|
PHOSPHORUS
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: AETNA Commercial |
$62.70
|
| Rate for Payer: AETNA Medicare |
$59.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$62.70
|
| Rate for Payer: BCBS Healthlink |
$59.40
|
| Rate for Payer: BCBS HMK CHIP |
$59.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$59.40
|
| Rate for Payer: BCBS POS |
$62.70
|
| Rate for Payer: BCBS Traditional |
$66.00
|
| Rate for Payer: CASH_PRICE |
$52.80
|
| Rate for Payer: CIGNA Commercial |
$62.70
|
| Rate for Payer: CIGNA Medicare |
$59.40
|
| Rate for Payer: HUMANA Commercial |
$59.40
|
| Rate for Payer: MEDICAID Medicaid |
$60.72
|
| Rate for Payer: MEDICARE Medicare |
$46.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$62.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$62.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$62.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.80
|
|
|
PHOSPHORUS
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: AETNA Commercial |
$62.70
|
| Rate for Payer: AETNA Medicare |
$59.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$62.70
|
| Rate for Payer: BCBS Healthlink |
$59.40
|
| Rate for Payer: BCBS HMK CHIP |
$59.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$59.40
|
| Rate for Payer: BCBS POS |
$62.70
|
| Rate for Payer: BCBS Traditional |
$66.00
|
| Rate for Payer: CASH_PRICE |
$52.80
|
| Rate for Payer: CIGNA Commercial |
$62.70
|
| Rate for Payer: CIGNA Medicare |
$59.40
|
| Rate for Payer: HUMANA Commercial |
$59.40
|
| Rate for Payer: MEDICAID Medicaid |
$60.72
|
| Rate for Payer: MEDICARE Medicare |
$46.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$62.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$62.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$62.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.80
|
|
|
PHYTONADIONE INJ [10 MG/ML]
|
Facility
IP
|
$195.00
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: AETNA Commercial |
$185.25
|
| Rate for Payer: AETNA Medicare |
$175.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$185.25
|
| Rate for Payer: BCBS Healthlink |
$175.50
|
| Rate for Payer: BCBS HMK CHIP |
$175.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$175.50
|
| Rate for Payer: BCBS POS |
$185.25
|
| Rate for Payer: BCBS Traditional |
$195.00
|
| Rate for Payer: CASH_PRICE |
$156.00
|
| Rate for Payer: CIGNA Commercial |
$185.25
|
| Rate for Payer: CIGNA Medicare |
$175.50
|
| Rate for Payer: HUMANA Commercial |
$175.50
|
| Rate for Payer: MEDICAID Medicaid |
$179.40
|
| Rate for Payer: MEDICARE Medicare |
$136.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$185.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$189.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$185.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$185.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$165.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.00
|
|
|
PHYTONADIONE INJ [10 MG/ML]
|
Facility
OP
|
$195.00
|
|
|
Service Code
|
CPT J3430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: AETNA Commercial |
$185.25
|
| Rate for Payer: AETNA Medicare |
$175.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$185.25
|
| Rate for Payer: BCBS Healthlink |
$175.50
|
| Rate for Payer: BCBS HMK CHIP |
$175.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$175.50
|
| Rate for Payer: BCBS POS |
$185.25
|
| Rate for Payer: BCBS Traditional |
$195.00
|
| Rate for Payer: CASH_PRICE |
$156.00
|
| Rate for Payer: CIGNA Commercial |
$185.25
|
| Rate for Payer: CIGNA Medicare |
$175.50
|
| Rate for Payer: HUMANA Commercial |
$175.50
|
| Rate for Payer: MEDICAID Medicaid |
$179.40
|
| Rate for Payer: MEDICARE Medicare |
$136.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$185.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$189.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$185.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$185.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$165.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.00
|
|
|
PLAIN PACKING STRIPS 1/4IN
|
Facility
IP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
PLAIN PACKING STRIPS 1/4IN
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
PLATELET COUNT, BLOOD
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
PLATELET COUNT, BLOOD
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
PNEUMOCOCCAL<5YRS PCV13
|
Facility
IP
|
$701.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$490.70 |
| Max. Negotiated Rate |
$701.00 |
| Rate for Payer: AETNA Commercial |
$665.95
|
| Rate for Payer: AETNA Medicare |
$630.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$665.95
|
| Rate for Payer: BCBS Healthlink |
$630.90
|
| Rate for Payer: BCBS HMK CHIP |
$630.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$630.90
|
| Rate for Payer: BCBS POS |
$665.95
|
| Rate for Payer: BCBS Traditional |
$701.00
|
| Rate for Payer: CASH_PRICE |
$560.80
|
| Rate for Payer: CIGNA Commercial |
$665.95
|
| Rate for Payer: CIGNA Medicare |
$630.90
|
| Rate for Payer: HUMANA Commercial |
$630.90
|
| Rate for Payer: MEDICAID Medicaid |
$644.92
|
| Rate for Payer: MEDICARE Medicare |
$490.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$665.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$679.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$665.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$665.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$595.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$560.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$560.80
|
|
|
PNEUMOCOCCAL<5YRS PCV13
|
Facility
OP
|
$701.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$490.70 |
| Max. Negotiated Rate |
$701.00 |
| Rate for Payer: AETNA Commercial |
$665.95
|
| Rate for Payer: AETNA Medicare |
$630.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$665.95
|
| Rate for Payer: BCBS Healthlink |
$630.90
|
| Rate for Payer: BCBS HMK CHIP |
$630.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$630.90
|
| Rate for Payer: BCBS POS |
$665.95
|
| Rate for Payer: BCBS Traditional |
$701.00
|
| Rate for Payer: CASH_PRICE |
$560.80
|
| Rate for Payer: CIGNA Commercial |
$665.95
|
| Rate for Payer: CIGNA Medicare |
$630.90
|
| Rate for Payer: HUMANA Commercial |
$630.90
|
| Rate for Payer: MEDICAID Medicaid |
$644.92
|
| Rate for Payer: MEDICARE Medicare |
$490.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$665.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$679.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$665.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$665.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$595.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$560.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$560.80
|
|
|
PODDUS BOOT LG
|
Facility
OP
|
$58.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
PODDUS BOOT LG
|
Facility
IP
|
$58.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
PODDUS BOOT XLG
|
Facility
IP
|
$46.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$43.70
|
| Rate for Payer: AETNA Commercial |
$43.70
|
| Rate for Payer: AETNA Medicare |
$41.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$43.70
|
| Rate for Payer: BCBS Healthlink |
$41.40
|
| Rate for Payer: BCBS HMK CHIP |
$41.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$41.40
|
| Rate for Payer: BCBS POS |
$43.70
|
| Rate for Payer: BCBS Traditional |
$46.00
|
| Rate for Payer: CASH_PRICE |
$36.80
|
| Rate for Payer: CIGNA Commercial |
$43.70
|
| Rate for Payer: CIGNA Medicare |
$41.40
|
| Rate for Payer: HUMANA Commercial |
$41.40
|
| Rate for Payer: MEDICAID Medicaid |
$42.32
|
| Rate for Payer: MEDICARE Medicare |
$32.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$44.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$43.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$43.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.80
|
|
|
PODDUS BOOT XLG
|
Facility
OP
|
$46.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: AETNA Commercial |
$43.70
|
| Rate for Payer: AETNA Medicare |
$41.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$43.70
|
| Rate for Payer: BCBS Healthlink |
$41.40
|
| Rate for Payer: BCBS HMK CHIP |
$41.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$41.40
|
| Rate for Payer: BCBS POS |
$43.70
|
| Rate for Payer: BCBS Traditional |
$46.00
|
| Rate for Payer: CASH_PRICE |
$36.80
|
| Rate for Payer: CIGNA Commercial |
$43.70
|
| Rate for Payer: CIGNA Medicare |
$41.40
|
| Rate for Payer: HUMANA Commercial |
$41.40
|
| Rate for Payer: MEDICAID Medicaid |
$42.32
|
| Rate for Payer: MEDICARE Medicare |
$32.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$43.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$44.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$43.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$43.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.80
|
|
|
POLYETHYLENE GLYCOL POWD [17 GM]
|
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
|
|
|
POLYETHYLENE GLYCOL POWD [17 GM]
|
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
|
|
|
POSEY BED ALARM
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
POSEY BED ALARM
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
POSEY CHAIR ALARM
|
Facility
OP
|
$61.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
POSEY CHAIR ALARM
|
Facility
IP
|
$61.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
POSTVASECTOMY SPERM EVALUATION
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
POSTVASECTOMY SPERM EVALUATION
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
POTASSIUM
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
POTASSIUM
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
POTASSIUM CHLORIDE INJ 30 ML MDV
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
