|
CBC W/O 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: 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/O 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
|
|
|
CCP AB, IGG/IGA (164914)
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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 CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
CCP AB, IGG/IGA (164914)
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
CD3 (096834)
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
CD3 (096834)
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
CD4 (505008)
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
CD4 (505008)
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
C DIFF TOXIN GENE, NAA (183988)
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: BCBS HMK CHIP |
$181.80
|
| Rate for Payer: AETNA Commercial |
$191.90
|
| Rate for Payer: AETNA Medicare |
$181.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$191.90
|
| Rate for Payer: BCBS Healthlink |
$181.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$181.80
|
| Rate for Payer: BCBS POS |
$191.90
|
| Rate for Payer: BCBS Traditional |
$202.00
|
| Rate for Payer: CASH_PRICE |
$161.60
|
| Rate for Payer: CIGNA Commercial |
$191.90
|
| Rate for Payer: CIGNA Medicare |
$181.80
|
| Rate for Payer: HUMANA Commercial |
$181.80
|
| Rate for Payer: MEDICAID Medicaid |
$185.84
|
| Rate for Payer: MEDICARE Medicare |
$141.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$191.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$195.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$191.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$191.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$171.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$161.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$161.60
|
|
|
C DIFF TOXIN GENE, NAA (183988)
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: AETNA Commercial |
$191.90
|
| Rate for Payer: AETNA Medicare |
$181.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$191.90
|
| Rate for Payer: BCBS Healthlink |
$181.80
|
| Rate for Payer: BCBS HMK CHIP |
$181.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$181.80
|
| Rate for Payer: BCBS POS |
$191.90
|
| Rate for Payer: BCBS Traditional |
$202.00
|
| Rate for Payer: CASH_PRICE |
$161.60
|
| Rate for Payer: CIGNA Commercial |
$191.90
|
| Rate for Payer: CIGNA Medicare |
$181.80
|
| Rate for Payer: HUMANA Commercial |
$181.80
|
| Rate for Payer: MEDICAID Medicaid |
$185.84
|
| Rate for Payer: MEDICARE Medicare |
$141.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$191.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$195.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$191.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$191.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$171.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$161.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$161.60
|
|
|
C DIFF TOXINS A & B, EIA (086207)
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
C DIFF TOXINS A & B, EIA (086207)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
CEFAZOLIN INJ [1GM]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
CEFAZOLIN INJ [1GM]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
CEFAZOLIN INJ (2GM)
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
20230428
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
CEFAZOLIN INJ (2GM)
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
20230428
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
CEFDINIR ORAL SUSP 125MG/5ML
|
Facility
IP
|
$171.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: AETNA Commercial |
$162.45
|
| Rate for Payer: AETNA Medicare |
$153.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$162.45
|
| Rate for Payer: BCBS Healthlink |
$153.90
|
| Rate for Payer: BCBS HMK CHIP |
$153.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$153.90
|
| Rate for Payer: BCBS POS |
$162.45
|
| Rate for Payer: BCBS Traditional |
$171.00
|
| Rate for Payer: CASH_PRICE |
$136.80
|
| Rate for Payer: CIGNA Commercial |
$162.45
|
| Rate for Payer: CIGNA Medicare |
$153.90
|
| Rate for Payer: HUMANA Commercial |
$153.90
|
| Rate for Payer: MEDICAID Medicaid |
$157.32
|
| Rate for Payer: MEDICARE Medicare |
$119.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$162.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$165.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$162.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$162.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$136.80
|
|
|
CEFDINIR ORAL SUSP 125MG/5ML
|
Facility
OP
|
$171.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: AETNA Commercial |
$162.45
|
| Rate for Payer: AETNA Medicare |
$153.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$162.45
|
| Rate for Payer: BCBS Healthlink |
$153.90
|
| Rate for Payer: BCBS HMK CHIP |
$153.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$153.90
|
| Rate for Payer: BCBS POS |
$162.45
|
| Rate for Payer: BCBS Traditional |
$171.00
|
| Rate for Payer: CASH_PRICE |
$136.80
|
| Rate for Payer: CIGNA Commercial |
$162.45
|
| Rate for Payer: CIGNA Medicare |
$153.90
|
| Rate for Payer: HUMANA Commercial |
$153.90
|
| Rate for Payer: MEDICAID Medicaid |
$157.32
|
| Rate for Payer: MEDICARE Medicare |
$119.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$162.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$165.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$162.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$162.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$136.80
|
|
|
CEFDINIR ORAL SUSP 250MG/5ML
|
Facility
IP
|
$334.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$233.80 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: BCBS HMK CHIP |
$300.60
|
| Rate for Payer: AETNA Commercial |
$317.30
|
| Rate for Payer: AETNA Medicare |
$300.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$317.30
|
| Rate for Payer: BCBS Healthlink |
$300.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$300.60
|
| Rate for Payer: BCBS POS |
$317.30
|
| Rate for Payer: BCBS Traditional |
$334.00
|
| Rate for Payer: CASH_PRICE |
$267.20
|
| Rate for Payer: CIGNA Commercial |
$317.30
|
| Rate for Payer: CIGNA Medicare |
$300.60
|
| Rate for Payer: HUMANA Commercial |
$300.60
|
| Rate for Payer: MEDICAID Medicaid |
$307.28
|
| Rate for Payer: MEDICARE Medicare |
$233.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$317.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$317.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$317.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$267.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$267.20
|
|
|
CEFDINIR ORAL SUSP 250MG/5ML
|
Facility
OP
|
$334.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$233.80 |
| Max. Negotiated Rate |
$334.00 |
| Rate for Payer: AETNA Commercial |
$317.30
|
| Rate for Payer: AETNA Medicare |
$300.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$317.30
|
| Rate for Payer: BCBS Healthlink |
$300.60
|
| Rate for Payer: BCBS HMK CHIP |
$300.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$300.60
|
| Rate for Payer: BCBS POS |
$317.30
|
| Rate for Payer: BCBS Traditional |
$334.00
|
| Rate for Payer: CASH_PRICE |
$267.20
|
| Rate for Payer: CIGNA Commercial |
$317.30
|
| Rate for Payer: CIGNA Medicare |
$300.60
|
| Rate for Payer: HUMANA Commercial |
$300.60
|
| Rate for Payer: MEDICAID Medicaid |
$307.28
|
| Rate for Payer: MEDICARE Medicare |
$233.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$317.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$317.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$317.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$267.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$267.20
|
|
|
CEFEPIME 1GM INJ
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| 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 CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
CEFEPIME 1GM INJ
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT J0692
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| 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 CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
cefTRIAXone 1 GM /NS IVPB : 1GM/100ML
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
cefTRIAXone 1 GM /NS IVPB : 1GM/100ML
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
cefTRIAXone 2 GM /NS IVPB : 2GM/100mL
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
