|
HC ALLERGEN SPEC IGE - ALLERGEN PORK IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003T3
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN PORK IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003T3
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN POTATO IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003AZ
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN POTATO IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003AZ
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN POTATO, SWEET IGE
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003U3
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$45.44
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.31
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$41.14
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.31
|
| Rate for Payer: United Healthcare Commercial |
$67.80
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
| Rate for Payer: WINHealth Partners Commercial |
$67.45
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN POTATO, SWEET IGE
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003U3
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$46.86
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.47
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$38.45
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$40.47
|
| Rate for Payer: United Healthcare Commercial |
$67.80
|
| Rate for Payer: United Healthcare Medicare |
$40.47
|
| Rate for Payer: WINHealth Partners Commercial |
$69.58
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RADISH IGE
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003BF
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$46.86
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.47
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$38.45
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$40.47
|
| Rate for Payer: United Healthcare Commercial |
$67.80
|
| Rate for Payer: United Healthcare Medicare |
$40.47
|
| Rate for Payer: WINHealth Partners Commercial |
$69.58
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RADISH IGE
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003BF
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$45.44
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.31
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$41.14
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.31
|
| Rate for Payer: United Healthcare Commercial |
$67.80
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
| Rate for Payer: WINHealth Partners Commercial |
$67.45
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RAGWEED, SHORT/COMMON IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003Z3
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RAGWEED, SHORT/COMMON IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003Z3
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RAGWEED, WESTERN IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003A4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RAGWEED, WESTERN IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003A4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RASPBERRY IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003B4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RASPBERRY IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003B4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RAT URINE IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003RR
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RAT URINE IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003RR
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RICE IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003I4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RICE IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003I4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RYE GRASS, CULTIVATED IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003J4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RYE GRASS, CULTIVATED IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003J4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RYE IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003K4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN RYE IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003K4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN SAGEBRUSH, COMMON IGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003BK
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$74.24
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.76
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$67.22
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$70.76
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$70.76
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN SAGEBRUSH, COMMON IGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003BK
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.81 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$76.56
|
| Rate for Payer: Altius Commercial |
$111.36
|
| Rate for Payer: Beech Street Commercial |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$112.52
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: Entrust Commercial |
$110.20
|
| Rate for Payer: First Choice Health Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.12
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$62.81
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$113.68
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$66.12
|
| Rate for Payer: United Healthcare Commercial |
$110.78
|
| Rate for Payer: United Healthcare Medicare |
$66.12
|
| Rate for Payer: WINHealth Partners Commercial |
$113.68
|
| Rate for Payer: Wise Provider Network Commercial |
$110.20
|
|
|
HC ALLERGEN SPEC IGE - ALLERGEN SALMON IGE
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30286003N4
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Aetna of WY Medicare |
$45.44
|
| Rate for Payer: Altius Commercial |
$68.16
|
| Rate for Payer: Beech Street Commercial |
$69.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: Entrust Commercial |
$67.45
|
| Rate for Payer: First Choice Health Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.31
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: Multiplan Medicare/VA |
$41.14
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$69.58
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.31
|
| Rate for Payer: United Healthcare Commercial |
$67.80
|
| Rate for Payer: United Healthcare Medicare |
$43.31
|
| Rate for Payer: WINHealth Partners Commercial |
$67.45
|
| Rate for Payer: Wise Provider Network Commercial |
$67.45
|
|
