|
HC ALLERGEN SPEC IGE - ALLERGEN CRANBERRY IGE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600372
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.90
|
| Rate for Payer: Aetna of WY Medicare |
$36.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.80
|
| Rate for Payer: Altius Commercial |
$52.80
|
| Rate for Payer: Beech Street Commercial |
$53.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.35
|
| Rate for Payer: Cigna of WY Commercial |
$53.90
|
| Rate for Payer: Entrust Commercial |
$52.25
|
| Rate for Payer: First Choice Health Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.90
|
| Rate for Payer: HealthUtah PPO |
$55.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.35
|
| Rate for Payer: Multiplan Medicare/VA |
$30.30
|
| Rate for Payer: One Health Plan of WY PPO |
$53.90
|
| Rate for Payer: PacificSource Commercial |
$49.50
|
| Rate for Payer: PHCS PPO |
$53.90
|
| Rate for Payer: Three Rivers PPO |
$41.25
|
| Rate for Payer: TriWest Veterans Administration |
$31.90
|
| Rate for Payer: United Healthcare Commercial |
$47.85
|
| Rate for Payer: United Healthcare Medicare |
$31.90
|
| Rate for Payer: WINHealth Partners Commercial |
$53.90
|
| Rate for Payer: Wise Provider Network Commercial |
$52.25
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN D FARINAE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860038U
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN D FARINAE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860038U
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN DOCKWEED, YELLOW IGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN DOCKWEED, YELLOW IGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN DOG DANDER
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860038Z
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN DOG DANDER
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860038Z
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN D PTERONYSSINUS
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860038V
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN D PTERONYSSINUS
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860038V
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN DRUG: AMOXICILLOYL IGE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003C7
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN DRUG: AMOXICILLOYL IGE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003C7
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EGG WHITE IGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860039B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EGG WHITE IGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
302860039B
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EGG, WHOLE IGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EGG, WHOLE IGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EGG YOLK IGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EGG YOLK IGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ELM TREE IGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN ELM TREE IGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600386
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EPICOCCUM PURPURASCEN IGE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EPICOCCUM PURPURASCEN IGE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EUCALYPTUS IGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.20
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$75.24
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WINHealth Partners Commercial |
$114.00
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN EUCALYPTUS IGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.12 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.60
|
| Rate for Payer: Aetna of WY Medicare |
$79.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.20
|
| Rate for Payer: Altius Commercial |
$115.20
|
| Rate for Payer: Beech Street Commercial |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.40
|
| Rate for Payer: Cigna of WY Commercial |
$117.60
|
| Rate for Payer: Entrust Commercial |
$114.00
|
| Rate for Payer: First Choice Health Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.60
|
| Rate for Payer: HealthUtah PPO |
$120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.40
|
| Rate for Payer: Multiplan Medicare/VA |
$66.12
|
| Rate for Payer: One Health Plan of WY PPO |
$117.60
|
| Rate for Payer: PacificSource Commercial |
$108.00
|
| Rate for Payer: PHCS PPO |
$117.60
|
| Rate for Payer: Three Rivers PPO |
$90.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.60
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Medicare |
$69.60
|
| Rate for Payer: WINHealth Partners Commercial |
$117.60
|
| Rate for Payer: Wise Provider Network Commercial |
$114.00
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN FESCUE, MEADOW IGE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN FESCUE, MEADOW IGE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
3028600393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
