|
RESPIRATORY PANEL, NAD
|
Facility
OP
|
$578.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: AETNA Commercial |
$549.10
|
| Rate for Payer: AETNA Medicare |
$520.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$549.10
|
| Rate for Payer: BCBS Healthlink |
$520.20
|
| Rate for Payer: BCBS HMK CHIP |
$520.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$520.20
|
| Rate for Payer: BCBS POS |
$549.10
|
| Rate for Payer: BCBS Traditional |
$578.00
|
| Rate for Payer: CASH_PRICE |
$462.40
|
| Rate for Payer: CIGNA Commercial |
$549.10
|
| Rate for Payer: CIGNA Medicare |
$520.20
|
| Rate for Payer: HUMANA Commercial |
$520.20
|
| Rate for Payer: MEDICAID Medicaid |
$531.76
|
| Rate for Payer: MEDICARE Medicare |
$404.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$549.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$560.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$549.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$549.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$491.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$462.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$462.40
|
|
|
RESPITE CARE
|
Facility
OP
|
$420.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
RESPITE CARE
|
Facility
IP
|
$420.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
RESUSCITATOR INFANT
|
Facility
OP
|
$152.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
RESUSCITATOR INFANT
|
Facility
IP
|
$152.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
RETICULOCYTE COUNT (005280)
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
RETICULOCYTE COUNT (005280)
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
RF ABLTJ NRV NRVTG SI JT W/I 64625
|
Facility
IP
|
$4,767.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,336.90 |
| Max. Negotiated Rate |
$4,767.00 |
| Rate for Payer: AETNA Commercial |
$4,528.65
|
| Rate for Payer: AETNA Medicare |
$4,290.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4,528.65
|
| Rate for Payer: BCBS Healthlink |
$4,290.30
|
| Rate for Payer: BCBS HMK CHIP |
$4,290.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4,290.30
|
| Rate for Payer: BCBS POS |
$4,528.65
|
| Rate for Payer: BCBS Traditional |
$4,767.00
|
| Rate for Payer: CASH_PRICE |
$3,813.60
|
| Rate for Payer: CIGNA Commercial |
$4,528.65
|
| Rate for Payer: CIGNA Medicare |
$4,290.30
|
| Rate for Payer: HUMANA Commercial |
$4,290.30
|
| Rate for Payer: MEDICAID Medicaid |
$4,385.64
|
| Rate for Payer: MEDICARE Medicare |
$3,336.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4,528.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4,623.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4,528.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4,528.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4,051.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3,813.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3,813.60
|
|
|
RF ABLTJ NRV NRVTG SI JT W/I 64625
|
Facility
OP
|
$4,767.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,336.90 |
| Max. Negotiated Rate |
$4,767.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4,051.95
|
| Rate for Payer: AETNA Commercial |
$4,528.65
|
| Rate for Payer: AETNA Medicare |
$4,290.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4,528.65
|
| Rate for Payer: BCBS Healthlink |
$4,290.30
|
| Rate for Payer: BCBS HMK CHIP |
$4,290.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4,290.30
|
| Rate for Payer: BCBS POS |
$4,528.65
|
| Rate for Payer: BCBS Traditional |
$4,767.00
|
| Rate for Payer: CASH_PRICE |
$3,813.60
|
| Rate for Payer: CIGNA Commercial |
$4,528.65
|
| Rate for Payer: CIGNA Medicare |
$4,290.30
|
| Rate for Payer: HUMANA Commercial |
$4,290.30
|
| Rate for Payer: MEDICAID Medicaid |
$4,385.64
|
| Rate for Payer: MEDICARE Medicare |
$3,336.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4,528.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4,623.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4,528.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4,528.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3,813.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3,813.60
|
|
|
RHEUMATOID FACTOR (006502)
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
RHEUMATOID FACTOR (006502)
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
RH TYPE
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
RH TYPE
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
RHYTHM STRIPS
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
RHYTHM STRIPS
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
RIB BELT
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
RIB BELT
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT L0220
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
RIB BELT MALE LG
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
RIB BELT MALE LG
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
RIB BELT MALE SM
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
RIB BELT MALE SM
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
RIB BELT MALE UNIV
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
RIB BELT MALE UNIV
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
RIB BELT MALE XLG DELUXE
|
Facility
OP
|
$24.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
RIB BELT MALE XLG DELUXE
|
Facility
IP
|
$24.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
