|
ESCITALOPRAM TAB [10 MG]
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: AETNA Commercial |
$14.25
|
| Rate for Payer: AETNA Medicare |
$13.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14.25
|
| Rate for Payer: BCBS Healthlink |
$13.50
|
| Rate for Payer: BCBS HMK CHIP |
$13.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.50
|
| Rate for Payer: BCBS POS |
$14.25
|
| Rate for Payer: BCBS Traditional |
$15.00
|
| Rate for Payer: CASH_PRICE |
$12.00
|
| Rate for Payer: CIGNA Commercial |
$14.25
|
| Rate for Payer: CIGNA Medicare |
$13.50
|
| Rate for Payer: HUMANA Commercial |
$13.50
|
| Rate for Payer: MEDICAID Medicaid |
$13.80
|
| Rate for Payer: MEDICARE Medicare |
$10.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.00
|
|
|
ESTRADIOL (004515)
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
ESTRADIOL (004515)
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
ESTRIOL (004614)
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: AETNA Commercial |
$70.30
|
| Rate for Payer: AETNA Medicare |
$66.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$70.30
|
| Rate for Payer: BCBS Healthlink |
$66.60
|
| Rate for Payer: BCBS HMK CHIP |
$66.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$66.60
|
| Rate for Payer: BCBS POS |
$70.30
|
| Rate for Payer: BCBS Traditional |
$74.00
|
| Rate for Payer: CASH_PRICE |
$59.20
|
| Rate for Payer: CIGNA Commercial |
$70.30
|
| Rate for Payer: CIGNA Medicare |
$66.60
|
| Rate for Payer: HUMANA Commercial |
$66.60
|
| Rate for Payer: MEDICAID Medicaid |
$68.08
|
| Rate for Payer: MEDICARE Medicare |
$51.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$70.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$71.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$70.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$70.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$59.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$59.20
|
|
|
ESTRIOL (004614)
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: BCBS HMK CHIP |
$66.60
|
| Rate for Payer: AETNA Commercial |
$70.30
|
| Rate for Payer: AETNA Medicare |
$66.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$70.30
|
| Rate for Payer: BCBS Healthlink |
$66.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$66.60
|
| Rate for Payer: BCBS POS |
$70.30
|
| Rate for Payer: BCBS Traditional |
$74.00
|
| Rate for Payer: CASH_PRICE |
$59.20
|
| Rate for Payer: CIGNA Commercial |
$70.30
|
| Rate for Payer: CIGNA Medicare |
$66.60
|
| Rate for Payer: HUMANA Commercial |
$66.60
|
| Rate for Payer: MEDICAID Medicaid |
$68.08
|
| Rate for Payer: MEDICARE Medicare |
$51.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$70.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$71.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$70.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$70.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$59.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$59.20
|
|
|
ESTRONE (004564)
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
ESTRONE (004564)
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
ETHANOL, BLOOD
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
CPT 82077
|
| 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
|
|
|
ETHANOL, BLOOD
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 82077
|
| 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
|
|
|
ETOMIDATE INJ [2MG/ML]
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
ETOMIDATE INJ [2MG/ML]
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
ET TUBE SIZE 2.0
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
ET TUBE SIZE 2.0
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
ET TUBE SIZE 5.5
|
Facility
OP
|
$51.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
ET TUBE SIZE 5.5
|
Facility
IP
|
$51.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
Eucerin Topical Cream-NF
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
Eucerin Topical Cream-NF
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
EVEROLIMUS (700003)
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: AETNA Commercial |
$330.60
|
| Rate for Payer: AETNA Medicare |
$313.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$330.60
|
| Rate for Payer: BCBS Healthlink |
$313.20
|
| Rate for Payer: BCBS HMK CHIP |
$313.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$313.20
|
| Rate for Payer: BCBS POS |
$330.60
|
| Rate for Payer: BCBS Traditional |
$348.00
|
| Rate for Payer: CASH_PRICE |
$278.40
|
| Rate for Payer: CIGNA Commercial |
$330.60
|
| Rate for Payer: CIGNA Medicare |
$313.20
|
| Rate for Payer: HUMANA Commercial |
$313.20
|
| Rate for Payer: MEDICAID Medicaid |
$320.16
|
| Rate for Payer: MEDICARE Medicare |
$243.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$330.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$337.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$330.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$330.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$295.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$278.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$278.40
|
|
|
EVEROLIMUS (700003)
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: AETNA Commercial |
$330.60
|
| Rate for Payer: AETNA Medicare |
$313.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$330.60
|
| Rate for Payer: BCBS Healthlink |
$313.20
|
| Rate for Payer: BCBS HMK CHIP |
$313.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$313.20
|
| Rate for Payer: BCBS POS |
$330.60
|
| Rate for Payer: BCBS Traditional |
$348.00
|
| Rate for Payer: CASH_PRICE |
$278.40
|
| Rate for Payer: CIGNA Commercial |
$330.60
|
| Rate for Payer: CIGNA Medicare |
$313.20
|
| Rate for Payer: HUMANA Commercial |
$313.20
|
| Rate for Payer: MEDICAID Medicaid |
$320.16
|
| Rate for Payer: MEDICARE Medicare |
$243.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$330.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$337.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$330.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$330.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$295.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$278.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$278.40
|
|
|
EXCISION BENIGN LESION 0.5CM LESS
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: AETNA Commercial |
$359.10
|
| Rate for Payer: AETNA Medicare |
$340.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$359.10
|
| Rate for Payer: BCBS Healthlink |
$340.20
|
| Rate for Payer: BCBS HMK CHIP |
$340.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$340.20
|
| Rate for Payer: BCBS POS |
$359.10
|
| Rate for Payer: BCBS Traditional |
$378.00
|
| Rate for Payer: CASH_PRICE |
$302.40
|
| Rate for Payer: CIGNA Commercial |
$359.10
|
| Rate for Payer: CIGNA Medicare |
$340.20
|
| Rate for Payer: HUMANA Commercial |
$340.20
|
| Rate for Payer: MEDICAID Medicaid |
$347.76
|
| Rate for Payer: MEDICARE Medicare |
$264.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$359.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$366.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$359.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$359.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$321.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$302.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$302.40
|
|
|
EXCISION BENIGN LESION 0.5CM LESS
|
Facility
IP
|
$378.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: BCBS HMK CHIP |
$340.20
|
| Rate for Payer: AETNA Commercial |
$359.10
|
| Rate for Payer: AETNA Medicare |
$340.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$359.10
|
| Rate for Payer: BCBS Healthlink |
$340.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$340.20
|
| Rate for Payer: BCBS POS |
$359.10
|
| Rate for Payer: BCBS Traditional |
$378.00
|
| Rate for Payer: CASH_PRICE |
$302.40
|
| Rate for Payer: CIGNA Commercial |
$359.10
|
| Rate for Payer: CIGNA Medicare |
$340.20
|
| Rate for Payer: HUMANA Commercial |
$340.20
|
| Rate for Payer: MEDICAID Medicaid |
$347.76
|
| Rate for Payer: MEDICARE Medicare |
$264.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$359.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$366.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$359.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$359.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$321.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$302.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$302.40
|
|
|
EXCISION BENIGN LESION 0.5CM/LESS
|
Facility
IP
|
$386.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$270.20 |
| Max. Negotiated Rate |
$386.00 |
| Rate for Payer: AETNA Commercial |
$366.70
|
| Rate for Payer: AETNA Medicare |
$347.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$366.70
|
| Rate for Payer: BCBS Healthlink |
$347.40
|
| Rate for Payer: BCBS HMK CHIP |
$347.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$347.40
|
| Rate for Payer: BCBS POS |
$366.70
|
| Rate for Payer: BCBS Traditional |
$386.00
|
| Rate for Payer: CASH_PRICE |
$308.80
|
| Rate for Payer: CIGNA Commercial |
$366.70
|
| Rate for Payer: CIGNA Medicare |
$347.40
|
| Rate for Payer: HUMANA Commercial |
$347.40
|
| Rate for Payer: MEDICAID Medicaid |
$355.12
|
| Rate for Payer: MEDICARE Medicare |
$270.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$366.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$374.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$366.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$366.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$308.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$308.80
|
|
|
EXCISION BENIGN LESION 0.5CM/LESS
|
Facility
OP
|
$386.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$270.20 |
| Max. Negotiated Rate |
$386.00 |
| Rate for Payer: AETNA Commercial |
$366.70
|
| Rate for Payer: AETNA Medicare |
$347.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$366.70
|
| Rate for Payer: BCBS Healthlink |
$347.40
|
| Rate for Payer: BCBS HMK CHIP |
$347.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$347.40
|
| Rate for Payer: BCBS POS |
$366.70
|
| Rate for Payer: BCBS Traditional |
$386.00
|
| Rate for Payer: CASH_PRICE |
$308.80
|
| Rate for Payer: CIGNA Commercial |
$366.70
|
| Rate for Payer: CIGNA Medicare |
$347.40
|
| Rate for Payer: HUMANA Commercial |
$347.40
|
| Rate for Payer: MEDICAID Medicaid |
$355.12
|
| Rate for Payer: MEDICARE Medicare |
$270.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$366.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$374.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$366.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$366.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$308.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$308.80
|
|
|
EXCISION BENIGN LESION 0.6-1.0CM
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: BCBS HMK CHIP |
$366.30
|
| Rate for Payer: AETNA Commercial |
$386.65
|
| Rate for Payer: AETNA Medicare |
$366.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.65
|
| Rate for Payer: BCBS Healthlink |
$366.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$366.30
|
| Rate for Payer: BCBS POS |
$386.65
|
| Rate for Payer: BCBS Traditional |
$407.00
|
| Rate for Payer: CASH_PRICE |
$325.60
|
| Rate for Payer: CIGNA Commercial |
$386.65
|
| Rate for Payer: CIGNA Medicare |
$366.30
|
| Rate for Payer: HUMANA Commercial |
$366.30
|
| Rate for Payer: MEDICAID Medicaid |
$374.44
|
| Rate for Payer: MEDICARE Medicare |
$284.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.60
|
|
|
EXCISION BENIGN LESION 0.6-1.0CM
|
Facility
OP
|
$407.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: AETNA Commercial |
$386.65
|
| Rate for Payer: AETNA Medicare |
$366.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.65
|
| Rate for Payer: BCBS Healthlink |
$366.30
|
| Rate for Payer: BCBS HMK CHIP |
$366.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$366.30
|
| Rate for Payer: BCBS POS |
$386.65
|
| Rate for Payer: BCBS Traditional |
$407.00
|
| Rate for Payer: CASH_PRICE |
$325.60
|
| Rate for Payer: CIGNA Commercial |
$386.65
|
| Rate for Payer: CIGNA Medicare |
$366.30
|
| Rate for Payer: HUMANA Commercial |
$366.30
|
| Rate for Payer: MEDICAID Medicaid |
$374.44
|
| Rate for Payer: MEDICARE Medicare |
$284.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.60
|
|
