|
TSH
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
|
TSH
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
|
TSH W/ REFLEX
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
|
TSH W/ REFLEX
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
|
TTG ANTIBODY, IGA (164640)
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
TTG ANTIBODY, IGA (164640)
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
TTG ANTIBODY, IGG (164988)
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
TTG ANTIBODY, IGG (164988)
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
TUBERSOL PPD INJ [5 TU/0.1 ML]
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
TUBERSOL PPD INJ [5 TU/0.1 ML]
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
TUBING FILTER
|
Facility
OP
|
$59.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
TUBING FILTER
|
Facility
IP
|
$59.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
TUBING PRIMARY (HOSPIRA)
|
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
|
|
|
TUBING PRIMARY (HOSPIRA)
|
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
|
|
|
TUBING SECONDARY (HOSPIRA)
|
Facility
IP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
TUBING SECONDARY (HOSPIRA)
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
TUCKS MEDICATED COOLING PADS
|
Facility
OP
|
$12.45
|
|
| Hospital Charge Code |
20230803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: AETNA Commercial |
$11.83
|
| Rate for Payer: AETNA Medicare |
$11.21
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.83
|
| Rate for Payer: BCBS Healthlink |
$11.21
|
| Rate for Payer: BCBS HMK CHIP |
$11.21
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.21
|
| Rate for Payer: BCBS POS |
$11.83
|
| Rate for Payer: BCBS Traditional |
$12.45
|
| Rate for Payer: CASH_PRICE |
$9.96
|
| Rate for Payer: CIGNA Commercial |
$11.83
|
| Rate for Payer: CIGNA Medicare |
$11.21
|
| Rate for Payer: HUMANA Commercial |
$11.21
|
| Rate for Payer: MEDICAID Medicaid |
$11.45
|
| Rate for Payer: MEDICARE Medicare |
$8.71
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.83
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.83
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.83
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.58
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.96
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.96
|
|
|
TUCKS MEDICATED COOLING PADS
|
Facility
IP
|
$12.45
|
|
| Hospital Charge Code |
20230803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: AETNA Commercial |
$11.83
|
| Rate for Payer: AETNA Medicare |
$11.21
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.83
|
| Rate for Payer: BCBS Healthlink |
$11.21
|
| Rate for Payer: BCBS HMK CHIP |
$11.21
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.21
|
| Rate for Payer: BCBS POS |
$11.83
|
| Rate for Payer: BCBS Traditional |
$12.45
|
| Rate for Payer: CASH_PRICE |
$9.96
|
| Rate for Payer: CIGNA Commercial |
$11.83
|
| Rate for Payer: CIGNA Medicare |
$11.21
|
| Rate for Payer: HUMANA Commercial |
$11.21
|
| Rate for Payer: MEDICAID Medicaid |
$11.45
|
| Rate for Payer: MEDICARE Medicare |
$8.71
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.83
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.83
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.83
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.58
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.96
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.96
|
|
|
TX DISLOC JT W/O ANES W/MANIP CLO
|
Facility
OP
|
$606.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$424.20 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: AETNA Commercial |
$575.70
|
| Rate for Payer: AETNA Medicare |
$545.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$575.70
|
| Rate for Payer: BCBS Healthlink |
$545.40
|
| Rate for Payer: BCBS HMK CHIP |
$545.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$545.40
|
| Rate for Payer: BCBS POS |
$575.70
|
| Rate for Payer: BCBS Traditional |
$606.00
|
| Rate for Payer: CASH_PRICE |
$484.80
|
| Rate for Payer: CIGNA Commercial |
$575.70
|
| Rate for Payer: CIGNA Medicare |
$545.40
|
| Rate for Payer: HUMANA Commercial |
$545.40
|
| Rate for Payer: MEDICAID Medicaid |
$557.52
|
| Rate for Payer: MEDICARE Medicare |
$424.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$575.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$587.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$575.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$575.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$515.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$484.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$484.80
|
|
|
TX DISLOC JT W/O ANES W/MANIP CLO
|
Facility
IP
|
$606.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$424.20 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: AETNA Commercial |
$575.70
|
| Rate for Payer: AETNA Medicare |
$545.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$575.70
|
| Rate for Payer: BCBS Healthlink |
$545.40
|
| Rate for Payer: BCBS HMK CHIP |
$545.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$545.40
|
| Rate for Payer: BCBS POS |
$575.70
|
| Rate for Payer: BCBS Traditional |
$606.00
|
| Rate for Payer: CASH_PRICE |
$484.80
|
| Rate for Payer: CIGNA Commercial |
$575.70
|
| Rate for Payer: CIGNA Medicare |
$545.40
|
| Rate for Payer: HUMANA Commercial |
$545.40
|
| Rate for Payer: MEDICAID Medicaid |
$557.52
|
| Rate for Payer: MEDICARE Medicare |
$424.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$575.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$587.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$575.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$575.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$515.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$484.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$484.80
|
|
|
UNLISTED PSYCIATRIC PRO/THERAPY
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
UNLISTED PSYCIATRIC PRO/THERAPY
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 90899
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
UNLISTED VACCINE/TOXOID
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 90749
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AETNA Commercial |
$32.30
|
| Rate for Payer: AETNA Medicare |
$30.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$32.30
|
| Rate for Payer: BCBS Healthlink |
$30.60
|
| Rate for Payer: BCBS HMK CHIP |
$30.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$30.60
|
| Rate for Payer: BCBS POS |
$32.30
|
| Rate for Payer: BCBS Traditional |
$34.00
|
| Rate for Payer: CASH_PRICE |
$27.20
|
| Rate for Payer: CIGNA Commercial |
$32.30
|
| Rate for Payer: CIGNA Medicare |
$30.60
|
| Rate for Payer: HUMANA Commercial |
$30.60
|
| Rate for Payer: MEDICAID Medicaid |
$31.28
|
| Rate for Payer: MEDICARE Medicare |
$23.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$32.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$32.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$27.20
|
|
|
UNLISTED VACCINE/TOXOID
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT 90749
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AETNA Commercial |
$32.30
|
| Rate for Payer: AETNA Medicare |
$30.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$32.30
|
| Rate for Payer: BCBS Healthlink |
$30.60
|
| Rate for Payer: BCBS HMK CHIP |
$30.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$30.60
|
| Rate for Payer: BCBS POS |
$32.30
|
| Rate for Payer: BCBS Traditional |
$34.00
|
| Rate for Payer: CASH_PRICE |
$27.20
|
| Rate for Payer: CIGNA Commercial |
$32.30
|
| Rate for Payer: CIGNA Medicare |
$30.60
|
| Rate for Payer: HUMANA Commercial |
$30.60
|
| Rate for Payer: MEDICAID Medicaid |
$31.28
|
| Rate for Payer: MEDICARE Medicare |
$23.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$32.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$32.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$27.20
|
|
|
UNNA BOOT
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AETNA Commercial |
$256.50
|
| Rate for Payer: AETNA Medicare |
$243.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$256.50
|
| Rate for Payer: BCBS Healthlink |
$243.00
|
| Rate for Payer: BCBS HMK CHIP |
$243.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.00
|
| Rate for Payer: BCBS POS |
$256.50
|
| Rate for Payer: BCBS Traditional |
$270.00
|
| Rate for Payer: CASH_PRICE |
$216.00
|
| Rate for Payer: CIGNA Commercial |
$256.50
|
| Rate for Payer: CIGNA Medicare |
$243.00
|
| Rate for Payer: HUMANA Commercial |
$243.00
|
| Rate for Payer: MEDICAID Medicaid |
$248.40
|
| Rate for Payer: MEDICARE Medicare |
$189.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$256.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$261.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$256.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$256.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$229.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.00
|
|
