|
SUTURE 3-0 PROLENE 18" PC-5
|
Facility
OP
|
$56.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
SUTURE 3-0 PROLENE 18" PC-5
|
Facility
IP
|
$56.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
SUTURE 3-0 VICRYL PS2
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
SUTURE 3-0 VICRYL PS2
|
Facility
IP
|
$45.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
SUTURE CHROMIC GUT 3-0 27" FS-
|
Facility
OP
|
$33.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
SUTURE CHROMIC GUT 3-0 27" FS-
|
Facility
IP
|
$33.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
SUTURE REMOVAL KIT A49
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
SUTURE REMOVAL KIT A49
|
Facility
IP
|
$5.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
SWABSTICKS
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
SWABSTICKS
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
SWING BED
|
Facility
OP
|
$1,365.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: AETNA Commercial |
$1,296.75
|
| Rate for Payer: AETNA Medicare |
$1,228.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,296.75
|
| Rate for Payer: BCBS Healthlink |
$1,228.50
|
| Rate for Payer: BCBS HMK CHIP |
$1,228.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,228.50
|
| Rate for Payer: BCBS POS |
$1,296.75
|
| Rate for Payer: BCBS Traditional |
$1,365.00
|
| Rate for Payer: CASH_PRICE |
$1,092.00
|
| Rate for Payer: CIGNA Commercial |
$1,296.75
|
| Rate for Payer: CIGNA Medicare |
$1,228.50
|
| Rate for Payer: HUMANA Commercial |
$1,228.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,255.80
|
| Rate for Payer: MEDICARE Medicare |
$955.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,296.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,324.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,296.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,296.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,160.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,092.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,092.00
|
|
|
SWING BED
|
Facility
IP
|
$1,365.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,365.00 |
| Rate for Payer: AETNA Commercial |
$1,296.75
|
| Rate for Payer: AETNA Medicare |
$1,228.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,296.75
|
| Rate for Payer: BCBS Healthlink |
$1,228.50
|
| Rate for Payer: BCBS HMK CHIP |
$1,228.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,228.50
|
| Rate for Payer: BCBS POS |
$1,296.75
|
| Rate for Payer: BCBS Traditional |
$1,365.00
|
| Rate for Payer: CASH_PRICE |
$1,092.00
|
| Rate for Payer: CIGNA Commercial |
$1,296.75
|
| Rate for Payer: CIGNA Medicare |
$1,228.50
|
| Rate for Payer: HUMANA Commercial |
$1,228.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,255.80
|
| Rate for Payer: MEDICARE Medicare |
$955.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,296.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,324.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,296.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,296.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,160.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,092.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,092.00
|
|
|
T3, FREE (010389)
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
T3, FREE (010389)
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
T3, REVERSE (070104)
|
Facility
OP
|
$516.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$361.20 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: AETNA Commercial |
$490.20
|
| Rate for Payer: AETNA Medicare |
$464.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$490.20
|
| Rate for Payer: BCBS Healthlink |
$464.40
|
| Rate for Payer: BCBS HMK CHIP |
$464.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$464.40
|
| Rate for Payer: BCBS POS |
$490.20
|
| Rate for Payer: BCBS Traditional |
$516.00
|
| Rate for Payer: CASH_PRICE |
$412.80
|
| Rate for Payer: CIGNA Commercial |
$490.20
|
| Rate for Payer: CIGNA Medicare |
$464.40
|
| Rate for Payer: HUMANA Commercial |
$464.40
|
| Rate for Payer: MEDICAID Medicaid |
$474.72
|
| Rate for Payer: MEDICARE Medicare |
$361.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$490.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$500.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$490.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$490.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$438.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$412.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$412.80
|
|
|
T3, REVERSE (070104)
|
Facility
IP
|
$516.00
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$361.20 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: AETNA Commercial |
$490.20
|
| Rate for Payer: AETNA Medicare |
$464.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$490.20
|
| Rate for Payer: BCBS Healthlink |
$464.40
|
| Rate for Payer: BCBS HMK CHIP |
$464.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$464.40
|
| Rate for Payer: BCBS POS |
$490.20
|
| Rate for Payer: BCBS Traditional |
$516.00
|
| Rate for Payer: CASH_PRICE |
$412.80
|
| Rate for Payer: CIGNA Commercial |
$490.20
|
| Rate for Payer: CIGNA Medicare |
$464.40
|
| Rate for Payer: HUMANA Commercial |
$464.40
|
| Rate for Payer: MEDICAID Medicaid |
$474.72
|
| Rate for Payer: MEDICARE Medicare |
$361.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$490.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$500.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$490.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$490.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$438.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$412.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$412.80
|
|
|
T3, TOTAL (002188)
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
T3, TOTAL (002188)
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
T3, UPTAKE (001156)
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
T3, UPTAKE (001156)
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
T4, FREE
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: AETNA Commercial |
$118.75
|
| Rate for Payer: AETNA Medicare |
$112.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$118.75
|
| Rate for Payer: BCBS Healthlink |
$112.50
|
| Rate for Payer: BCBS HMK CHIP |
$112.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$112.50
|
| Rate for Payer: BCBS POS |
$118.75
|
| Rate for Payer: BCBS Traditional |
$125.00
|
| Rate for Payer: CASH_PRICE |
$100.00
|
| Rate for Payer: CIGNA Commercial |
$118.75
|
| Rate for Payer: CIGNA Medicare |
$112.50
|
| Rate for Payer: HUMANA Commercial |
$112.50
|
| Rate for Payer: MEDICAID Medicaid |
$115.00
|
| Rate for Payer: MEDICARE Medicare |
$87.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$118.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$121.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$118.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$118.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$106.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.00
|
|
|
T4, FREE
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: AETNA Commercial |
$118.75
|
| Rate for Payer: AETNA Medicare |
$112.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$118.75
|
| Rate for Payer: BCBS Healthlink |
$112.50
|
| Rate for Payer: BCBS HMK CHIP |
$112.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$112.50
|
| Rate for Payer: BCBS POS |
$118.75
|
| Rate for Payer: BCBS Traditional |
$125.00
|
| Rate for Payer: CASH_PRICE |
$100.00
|
| Rate for Payer: CIGNA Commercial |
$118.75
|
| Rate for Payer: CIGNA Medicare |
$112.50
|
| Rate for Payer: HUMANA Commercial |
$112.50
|
| Rate for Payer: MEDICAID Medicaid |
$115.00
|
| Rate for Payer: MEDICARE Medicare |
$87.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$118.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$121.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$118.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$118.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$106.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.00
|
|
|
T4, TOTAL (001149)
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
T4, TOTAL (001149)
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
TACROLIMUS (700248)
|
Facility
OP
|
$158.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: AETNA Commercial |
$150.10
|
| Rate for Payer: AETNA Medicare |
$142.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$150.10
|
| Rate for Payer: BCBS Healthlink |
$142.20
|
| Rate for Payer: BCBS HMK CHIP |
$142.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$142.20
|
| Rate for Payer: BCBS POS |
$150.10
|
| Rate for Payer: BCBS Traditional |
$158.00
|
| Rate for Payer: CASH_PRICE |
$126.40
|
| Rate for Payer: CIGNA Commercial |
$150.10
|
| Rate for Payer: CIGNA Medicare |
$142.20
|
| Rate for Payer: HUMANA Commercial |
$142.20
|
| Rate for Payer: MEDICAID Medicaid |
$145.36
|
| Rate for Payer: MEDICARE Medicare |
$110.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$150.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$153.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$150.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$150.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$134.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$126.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$126.40
|
|
