|
.AEROBIC CULTURE
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AETNA Commercial |
$48.45
|
| Rate for Payer: AETNA Medicare |
$45.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$48.45
|
| Rate for Payer: BCBS Healthlink |
$45.90
|
| Rate for Payer: BCBS HMK CHIP |
$45.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.90
|
| Rate for Payer: BCBS POS |
$48.45
|
| Rate for Payer: BCBS Traditional |
$51.00
|
| Rate for Payer: CASH_PRICE |
$40.80
|
| Rate for Payer: CIGNA Commercial |
$48.45
|
| Rate for Payer: CIGNA Medicare |
$45.90
|
| Rate for Payer: HUMANA Commercial |
$45.90
|
| Rate for Payer: MEDICAID Medicaid |
$46.92
|
| Rate for Payer: MEDICARE Medicare |
$35.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$48.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$49.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$48.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$43.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.80
|
|
|
AFP TUMOR MARKER (002253)
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
AFP TUMOR MARKER (002253)
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
AIRSELECT BOOT LARGE
|
Facility
OP
|
$96.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
AIRSELECT BOOT LARGE
|
Facility
IP
|
$96.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
AIRSELECT BOOT MEDIUM
|
Facility
IP
|
$96.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
AIRSELECT BOOT MEDIUM
|
Facility
OP
|
$96.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
AIRSELECT BOOT SMALL
|
Facility
IP
|
$128.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: BCBS HMK CHIP |
$115.20
|
| Rate for Payer: AETNA Commercial |
$121.60
|
| Rate for Payer: AETNA Medicare |
$115.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$121.60
|
| Rate for Payer: BCBS Healthlink |
$115.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$115.20
|
| Rate for Payer: BCBS POS |
$121.60
|
| Rate for Payer: BCBS Traditional |
$128.00
|
| Rate for Payer: CASH_PRICE |
$102.40
|
| Rate for Payer: CIGNA Commercial |
$121.60
|
| Rate for Payer: CIGNA Medicare |
$115.20
|
| Rate for Payer: HUMANA Commercial |
$115.20
|
| Rate for Payer: MEDICAID Medicaid |
$117.76
|
| Rate for Payer: MEDICARE Medicare |
$89.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$121.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$124.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$121.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$108.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$102.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$102.40
|
|
|
AIRSELECT BOOT SMALL
|
Facility
OP
|
$128.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: AETNA Commercial |
$121.60
|
| Rate for Payer: AETNA Medicare |
$115.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$121.60
|
| Rate for Payer: BCBS Healthlink |
$115.20
|
| Rate for Payer: BCBS HMK CHIP |
$115.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$115.20
|
| Rate for Payer: BCBS POS |
$121.60
|
| Rate for Payer: BCBS Traditional |
$128.00
|
| Rate for Payer: CASH_PRICE |
$102.40
|
| Rate for Payer: CIGNA Commercial |
$121.60
|
| Rate for Payer: CIGNA Medicare |
$115.20
|
| Rate for Payer: HUMANA Commercial |
$115.20
|
| Rate for Payer: MEDICAID Medicaid |
$117.76
|
| Rate for Payer: MEDICARE Medicare |
$89.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$121.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$124.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$121.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$108.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$102.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$102.40
|
|
|
AIRSELECT BOOT XLARGE
|
Facility
OP
|
$96.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
AIRSELECT BOOT XLARGE
|
Facility
IP
|
$96.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
ALBUMIN
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: BCBS HMK CHIP |
$51.30
|
| Rate for Payer: AETNA Commercial |
$54.15
|
| Rate for Payer: AETNA Medicare |
$51.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$54.15
|
| Rate for Payer: BCBS Healthlink |
$51.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$51.30
|
| Rate for Payer: BCBS POS |
$54.15
|
| Rate for Payer: BCBS Traditional |
$57.00
|
| Rate for Payer: CASH_PRICE |
$45.60
|
| Rate for Payer: CIGNA Commercial |
$54.15
|
| Rate for Payer: CIGNA Medicare |
$51.30
|
| Rate for Payer: HUMANA Commercial |
$51.30
|
| Rate for Payer: MEDICAID Medicaid |
$52.44
|
| Rate for Payer: MEDICARE Medicare |
$39.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$54.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$55.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$54.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$54.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$45.60
|
|
|
ALBUMIN
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: AETNA Commercial |
$54.15
|
| Rate for Payer: AETNA Medicare |
$51.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$54.15
|
| Rate for Payer: BCBS Healthlink |
$51.30
|
| Rate for Payer: BCBS HMK CHIP |
$51.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$51.30
|
| Rate for Payer: BCBS POS |
$54.15
|
| Rate for Payer: BCBS Traditional |
$57.00
|
| Rate for Payer: CASH_PRICE |
$45.60
|
| Rate for Payer: CIGNA Commercial |
$54.15
|
| Rate for Payer: CIGNA Medicare |
$51.30
|
| Rate for Payer: HUMANA Commercial |
$51.30
|
| Rate for Payer: MEDICAID Medicaid |
$52.44
|
| Rate for Payer: MEDICARE Medicare |
$39.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$54.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$55.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$54.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$54.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$45.60
|
|
|
ALBUTEROL 0.083% NEB SLN [2.5MG/3 ML]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J7609
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
ALBUTEROL 0.083% NEB SLN [2.5MG/3 ML]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J7609
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
ALBUTEROL HFA MDI [90 MCG]
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: BCBS HMK CHIP |
$135.90
|
| Rate for Payer: AETNA Commercial |
$143.45
|
| Rate for Payer: AETNA Medicare |
$135.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$143.45
|
| Rate for Payer: BCBS Healthlink |
$135.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$135.90
|
| Rate for Payer: BCBS POS |
$143.45
|
| Rate for Payer: BCBS Traditional |
$151.00
|
| Rate for Payer: CASH_PRICE |
$120.80
|
| Rate for Payer: CIGNA Commercial |
$143.45
|
| Rate for Payer: CIGNA Medicare |
$135.90
|
| Rate for Payer: HUMANA Commercial |
$135.90
|
| Rate for Payer: MEDICAID Medicaid |
$138.92
|
| Rate for Payer: MEDICARE Medicare |
$105.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$143.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$146.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$143.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$143.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$128.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$120.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$120.80
|
|
|
ALBUTEROL HFA MDI [90 MCG]
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: AETNA Commercial |
$143.45
|
| Rate for Payer: AETNA Medicare |
$135.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$143.45
|
| Rate for Payer: BCBS Healthlink |
$135.90
|
| Rate for Payer: BCBS HMK CHIP |
$135.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$135.90
|
| Rate for Payer: BCBS POS |
$143.45
|
| Rate for Payer: BCBS Traditional |
$151.00
|
| Rate for Payer: CASH_PRICE |
$120.80
|
| Rate for Payer: CIGNA Commercial |
$143.45
|
| Rate for Payer: CIGNA Medicare |
$135.90
|
| Rate for Payer: HUMANA Commercial |
$135.90
|
| Rate for Payer: MEDICAID Medicaid |
$138.92
|
| Rate for Payer: MEDICARE Medicare |
$105.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$143.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$146.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$143.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$143.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$128.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$120.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$120.80
|
|
|
ALBUTEROL/ IPRATROPIUM NEB SOLN
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
ALBUTEROL/ IPRATROPIUM NEB SOLN
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
ALCOHOL BIOMARKERS; 1 OR 2 80321
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: BCBS HMK CHIP |
$109.80
|
| Rate for Payer: AETNA Commercial |
$115.90
|
| Rate for Payer: AETNA Medicare |
$109.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$115.90
|
| Rate for Payer: BCBS Healthlink |
$109.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$109.80
|
| Rate for Payer: BCBS POS |
$115.90
|
| Rate for Payer: BCBS Traditional |
$122.00
|
| Rate for Payer: CASH_PRICE |
$97.60
|
| Rate for Payer: CIGNA Commercial |
$115.90
|
| Rate for Payer: CIGNA Medicare |
$109.80
|
| Rate for Payer: HUMANA Commercial |
$109.80
|
| Rate for Payer: MEDICAID Medicaid |
$112.24
|
| Rate for Payer: MEDICARE Medicare |
$85.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$115.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$118.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$115.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$115.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$103.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$97.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$97.60
|
|
|
ALCOHOL BIOMARKERS; 1 OR 2 80321
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: AETNA Commercial |
$115.90
|
| Rate for Payer: AETNA Medicare |
$109.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$115.90
|
| Rate for Payer: BCBS Healthlink |
$109.80
|
| Rate for Payer: BCBS HMK CHIP |
$109.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$109.80
|
| Rate for Payer: BCBS POS |
$115.90
|
| Rate for Payer: BCBS Traditional |
$122.00
|
| Rate for Payer: CASH_PRICE |
$97.60
|
| Rate for Payer: CIGNA Commercial |
$115.90
|
| Rate for Payer: CIGNA Medicare |
$109.80
|
| Rate for Payer: HUMANA Commercial |
$109.80
|
| Rate for Payer: MEDICAID Medicaid |
$112.24
|
| Rate for Payer: MEDICARE Medicare |
$85.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$115.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$118.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$115.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$115.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$103.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$97.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$97.60
|
|
|
ALDOLASE (002030)
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
ALDOLASE (002030)
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
ALDOSTERONE (004374)
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
ALDOSTERONE (004374)
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
