|
WARFARIN TAB [2 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
WARFARIN TAB [2 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
WARFARIN TAB [5 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
WARFARIN TAB [5 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
WELCOME TO MEDICARE EXAM
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: AETNA Commercial |
$342.00
|
| Rate for Payer: AETNA Medicare |
$324.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$342.00
|
| Rate for Payer: BCBS Healthlink |
$324.00
|
| Rate for Payer: BCBS HMK CHIP |
$324.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$324.00
|
| Rate for Payer: BCBS POS |
$342.00
|
| Rate for Payer: BCBS Traditional |
$360.00
|
| Rate for Payer: CASH_PRICE |
$288.00
|
| Rate for Payer: CIGNA Commercial |
$342.00
|
| Rate for Payer: CIGNA Medicare |
$324.00
|
| Rate for Payer: HUMANA Commercial |
$324.00
|
| Rate for Payer: MEDICAID Medicaid |
$331.20
|
| Rate for Payer: MEDICARE Medicare |
$252.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$342.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$349.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$342.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$342.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$306.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$288.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$288.00
|
|
|
WELCOME TO MEDICARE EXAM
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: AETNA Commercial |
$342.00
|
| Rate for Payer: AETNA Medicare |
$324.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$342.00
|
| Rate for Payer: BCBS Healthlink |
$324.00
|
| Rate for Payer: BCBS HMK CHIP |
$324.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$324.00
|
| Rate for Payer: BCBS POS |
$342.00
|
| Rate for Payer: BCBS Traditional |
$360.00
|
| Rate for Payer: CASH_PRICE |
$288.00
|
| Rate for Payer: CIGNA Commercial |
$342.00
|
| Rate for Payer: CIGNA Medicare |
$324.00
|
| Rate for Payer: HUMANA Commercial |
$324.00
|
| Rate for Payer: MEDICAID Medicaid |
$331.20
|
| Rate for Payer: MEDICARE Medicare |
$252.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$342.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$349.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$342.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$342.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$306.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$288.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$288.00
|
|
|
WET MOUNT, VAGINAL
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: AETNA Commercial |
$74.10
|
| Rate for Payer: AETNA Medicare |
$70.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$74.10
|
| Rate for Payer: BCBS Healthlink |
$70.20
|
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$70.20
|
| Rate for Payer: BCBS POS |
$74.10
|
| Rate for Payer: BCBS Traditional |
$78.00
|
| Rate for Payer: CASH_PRICE |
$62.40
|
| Rate for Payer: CIGNA Commercial |
$74.10
|
| Rate for Payer: CIGNA Medicare |
$70.20
|
| Rate for Payer: HUMANA Commercial |
$70.20
|
| Rate for Payer: MEDICAID Medicaid |
$71.76
|
| Rate for Payer: MEDICARE Medicare |
$54.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$74.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$75.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$74.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$74.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$66.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$62.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$62.40
|
|
|
WET MOUNT, VAGINAL
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: AETNA Commercial |
$74.10
|
| Rate for Payer: AETNA Medicare |
$70.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$74.10
|
| Rate for Payer: BCBS Healthlink |
$70.20
|
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$70.20
|
| Rate for Payer: BCBS POS |
$74.10
|
| Rate for Payer: BCBS Traditional |
$78.00
|
| Rate for Payer: CASH_PRICE |
$62.40
|
| Rate for Payer: CIGNA Commercial |
$74.10
|
| Rate for Payer: CIGNA Medicare |
$70.20
|
| Rate for Payer: HUMANA Commercial |
$70.20
|
| Rate for Payer: MEDICAID Medicaid |
$71.76
|
| Rate for Payer: MEDICARE Medicare |
$54.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$74.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$75.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$74.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$74.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$66.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$62.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$62.40
|
|
|
WHITE BLOOD CELL COUNT, BLOOD
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
WHITE BLOOD CELL COUNT, BLOOD
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
WIPES
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
WIPES
|
Facility
IP
|
$16.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
WOUND WASH
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
WOUND WASH
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
WRIST BRACE ELASTIC SM
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
WRIST BRACE ELASTIC SM
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
WRIST/FOREARM SPLINT ELASTIC L
|
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: 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
|
|
|
WRIST/FOREARM SPLINT ELASTIC L
|
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
|
|
|
WRIST & FOREARM SUPP LT/MED
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
WRIST & FOREARM SUPP LT/MED
|
Facility
IP
|
$34.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
WRIST & FOREARM SUPP LT/SM
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
WRIST & FOREARM SUPP LT/SM
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
WRIST & FOREARM SUPP LT XLG
|
Facility
OP
|
$40.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: AETNA Commercial |
$38.00
|
| Rate for Payer: AETNA Medicare |
$36.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.00
|
| Rate for Payer: BCBS Healthlink |
$36.00
|
| Rate for Payer: BCBS HMK CHIP |
$36.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.00
|
| Rate for Payer: BCBS POS |
$38.00
|
| Rate for Payer: BCBS Traditional |
$40.00
|
| Rate for Payer: CASH_PRICE |
$32.00
|
| Rate for Payer: CIGNA Commercial |
$38.00
|
| Rate for Payer: CIGNA Medicare |
$36.00
|
| Rate for Payer: HUMANA Commercial |
$36.00
|
| Rate for Payer: MEDICAID Medicaid |
$36.80
|
| Rate for Payer: MEDICARE Medicare |
$28.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$38.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.00
|
|
|
WRIST & FOREARM SUPP LT XLG
|
Facility
IP
|
$40.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: AETNA Commercial |
$38.00
|
| Rate for Payer: AETNA Medicare |
$36.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.00
|
| Rate for Payer: BCBS Healthlink |
$36.00
|
| Rate for Payer: BCBS HMK CHIP |
$36.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.00
|
| Rate for Payer: BCBS POS |
$38.00
|
| Rate for Payer: BCBS Traditional |
$40.00
|
| Rate for Payer: CASH_PRICE |
$32.00
|
| Rate for Payer: CIGNA Commercial |
$38.00
|
| Rate for Payer: CIGNA Medicare |
$36.00
|
| Rate for Payer: HUMANA Commercial |
$36.00
|
| Rate for Payer: MEDICAID Medicaid |
$36.80
|
| Rate for Payer: MEDICARE Medicare |
$28.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$38.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.00
|
|
|
WRIST & FOREARM SUPPORT LT/LG
|
Facility
IP
|
$34.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
