|
CATHETER 12FR 5CC
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
CATHETER - CL - INSERT INDWELLING
|
Facility
IP
|
$207.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
CATHETER - CL - INSERT INDWELLING
|
Facility
OP
|
$207.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
CATHETER - CL - INSERT NON-INDWELLING
|
Facility
OP
|
$193.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
CATHETER - CL - INSERT NON-INDWELLING
|
Facility
IP
|
$193.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
CATHETER COUDE 14FR 5CC
|
Facility
IP
|
$72.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
CATHETER COUDE 14FR 5CC
|
Facility
OP
|
$72.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
CATHETER - ER - INSERT INDWELLING
|
Facility
IP
|
$207.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
CATHETER - ER - INSERT INDWELLING
|
Facility
OP
|
$207.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
CATHETER - ER - INSERT NON-INDWELLING
|
Facility
IP
|
$193.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
CATHETER - ER - INSERT NON-INDWELLING
|
Facility
OP
|
$193.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
CATHETER IV INTROCAN 24G 5/8
|
Facility
IP
|
$25.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
CATHETER IV INTROCAN 24G 5/8
|
Facility
OP
|
$25.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
CATHETER SELF 14FR
|
Facility
OP
|
$72.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
CATHETER SELF 14FR
|
Facility
IP
|
$72.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
CATHETER STRAP
|
Facility
OP
|
$24.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
CATHETER STRAP
|
Facility
IP
|
$24.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
CATHETER - TR - INSERT INDWELLING
|
Facility
IP
|
$207.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
CATHETER - TR - INSERT INDWELLING
|
Facility
OP
|
$207.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: AETNA Commercial |
$196.65
|
| Rate for Payer: AETNA Medicare |
$186.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.65
|
| Rate for Payer: BCBS Healthlink |
$186.30
|
| Rate for Payer: BCBS HMK CHIP |
$186.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.30
|
| Rate for Payer: BCBS POS |
$196.65
|
| Rate for Payer: BCBS Traditional |
$207.00
|
| Rate for Payer: CASH_PRICE |
$165.60
|
| Rate for Payer: CIGNA Commercial |
$196.65
|
| Rate for Payer: CIGNA Medicare |
$186.30
|
| Rate for Payer: HUMANA Commercial |
$186.30
|
| Rate for Payer: MEDICAID Medicaid |
$190.44
|
| Rate for Payer: MEDICARE Medicare |
$144.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.60
|
|
|
CATHETER - TR - INSERT NON-INDWELLING
|
Facility
IP
|
$193.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
CATHETER - TR - INSERT NON-INDWELLING
|
Facility
OP
|
$193.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
CAUTERY HIGHTEMP LOOPTIP
|
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: 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
|
|
|
CAUTERY HIGHTEMP LOOPTIP
|
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
|
|
|
CBC W/ MANUAL DIFF
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: AETNA Commercial |
$83.60
|
| Rate for Payer: AETNA Medicare |
$79.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$83.60
|
| Rate for Payer: BCBS Healthlink |
$79.20
|
| Rate for Payer: BCBS HMK CHIP |
$79.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$79.20
|
| Rate for Payer: BCBS POS |
$83.60
|
| Rate for Payer: BCBS Traditional |
$88.00
|
| Rate for Payer: CASH_PRICE |
$70.40
|
| Rate for Payer: CIGNA Commercial |
$83.60
|
| Rate for Payer: CIGNA Medicare |
$79.20
|
| Rate for Payer: HUMANA Commercial |
$79.20
|
| Rate for Payer: MEDICAID Medicaid |
$80.96
|
| Rate for Payer: MEDICARE Medicare |
$61.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$83.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$85.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$83.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$83.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$74.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$70.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$70.40
|
|
|
CBC W/ MANUAL DIFF
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: BCBS HMK CHIP |
$79.20
|
| Rate for Payer: AETNA Commercial |
$83.60
|
| Rate for Payer: AETNA Medicare |
$79.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$83.60
|
| Rate for Payer: BCBS Healthlink |
$79.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$79.20
|
| Rate for Payer: BCBS POS |
$83.60
|
| Rate for Payer: BCBS Traditional |
$88.00
|
| Rate for Payer: CASH_PRICE |
$70.40
|
| Rate for Payer: CIGNA Commercial |
$83.60
|
| Rate for Payer: CIGNA Medicare |
$79.20
|
| Rate for Payer: HUMANA Commercial |
$79.20
|
| Rate for Payer: MEDICAID Medicaid |
$80.96
|
| Rate for Payer: MEDICARE Medicare |
$61.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$83.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$85.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$83.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$83.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$74.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$70.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$70.40
|
|
