|
SHAVE SKIN LESION 0.5 CM OR LESS
|
Facility
IP
|
$207.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
SHAVE SKIN LESION 0.5 CM OR LESS
|
Facility
OP
|
$207.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
SHAVE SKIN LESION 0.6-1CM
|
Facility
IP
|
$205.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: AETNA Commercial |
$194.75
|
| Rate for Payer: AETNA Medicare |
$184.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$194.75
|
| Rate for Payer: BCBS Healthlink |
$184.50
|
| Rate for Payer: BCBS HMK CHIP |
$184.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$184.50
|
| Rate for Payer: BCBS POS |
$194.75
|
| Rate for Payer: BCBS Traditional |
$205.00
|
| Rate for Payer: CASH_PRICE |
$164.00
|
| Rate for Payer: CIGNA Commercial |
$194.75
|
| Rate for Payer: CIGNA Medicare |
$184.50
|
| Rate for Payer: HUMANA Commercial |
$184.50
|
| Rate for Payer: MEDICAID Medicaid |
$188.60
|
| Rate for Payer: MEDICARE Medicare |
$143.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$194.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$198.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$194.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$194.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$174.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.00
|
|
|
SHAVE SKIN LESION 0.6-1CM
|
Facility
OP
|
$205.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: AETNA Commercial |
$194.75
|
| Rate for Payer: AETNA Medicare |
$184.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$194.75
|
| Rate for Payer: BCBS Healthlink |
$184.50
|
| Rate for Payer: BCBS HMK CHIP |
$184.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$184.50
|
| Rate for Payer: BCBS POS |
$194.75
|
| Rate for Payer: BCBS Traditional |
$205.00
|
| Rate for Payer: CASH_PRICE |
$164.00
|
| Rate for Payer: CIGNA Commercial |
$194.75
|
| Rate for Payer: CIGNA Medicare |
$184.50
|
| Rate for Payer: HUMANA Commercial |
$184.50
|
| Rate for Payer: MEDICAID Medicaid |
$188.60
|
| Rate for Payer: MEDICARE Medicare |
$143.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$194.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$198.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$194.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$194.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$174.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.00
|
|
|
SHAVE SKIN LESION 1.1-2.0CM
|
Facility
OP
|
$233.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
SHAVE SKIN LESION 1.1-2.0CM
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
SHAVE SKIN LESION >2.0CM
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
SHAVE SKIN LESION >2.0CM
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
SHAVE SKIN LESION >.5CM
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
SHAVE SKIN LESION >.5CM
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
.SHIGA-LIKE TOXIN
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
.SHIGA-LIKE TOXIN
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
SHOULDER IMMOB MD
|
Facility
IP
|
$28.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
SHOULDER IMMOB MD
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
SHOULDER IMMOBSM
|
Facility
IP
|
$32.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
SHOULDER IMMOBSM
|
Facility
OP
|
$32.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
SHOULDER IMMOB. XLG
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
SHOULDER IMMOB. XLG
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
SHOULDER IMMOB. XSM
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
SHOULDER IMMOB. XSM
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
SICKLE SOLUBILITY 85660
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
20230701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
SICKLE SOLUBILITY 85660
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
20230701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
SIGMOIDOSCOPY SCREENING MCR
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
CPT G0104
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
SIGMOIDOSCOPY SCREENING MCR
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT G0104
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
SILVER ANTIMICROBIAL GEL [1.5 OZ]
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: AETNA Commercial |
$97.85
|
| Rate for Payer: AETNA Medicare |
$92.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$97.85
|
| Rate for Payer: BCBS Healthlink |
$92.70
|
| Rate for Payer: BCBS HMK CHIP |
$92.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$92.70
|
| Rate for Payer: BCBS POS |
$97.85
|
| Rate for Payer: BCBS Traditional |
$103.00
|
| Rate for Payer: CASH_PRICE |
$82.40
|
| Rate for Payer: CIGNA Commercial |
$97.85
|
| Rate for Payer: CIGNA Medicare |
$92.70
|
| Rate for Payer: HUMANA Commercial |
$92.70
|
| Rate for Payer: MEDICAID Medicaid |
$94.76
|
| Rate for Payer: MEDICARE Medicare |
$72.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$97.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$99.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$97.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$97.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$87.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$82.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$82.40
|
|
