercial |
$1,020.60
|
| Rate for Payer: PHCS PPO |
$1,077.30
|
| Rate for Payer: Three Rivers PPO |
$850.50
|
| Rate for Payer: TriWest Veterans Administration |
$270.08
|
| Rate for Payer: United Healthcare Commercial |
$986.58
|
| Rate for Payer: United Healthcare Medicare |
$270.08
|
| Rate for Payer: WINHealth Partners Commercial |
$963.90
|
|
|
HC PRO EXC SKIN MALIG 3.1-4 CM REMAINDR BODY
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
HCPCS 11624 NONPBBPAYER
|
| Hospital Charge Code |
9831162401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$194.11 |
| Max. Negotiated Rate |
$1,193.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,169.14
|
| Rate for Payer: Aetna of WY Medicare |
$228.37
|
| Rate for Payer: Beech Street Commercial |
$1,133.35
|
| Rate for Payer: Cash Price |
$835.10
|
| Rate for Payer: Cash Price |
$835.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,157.21
|
| Rate for Payer: Cigna of WY Commercial |
$1,169.14
|
| Rate for Payer: First Choice Health Commercial |
$1,073.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,133.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.37
|
| Rate for Payer: HealthUtah PPO |
$1,193.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,157.21
|
| Rate for Payer: Multiplan Medicare/VA |
$194.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,169.14
|
| Rate for Payer: PacificSource Commercial |
$1,073.70
|
| Rate for Payer: PHCS PPO |
$1,133.35
|
| Rate for Payer: Three Rivers PPO |
$894.75
|
| Rate for Payer: TriWest Veterans Administration |
$228.37
|
| Rate for Payer: United Healthcare Commercial |
$1,037.91
|
| Rate for Payer: United Healthcare Medicare |
$228.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1,014.05
|
|
|
HC PRO EXC SKIN MALIG 3.1-4 CM REMAINDR BODY
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
9831162401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$194.11 |
| Max. Negotiated Rate |
$954.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$934.92
|
| Rate for Payer: Aetna of WY Medicare |
$228.37
|
| Rate for Payer: Beech Street Commercial |
$906.30
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: Cash Price |
$667.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$925.38
|
| Rate for Payer: Cigna of WY Commercial |
$934.92
|
| Rate for Payer: First Choice Health Commercial |
$858.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$906.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.37
|
| Rate for Payer: HealthUtah PPO |
$954.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$925.38
|
| Rate for Payer: Multiplan Medicare/VA |
$194.11
|
| Rate for Payer: One Health Plan of WY PPO |
$934.92
|
| Rate for Payer: PacificSource Commercial |
$858.60
|
| Rate for Payer: PHCS PPO |
$906.30
|
| Rate for Payer: Three Rivers PPO |
$715.50
|
| Rate for Payer: TriWest Veterans Administration |
$228.37
|
| Rate for Payer: United Healthcare Commercial |
$829.98
|
| Rate for Payer: United Healthcare Medicare |
$228.37
|
| Rate for Payer: WINHealth Partners Commercial |
$810.90
|
|
|
HC PRO EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
9831160401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$173.69 |
| Max. Negotiated Rate |
$853.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$835.94
|
| Rate for Payer: Aetna of WY Medicare |
$204.34
|
| Rate for Payer: Beech Street Commercial |
$810.35
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$827.41
|
| Rate for Payer: Cigna of WY Commercial |
$835.94
|
| Rate for Payer: First Choice Health Commercial |
$767.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.34
|
| Rate for Payer: HealthUtah PPO |
$853.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$827.41
|
| Rate for Payer: Multiplan Medicare/VA |
$173.69
|
| Rate for Payer: One Health Plan of WY PPO |
$835.94
|
| Rate for Payer: PacificSource Commercial |
$767.70
|
| Rate for Payer: PHCS PPO |
$810.35
|
| Rate for Payer: Three Rivers PPO |
$639.75
|
| Rate for Payer: TriWest Veterans Administration |
$204.34
|
| Rate for Payer: United Healthcare Commercial |
$742.11
|
| Rate for Payer: United Healthcare Medicare |
$204.34
|
| Rate for Payer: WINHealth Partners Commercial |
$725.05
|
|
