|
MATERNITY PAD
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
MAXORB ALGINATE DRESSING MSC94
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
MAXORB ALGINATE DRESSING MSC94
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
MEASLES AB, IGG (096560)
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
MEASLES AB, IGG (096560)
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
MECLIZINE TAB [12.5 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MECLIZINE TAB [12.5 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MEDICARE ANNUAL WELLNESS, INITIAL VISIT
|
Facility
OP
|
$372.00
|
|
|
Service Code
|
CPT G0438
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: AETNA Commercial |
$353.40
|
| Rate for Payer: AETNA Medicare |
$334.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$353.40
|
| Rate for Payer: BCBS Healthlink |
$334.80
|
| Rate for Payer: BCBS HMK CHIP |
$334.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$334.80
|
| Rate for Payer: BCBS POS |
$353.40
|
| Rate for Payer: BCBS Traditional |
$372.00
|
| Rate for Payer: CASH_PRICE |
$297.60
|
| Rate for Payer: CIGNA Commercial |
$353.40
|
| Rate for Payer: CIGNA Medicare |
$334.80
|
| Rate for Payer: HUMANA Commercial |
$334.80
|
| Rate for Payer: MEDICAID Medicaid |
$342.24
|
| Rate for Payer: MEDICARE Medicare |
$260.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$353.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$360.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$353.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$353.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$316.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$297.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$297.60
|
|
|
MEDICARE ANNUAL WELLNESS, INITIAL VISIT
|
Facility
IP
|
$372.00
|
|
|
Service Code
|
CPT G0438
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: AETNA Commercial |
$353.40
|
| Rate for Payer: AETNA Medicare |
$334.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$353.40
|
| Rate for Payer: BCBS Healthlink |
$334.80
|
| Rate for Payer: BCBS HMK CHIP |
$334.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$334.80
|
| Rate for Payer: BCBS POS |
$353.40
|
| Rate for Payer: BCBS Traditional |
$372.00
|
| Rate for Payer: CASH_PRICE |
$297.60
|
| Rate for Payer: CIGNA Commercial |
$353.40
|
| Rate for Payer: CIGNA Medicare |
$334.80
|
| Rate for Payer: HUMANA Commercial |
$334.80
|
| Rate for Payer: MEDICAID Medicaid |
$342.24
|
| Rate for Payer: MEDICARE Medicare |
$260.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$353.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$360.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$353.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$353.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$316.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$297.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$297.60
|
|
|
MEDICARE ANNUAL WELLNESS VISIT, SUBSEQ
|
Facility
IP
|
$311.00
|
|
|
Service Code
|
CPT G0439
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
MEDICARE ANNUAL WELLNESS VISIT, SUBSEQ
|
Facility
OP
|
$311.00
|
|
|
Service Code
|
CPT G0439
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
MEDICARE DISTANCE SITE TELEHEALTH/PHONE
|
Facility
OP
|
$137.00
|
|
|
Service Code
|
CPT G2025 CS
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
MEDICARE DISTANCE SITE TELEHEALTH/PHONE
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT G2025 CS
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
MEDROXYPROGESTERONE ACETATE 150MG INJ
|
Facility
IP
|
$182.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: AETNA Commercial |
$172.90
|
| Rate for Payer: AETNA Medicare |
$163.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$172.90
|
| Rate for Payer: BCBS Healthlink |
$163.80
|
| Rate for Payer: BCBS HMK CHIP |
$163.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$163.80
|
| Rate for Payer: BCBS POS |
$172.90
|
| Rate for Payer: BCBS Traditional |
$182.00
|
| Rate for Payer: CASH_PRICE |
$145.60
|
| Rate for Payer: CIGNA Commercial |
$172.90
|
| Rate for Payer: CIGNA Medicare |
$163.80
|
| Rate for Payer: HUMANA Commercial |
$163.80
|
| Rate for Payer: MEDICAID Medicaid |
$167.44
|
| Rate for Payer: MEDICARE Medicare |
$127.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$172.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$176.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$172.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$172.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$154.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$145.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$145.60
|
|
|
MEDROXYPROGESTERONE ACETATE 150MG INJ
|
Facility
OP
|
$182.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: AETNA Commercial |
$172.90
|
| Rate for Payer: AETNA Medicare |
$163.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$172.90
|
| Rate for Payer: BCBS Healthlink |
$163.80
|
| Rate for Payer: BCBS HMK CHIP |
$163.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$163.80
|
| Rate for Payer: BCBS POS |
$172.90
|
| Rate for Payer: BCBS Traditional |
$182.00
|
| Rate for Payer: CASH_PRICE |
$145.60
|
| Rate for Payer: CIGNA Commercial |
$172.90
|
| Rate for Payer: CIGNA Medicare |
$163.80
|
| Rate for Payer: HUMANA Commercial |
$163.80
|
| Rate for Payer: MEDICAID Medicaid |
$167.44
|
| Rate for Payer: MEDICARE Medicare |
$127.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$172.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$176.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$172.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$172.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$154.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$145.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$145.60
|
|
|
MEGESTROL 40 MG TABLET-NF
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MEGESTROL 40 MG TABLET-NF
|
Facility
IP
|
$8.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MELATONIN TAB [3 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MELATONIN TAB [3 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MELOXICAM 7.5 MG TABLET-NF
|
Facility
IP
|
$16.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
MELOXICAM 7.5 MG TABLET-NF
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
MEMANTINE TAB [10 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MEMANTINE TAB [10 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
MEROPENEM 1 GM INJECTION
|
Facility
OP
|
$76.80
|
|
| Hospital Charge Code |
20230110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: AETNA Commercial |
$72.96
|
| Rate for Payer: AETNA Medicare |
$69.12
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.96
|
| Rate for Payer: BCBS Healthlink |
$69.12
|
| Rate for Payer: BCBS HMK CHIP |
$69.12
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.12
|
| Rate for Payer: BCBS POS |
$72.96
|
| Rate for Payer: BCBS Traditional |
$76.80
|
| Rate for Payer: CASH_PRICE |
$61.44
|
| Rate for Payer: CIGNA Commercial |
$72.96
|
| Rate for Payer: CIGNA Medicare |
$69.12
|
| Rate for Payer: HUMANA Commercial |
$69.12
|
| Rate for Payer: MEDICAID Medicaid |
$70.66
|
| Rate for Payer: MEDICARE Medicare |
$53.76
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.96
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.96
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.96
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.28
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.44
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.44
|
|
|
MEROPENEM 1 GM INJECTION
|
Facility
IP
|
$76.80
|
|
| Hospital Charge Code |
20230110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: AETNA Commercial |
$72.96
|
| Rate for Payer: AETNA Medicare |
$69.12
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.96
|
| Rate for Payer: BCBS Healthlink |
$69.12
|
| Rate for Payer: BCBS HMK CHIP |
$69.12
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.12
|
| Rate for Payer: BCBS POS |
$72.96
|
| Rate for Payer: BCBS Traditional |
$76.80
|
| Rate for Payer: CASH_PRICE |
$61.44
|
| Rate for Payer: CIGNA Commercial |
$72.96
|
| Rate for Payer: CIGNA Medicare |
$69.12
|
| Rate for Payer: HUMANA Commercial |
$69.12
|
| Rate for Payer: MEDICAID Medicaid |
$70.66
|
| Rate for Payer: MEDICARE Medicare |
$53.76
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.96
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.96
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.96
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.28
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.44
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.44
|
|
