|
LAB ACETYLCHOLINE RECEPTOR AB BINDING
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
4084299
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS MT CHIP |
$157.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$166.25
|
| Rate for Payer: BCBS MT HealthLink |
$157.50
|
| Rate for Payer: BCBS MT Medicare |
$157.50
|
| Rate for Payer: BCBS MT POS |
$166.25
|
| Rate for Payer: BCBS MT Traditional |
$175.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cigna Medicare |
$157.50
|
| Rate for Payer: Medicaid All Medicaid |
$161.00
|
| Rate for Payer: Medicare All Medicare |
$122.50
|
| Rate for Payer: Monida Allegiance |
$166.25
|
| Rate for Payer: Monida First Choice Health |
$169.75
|
| Rate for Payer: Monida Montana Health Co-op |
$166.25
|
| Rate for Payer: Monida PacificSource |
$166.25
|
|
|
LAB ACETYLCHOLINE RECEPTOR AB MODULATIN
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
4084238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS MT CHIP |
$157.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$166.25
|
| Rate for Payer: BCBS MT HealthLink |
$157.50
|
| Rate for Payer: BCBS MT Medicare |
$157.50
|
| Rate for Payer: BCBS MT POS |
$166.25
|
| Rate for Payer: BCBS MT Traditional |
$175.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cigna Medicare |
$157.50
|
| Rate for Payer: Medicaid All Medicaid |
$161.00
|
| Rate for Payer: Medicare All Medicare |
$122.50
|
| Rate for Payer: Monida Allegiance |
$166.25
|
| Rate for Payer: Monida First Choice Health |
$169.75
|
| Rate for Payer: Monida Montana Health Co-op |
$166.25
|
| Rate for Payer: Monida PacificSource |
$166.25
|
|
|
LAB ACETYLCHOLINE RECEPTOR AB MODULATIN
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
4084238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS MT CHIP |
$157.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$166.25
|
| Rate for Payer: BCBS MT HealthLink |
$157.50
|
| Rate for Payer: BCBS MT Medicare |
$157.50
|
| Rate for Payer: BCBS MT POS |
$166.25
|
| Rate for Payer: BCBS MT Traditional |
$175.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cigna Medicare |
$157.50
|
| Rate for Payer: Medicaid All Medicaid |
$161.00
|
| Rate for Payer: Medicare All Medicare |
$122.50
|
| Rate for Payer: Monida Allegiance |
$166.25
|
| Rate for Payer: Monida First Choice Health |
$169.75
|
| Rate for Payer: Monida Montana Health Co-op |
$166.25
|
| Rate for Payer: Monida PacificSource |
$166.25
|
|
|
LAB ACYLEARNITINE DISORDER
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
4082017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Medicare |
$98.10
|
| Rate for Payer: BCBS MT CHIP |
$98.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$103.55
|
| Rate for Payer: BCBS MT HealthLink |
$98.10
|
| Rate for Payer: BCBS MT Medicare |
$98.10
|
| Rate for Payer: BCBS MT POS |
$103.55
|
| Rate for Payer: BCBS MT Traditional |
$109.00
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cigna Medicare |
$98.10
|
| Rate for Payer: Medicaid All Medicaid |
$100.28
|
| Rate for Payer: Medicare All Medicare |
$76.30
|
| Rate for Payer: Monida Allegiance |
$103.55
|
| Rate for Payer: Monida First Choice Health |
$105.73
|
| Rate for Payer: Monida Montana Health Co-op |
$103.55
|
| Rate for Payer: Monida PacificSource |
$103.55
|
|
|
LAB ACYLEARNITINE DISORDER
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
4082017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Medicare |
$98.10
|
| Rate for Payer: BCBS MT CHIP |
$98.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$103.55
|
| Rate for Payer: BCBS MT HealthLink |
$98.10
|
| Rate for Payer: BCBS MT Medicare |
$98.10
|
| Rate for Payer: BCBS MT POS |
$103.55
|
| Rate for Payer: BCBS MT Traditional |
$109.00
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cigna Medicare |
$98.10
|
| Rate for Payer: Medicaid All Medicaid |
$100.28
|
| Rate for Payer: Medicare All Medicare |
$76.30
|
| Rate for Payer: Monida Allegiance |
$103.55
|
| Rate for Payer: Monida First Choice Health |
$105.73
|
| Rate for Payer: Monida Montana Health Co-op |
$103.55
|
| Rate for Payer: Monida PacificSource |
$103.55
|
|
|
LAB ALKALOIDS
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
4080323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Aetna Medicare |
$57.60
|
| Rate for Payer: BCBS MT CHIP |
$57.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$60.80
|
| Rate for Payer: BCBS MT HealthLink |
$57.60
|
| Rate for Payer: BCBS MT Medicare |
$57.60
|
| Rate for Payer: BCBS MT POS |
$60.80
|
| Rate for Payer: BCBS MT Traditional |
$64.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$60.80
|
| Rate for Payer: Cigna Medicare |
$57.60
|
| Rate for Payer: Medicaid All Medicaid |
$58.88
|
| Rate for Payer: Medicare All Medicare |
$44.80
|
| Rate for Payer: Monida Allegiance |
$60.80
|
| Rate for Payer: Monida First Choice Health |
$62.08
|
| Rate for Payer: Monida Montana Health Co-op |
$60.80
|
| Rate for Payer: Monida PacificSource |
$60.80
|
|
|
LAB ALKALOIDS
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 80323
|
| Hospital Charge Code |
4080323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Aetna Medicare |
$57.60
|
| Rate for Payer: BCBS MT CHIP |
$57.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$60.80
|
| Rate for Payer: BCBS MT HealthLink |
$57.60
|
| Rate for Payer: BCBS MT Medicare |
$57.60
|
| Rate for Payer: BCBS MT POS |
$60.80
|
| Rate for Payer: BCBS MT Traditional |
$64.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$60.80
|
| Rate for Payer: Cigna Medicare |
$57.60
|
| Rate for Payer: Medicaid All Medicaid |
$58.88
|
| Rate for Payer: Medicare All Medicare |
$44.80
|
| Rate for Payer: Monida Allegiance |
$60.80
|
| Rate for Payer: Monida First Choice Health |
$62.08
|
| Rate for Payer: Monida Montana Health Co-op |
$60.80
|
| Rate for Payer: Monida PacificSource |
$60.80
|
|
|
LAB ALLERGY TEST: ALMOND
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: ALMOND
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000310
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: CASHEW NUT
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: CASHEW NUT
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: COD FISH
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: COD FISH
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST EGG WHITE
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST EGG WHITE
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: HAZELNUT
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: HAZELNUT
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST MILK
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST MILK
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: PEANUT
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: PEANUT
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4060039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: SALMON
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: SALMON
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: SCALLOPS
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
|
LAB ALLERGY TEST: SCALLOPS
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
4000311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: BCBS MT CHIP |
$32.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$34.20
|
| Rate for Payer: BCBS MT HealthLink |
$32.40
|
| Rate for Payer: BCBS MT Medicare |
$32.40
|
| Rate for Payer: BCBS MT POS |
$34.20
|
| Rate for Payer: BCBS MT Traditional |
$36.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cigna Medicare |
$32.40
|
| Rate for Payer: Medicaid All Medicaid |
$33.12
|
| Rate for Payer: Medicare All Medicare |
$25.20
|
| Rate for Payer: Monida Allegiance |
$34.20
|
| Rate for Payer: Monida First Choice Health |
$34.92
|
| Rate for Payer: Monida Montana Health Co-op |
$34.20
|
| Rate for Payer: Monida PacificSource |
$34.20
|
|
