|
CO2 DETECTOR ADULT
|
Facility
IP
|
$77.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
CO2 DETECTOR ADULT
|
Facility
OP
|
$77.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
CO2 DETECTOR PED
|
Facility
OP
|
$77.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
CO2 DETECTOR PED
|
Facility
IP
|
$77.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
COBALT (071506)
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
COBALT (071506)
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
COENZYME Q10, TOTAL (120251)
|
Facility
IP
|
$116.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: BCBS HMK CHIP |
$104.40
|
| Rate for Payer: AETNA Commercial |
$110.20
|
| Rate for Payer: AETNA Medicare |
$104.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$110.20
|
| Rate for Payer: BCBS Healthlink |
$104.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$104.40
|
| Rate for Payer: BCBS POS |
$110.20
|
| Rate for Payer: BCBS Traditional |
$116.00
|
| Rate for Payer: CASH_PRICE |
$92.80
|
| Rate for Payer: CIGNA Commercial |
$110.20
|
| Rate for Payer: CIGNA Medicare |
$104.40
|
| Rate for Payer: HUMANA Commercial |
$104.40
|
| Rate for Payer: MEDICAID Medicaid |
$106.72
|
| Rate for Payer: MEDICARE Medicare |
$81.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$110.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$112.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$110.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$110.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$98.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$92.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$92.80
|
|
|
COENZYME Q10, TOTAL (120251)
|
Facility
OP
|
$116.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: AETNA Commercial |
$110.20
|
| Rate for Payer: AETNA Medicare |
$104.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$110.20
|
| Rate for Payer: BCBS Healthlink |
$104.40
|
| Rate for Payer: BCBS HMK CHIP |
$104.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$104.40
|
| Rate for Payer: BCBS POS |
$110.20
|
| Rate for Payer: BCBS Traditional |
$116.00
|
| Rate for Payer: CASH_PRICE |
$92.80
|
| Rate for Payer: CIGNA Commercial |
$110.20
|
| Rate for Payer: CIGNA Medicare |
$104.40
|
| Rate for Payer: HUMANA Commercial |
$104.40
|
| Rate for Payer: MEDICAID Medicaid |
$106.72
|
| Rate for Payer: MEDICARE Medicare |
$81.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$110.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$112.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$110.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$110.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$98.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$92.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$92.80
|
|
|
COFLEX 2'' COLORPAK
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
COFLEX 2'' COLORPAK
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
COFLEX 3'' COLORPAK
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
COFLEX 3'' COLORPAK
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
COFLEX 4'' COLORPAK
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
COFLEX 4'' COLORPAK
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
COLCHICINE TAB [0.6 MG]
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
COLCHICINE TAB [0.6 MG]
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
COLLAGENASE OINT [250 IU/G] 30G TUBE
|
Facility
OP
|
$657.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$459.90 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: AETNA Commercial |
$624.15
|
| Rate for Payer: AETNA Medicare |
$591.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$624.15
|
| Rate for Payer: BCBS Healthlink |
$591.30
|
| Rate for Payer: BCBS HMK CHIP |
$591.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$591.30
|
| Rate for Payer: BCBS POS |
$624.15
|
| Rate for Payer: BCBS Traditional |
$657.00
|
| Rate for Payer: CASH_PRICE |
$525.60
|
| Rate for Payer: CIGNA Commercial |
$624.15
|
| Rate for Payer: CIGNA Medicare |
$591.30
|
| Rate for Payer: HUMANA Commercial |
$591.30
|
| Rate for Payer: MEDICAID Medicaid |
$604.44
|
| Rate for Payer: MEDICARE Medicare |
$459.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$624.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$637.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$624.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$624.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$558.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$525.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$525.60
|
|
|
COLLAGENASE OINT [250 IU/G] 30G TUBE
|
Facility
IP
|
$657.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$459.90 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: AETNA Commercial |
$624.15
|
| Rate for Payer: AETNA Medicare |
$591.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$624.15
|
| Rate for Payer: BCBS Healthlink |
$591.30
|
| Rate for Payer: BCBS HMK CHIP |
$591.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$591.30
|
| Rate for Payer: BCBS POS |
$624.15
|
| Rate for Payer: BCBS Traditional |
$657.00
|
| Rate for Payer: CASH_PRICE |
$525.60
|
| Rate for Payer: CIGNA Commercial |
$624.15
|
| Rate for Payer: CIGNA Medicare |
$591.30
|
| Rate for Payer: HUMANA Commercial |
$591.30
|
| Rate for Payer: MEDICAID Medicaid |
$604.44
|
| Rate for Payer: MEDICARE Medicare |
$459.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$624.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$637.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$624.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$624.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$558.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$525.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$525.60
|
|
|
COLLAR ADJ ADULT EXTRICAT
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
COLLAR ADJ ADULT EXTRICAT
|
Facility
IP
|
$38.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
COLLAR ADJ PEDS (EXTIRCATIO
|
Facility
IP
|
$38.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
COLLAR ADJ PEDS (EXTIRCATIO
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
COLLES SPLINT LT/LG W/PAD
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
COLLES SPLINT LT/LG W/PAD
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
COLLES SPLINT MED W/PAD
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
