|
UNLISTED PSYCIATRIC PRO/THERAPY
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 90899
|
| Hospital Charge Code |
8090899
|
|
Hospital Revenue Code
|
900
|
| 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 MT CHIP |
$216.00
|
| Rate for Payer: BCBS MT Closed Plan Network |
$228.00
|
| Rate for Payer: BCBS MT HealthLink |
$216.00
|
| Rate for Payer: BCBS MT Medicare |
$216.00
|
| Rate for Payer: BCBS MT POS |
$228.00
|
| Rate for Payer: BCBS MT Traditional |
$240.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cigna Medicare |
$216.00
|
| Rate for Payer: Medicaid All Medicaid |
$220.80
|
| Rate for Payer: Medicare All Medicare |
$168.00
|
| Rate for Payer: Monida Allegiance |
$228.00
|
| Rate for Payer: Monida First Choice Health |
$232.80
|
| Rate for Payer: Monida Montana Health Co-op |
$228.00
|
| Rate for Payer: Monida PacificSource |
$228.00
|
|
|
UNNA BOOT BANDAGE 3''
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
80030445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: BCBS MT CHIP |
$51.30
|
| Rate for Payer: BCBS MT Closed Plan Network |
$54.15
|
| Rate for Payer: BCBS MT HealthLink |
$51.30
|
| Rate for Payer: BCBS MT Medicare |
$51.30
|
| Rate for Payer: BCBS MT POS |
$54.15
|
| Rate for Payer: BCBS MT Traditional |
$57.00
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cigna Medicare |
$51.30
|
| Rate for Payer: Medicaid All Medicaid |
$52.44
|
| Rate for Payer: Medicare All Medicare |
$39.90
|
| Rate for Payer: Monida Allegiance |
$54.15
|
| Rate for Payer: Monida First Choice Health |
$55.29
|
| Rate for Payer: Monida Montana Health Co-op |
$54.15
|
| Rate for Payer: Monida PacificSource |
$54.15
|
|
|
UNNA BOOT BANDAGE 3''
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
80030445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: BCBS MT CHIP |
$51.30
|
| Rate for Payer: BCBS MT Closed Plan Network |
$54.15
|
| Rate for Payer: BCBS MT HealthLink |
$51.30
|
| Rate for Payer: BCBS MT Medicare |
$51.30
|
| Rate for Payer: BCBS MT POS |
$54.15
|
| Rate for Payer: BCBS MT Traditional |
$57.00
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cigna Medicare |
$51.30
|
| Rate for Payer: Medicaid All Medicaid |
$52.44
|
| Rate for Payer: Medicare All Medicare |
$39.90
|
| Rate for Payer: Monida Allegiance |
$54.15
|
| Rate for Payer: Monida First Choice Health |
$55.29
|
| Rate for Payer: Monida Montana Health Co-op |
$54.15
|
| Rate for Payer: Monida PacificSource |
$54.15
|
|
|
URETHRAL CATHETER TRAY ( STRAIGHT CATH)
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
80030068
|
|
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 MT CHIP |
$24.30
|
| Rate for Payer: BCBS MT Closed Plan Network |
$25.65
|
| Rate for Payer: BCBS MT HealthLink |
$24.30
|
| Rate for Payer: BCBS MT Medicare |
$24.30
|
| Rate for Payer: BCBS MT POS |
$25.65
|
| Rate for Payer: BCBS MT Traditional |
$27.00
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$25.65
|
| Rate for Payer: Cigna Medicare |
$24.30
|
| Rate for Payer: Medicaid All Medicaid |
$24.84
|
| Rate for Payer: Medicare All Medicare |
$18.90
|
| Rate for Payer: Monida Allegiance |
$25.65
|
| Rate for Payer: Monida First Choice Health |
$26.19
|
| Rate for Payer: Monida Montana Health Co-op |
$25.65
|
| Rate for Payer: Monida PacificSource |
$25.65
|
|
|
URETHRAL CATHETER TRAY ( STRAIGHT CATH)
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
80030068
|
|
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 MT CHIP |
$24.30
|
| Rate for Payer: BCBS MT Closed Plan Network |
$25.65
|
| Rate for Payer: BCBS MT HealthLink |
$24.30
|
| Rate for Payer: BCBS MT Medicare |
$24.30
|
| Rate for Payer: BCBS MT POS |
$25.65
|
| Rate for Payer: BCBS MT Traditional |
$27.00
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$25.65
|
| Rate for Payer: Cigna Medicare |
$24.30
|
| Rate for Payer: Medicaid All Medicaid |
$24.84
|
| Rate for Payer: Medicare All Medicare |
$18.90
|
| Rate for Payer: Monida Allegiance |
$25.65
|
| Rate for Payer: Monida First Choice Health |
$26.19
|
| Rate for Payer: Monida Montana Health Co-op |
$25.65
|
| Rate for Payer: Monida PacificSource |
$25.65
|
|
|
URETHRAL CATH KIT
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
80030430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Medicare |
$47.70
|
| Rate for Payer: BCBS MT CHIP |
$47.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$50.35
|
| Rate for Payer: BCBS MT HealthLink |
$47.70
|
| Rate for Payer: BCBS MT Medicare |
$47.70
|
| Rate for Payer: BCBS MT POS |
$50.35
|
| Rate for Payer: BCBS MT Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cigna Medicare |
$47.70
|
| Rate for Payer: Medicaid All Medicaid |
$48.76
|
| Rate for Payer: Medicare All Medicare |
$37.10
|
| Rate for Payer: Monida Allegiance |
$50.35
|
| Rate for Payer: Monida First Choice Health |
$51.41
|
| Rate for Payer: Monida Montana Health Co-op |
$50.35
|
| Rate for Payer: Monida PacificSource |
$50.35
|
|
|
URETHRAL CATH KIT
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
80030430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Medicare |
$47.70
|
| Rate for Payer: BCBS MT CHIP |
$47.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$50.35
|
| Rate for Payer: BCBS MT HealthLink |
$47.70
|
| Rate for Payer: BCBS MT Medicare |
$47.70
|
| Rate for Payer: BCBS MT POS |
$50.35
|
| Rate for Payer: BCBS MT Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cigna Medicare |
$47.70
|
| Rate for Payer: Medicaid All Medicaid |
$48.76
|
| Rate for Payer: Medicare All Medicare |
$37.10
|
| Rate for Payer: Monida Allegiance |
$50.35
|
| Rate for Payer: Monida First Choice Health |
$51.41
|
| Rate for Payer: Monida Montana Health Co-op |
$50.35
|
| Rate for Payer: Monida PacificSource |
$50.35
|
|
|
URIC ACID
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
4084550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Medicare |
$61.20
|
| Rate for Payer: BCBS MT CHIP |
$61.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$64.60
|
| Rate for Payer: BCBS MT HealthLink |
$61.20
|
| Rate for Payer: BCBS MT Medicare |
$61.20
|
| Rate for Payer: BCBS MT POS |
$64.60
|
| Rate for Payer: BCBS MT Traditional |
$68.00
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: Cigna Medicare |
$61.20
|
| Rate for Payer: Medicaid All Medicaid |
$62.56
|
| Rate for Payer: Medicare All Medicare |
$47.60
|
| Rate for Payer: Monida Allegiance |
$64.60
|
| Rate for Payer: Monida First Choice Health |
$65.96
|
| Rate for Payer: Monida Montana Health Co-op |
$64.60
|
| Rate for Payer: Monida PacificSource |
$64.60
|
|
|
URIC ACID
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
4084550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Medicare |
$61.20
|
| Rate for Payer: BCBS MT CHIP |
$61.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$64.60
|
| Rate for Payer: BCBS MT HealthLink |
$61.20
|
| Rate for Payer: BCBS MT Medicare |
$61.20
|
| Rate for Payer: BCBS MT POS |
$64.60
|
| Rate for Payer: BCBS MT Traditional |
$68.00
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: Cigna Medicare |
$61.20
|
| Rate for Payer: Medicaid All Medicaid |
$62.56
|
| Rate for Payer: Medicare All Medicare |
$47.60
|
| Rate for Payer: Monida Allegiance |
$64.60
|
| Rate for Payer: Monida First Choice Health |
$65.96
|
| Rate for Payer: Monida Montana Health Co-op |
$64.60
|
| Rate for Payer: Monida PacificSource |
$64.60
|
|
|
URINALYSIS
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
4090004
|
|
Hospital Revenue Code
|
300
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
URINALYSIS
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
4090004
|
|
Hospital Revenue Code
|
300
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
.URINALYSIS, DIPSTICK
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
4081003
|
|
Hospital Revenue Code
|
307
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
.URINALYSIS, DIPSTICK
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
4081003
|
|
Hospital Revenue Code
|
307
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
.URINALYSIS, DIPSTICK AND MICROSCOPIC
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
4081001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$62.10
|
| Rate for Payer: BCBS MT CHIP |
$62.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$65.55
|
| Rate for Payer: BCBS MT HealthLink |
$62.10
|
| Rate for Payer: BCBS MT Medicare |
$62.10
|
| Rate for Payer: BCBS MT POS |
$65.55
|
| Rate for Payer: BCBS MT Traditional |
$69.00
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$65.55
|
| Rate for Payer: Cigna Medicare |
$62.10
|
| Rate for Payer: Medicaid All Medicaid |
$63.48
|
| Rate for Payer: Medicare All Medicare |
$48.30
|
| Rate for Payer: Monida Allegiance |
$65.55
|
| Rate for Payer: Monida First Choice Health |
$66.93
|
| Rate for Payer: Monida Montana Health Co-op |
$65.55
|
| Rate for Payer: Monida PacificSource |
$65.55
|
|
|
.URINALYSIS, DIPSTICK AND MICROSCOPIC
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
4081001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$62.10
|
| Rate for Payer: BCBS MT CHIP |
$62.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$65.55
|
| Rate for Payer: BCBS MT HealthLink |
$62.10
|
| Rate for Payer: BCBS MT Medicare |
$62.10
|
| Rate for Payer: BCBS MT POS |
$65.55
|
| Rate for Payer: BCBS MT Traditional |
$69.00
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$65.55
|
| Rate for Payer: Cigna Medicare |
$62.10
|
| Rate for Payer: Medicaid All Medicaid |
$63.48
|
| Rate for Payer: Medicare All Medicare |
$48.30
|
| Rate for Payer: Monida Allegiance |
$65.55
|
| Rate for Payer: Monida First Choice Health |
$66.93
|
| Rate for Payer: Monida Montana Health Co-op |
$65.55
|
| Rate for Payer: Monida PacificSource |
$65.55
|
|
|
URINALYSIS, DIPSTICK - RVMC
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
8081003
|
|
Hospital Revenue Code
|
307
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
URINALYSIS, DIPSTICK - RVMC
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
8081003
|
|
Hospital Revenue Code
|
307
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
URINALYSIS, DIPSTICK - TWIN BRIDGES
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
8181003
|
|
Hospital Revenue Code
|
307
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
URINALYSIS, DIPSTICK - TWIN BRIDGES
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
8181003
|
|
Hospital Revenue Code
|
307
|
| 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 MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
URINALYSIS MICRO ONLY
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
4081015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
URINALYSIS MICRO ONLY
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
4081015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
URINE CULTURE (008847)
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
4087086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Medicare |
$52.20
|
| Rate for Payer: BCBS MT CHIP |
$52.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$55.10
|
| Rate for Payer: BCBS MT HealthLink |
$52.20
|
| Rate for Payer: BCBS MT Medicare |
$52.20
|
| Rate for Payer: BCBS MT POS |
$55.10
|
| Rate for Payer: BCBS MT Traditional |
$58.00
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$55.10
|
| Rate for Payer: Cigna Medicare |
$52.20
|
| Rate for Payer: Medicaid All Medicaid |
$53.36
|
| Rate for Payer: Medicare All Medicare |
$40.60
|
| Rate for Payer: Monida Allegiance |
$55.10
|
| Rate for Payer: Monida First Choice Health |
$56.26
|
| Rate for Payer: Monida Montana Health Co-op |
$55.10
|
| Rate for Payer: Monida PacificSource |
$55.10
|
|
|
URINE CULTURE (008847)
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
4087086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Medicare |
$52.20
|
| Rate for Payer: BCBS MT CHIP |
$52.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$55.10
|
| Rate for Payer: BCBS MT HealthLink |
$52.20
|
| Rate for Payer: BCBS MT Medicare |
$52.20
|
| Rate for Payer: BCBS MT POS |
$55.10
|
| Rate for Payer: BCBS MT Traditional |
$58.00
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$55.10
|
| Rate for Payer: Cigna Medicare |
$52.20
|
| Rate for Payer: Medicaid All Medicaid |
$53.36
|
| Rate for Payer: Medicare All Medicare |
$40.60
|
| Rate for Payer: Monida Allegiance |
$55.10
|
| Rate for Payer: Monida First Choice Health |
$56.26
|
| Rate for Payer: Monida Montana Health Co-op |
$55.10
|
| Rate for Payer: Monida PacificSource |
$55.10
|
|
|
URINE STRAINERS
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
80030556
|
|
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 MT CHIP |
$11.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$12.35
|
| Rate for Payer: BCBS MT HealthLink |
$11.70
|
| Rate for Payer: BCBS MT Medicare |
$11.70
|
| Rate for Payer: BCBS MT POS |
$12.35
|
| Rate for Payer: BCBS MT Traditional |
$13.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna Commercial |
$12.35
|
| Rate for Payer: Cigna Medicare |
$11.70
|
| Rate for Payer: Medicaid All Medicaid |
$11.96
|
| Rate for Payer: Medicare All Medicare |
$9.10
|
| Rate for Payer: Monida Allegiance |
$12.35
|
| Rate for Payer: Monida First Choice Health |
$12.61
|
| Rate for Payer: Monida Montana Health Co-op |
$12.35
|
| Rate for Payer: Monida PacificSource |
$12.35
|
|
|
URINE STRAINERS
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
80030556
|
|
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 MT CHIP |
$11.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$12.35
|
| Rate for Payer: BCBS MT HealthLink |
$11.70
|
| Rate for Payer: BCBS MT Medicare |
$11.70
|
| Rate for Payer: BCBS MT POS |
$12.35
|
| Rate for Payer: BCBS MT Traditional |
$13.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna Commercial |
$12.35
|
| Rate for Payer: Cigna Medicare |
$11.70
|
| Rate for Payer: Medicaid All Medicaid |
$11.96
|
| Rate for Payer: Medicare All Medicare |
$9.10
|
| Rate for Payer: Monida Allegiance |
$12.35
|
| Rate for Payer: Monida First Choice Health |
$12.61
|
| Rate for Payer: Monida Montana Health Co-op |
$12.35
|
| Rate for Payer: Monida PacificSource |
$12.35
|
|
