|
INITIAL PSYCH INTAKE WITH MEDICAL SERVIC
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
8190792
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: Aetna Commercial |
$335.35
|
| Rate for Payer: Aetna Medicare |
$317.70
|
| Rate for Payer: BCBS MT CHIP |
$317.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$335.35
|
| Rate for Payer: BCBS MT HealthLink |
$317.70
|
| Rate for Payer: BCBS MT Medicare |
$317.70
|
| Rate for Payer: BCBS MT POS |
$335.35
|
| Rate for Payer: BCBS MT Traditional |
$353.00
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna Commercial |
$335.35
|
| Rate for Payer: Cigna Medicare |
$317.70
|
| Rate for Payer: Medicaid All Medicaid |
$324.76
|
| Rate for Payer: Medicare All Medicare |
$247.10
|
| Rate for Payer: Monida Allegiance |
$335.35
|
| Rate for Payer: Monida First Choice Health |
$342.41
|
| Rate for Payer: Monida Montana Health Co-op |
$335.35
|
| Rate for Payer: Monida PacificSource |
$335.35
|
|
|
INJ ADMIN ALLERGY/MULTI
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
8095117
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: BCBS MT CHIP |
$67.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$71.25
|
| Rate for Payer: BCBS MT HealthLink |
$67.50
|
| Rate for Payer: BCBS MT Medicare |
$67.50
|
| Rate for Payer: BCBS MT POS |
$71.25
|
| Rate for Payer: BCBS MT Traditional |
$75.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cigna Medicare |
$67.50
|
| Rate for Payer: Medicaid All Medicaid |
$69.00
|
| Rate for Payer: Medicare All Medicare |
$52.50
|
| Rate for Payer: Monida Allegiance |
$71.25
|
| Rate for Payer: Monida First Choice Health |
$72.75
|
| Rate for Payer: Monida Montana Health Co-op |
$71.25
|
| Rate for Payer: Monida PacificSource |
$71.25
|
|
|
INJ ADMIN ALLERGY/MULTI
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
8095117
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: BCBS MT CHIP |
$67.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$71.25
|
| Rate for Payer: BCBS MT HealthLink |
$67.50
|
| Rate for Payer: BCBS MT Medicare |
$67.50
|
| Rate for Payer: BCBS MT POS |
$71.25
|
| Rate for Payer: BCBS MT Traditional |
$75.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cigna Medicare |
$67.50
|
| Rate for Payer: Medicaid All Medicaid |
$69.00
|
| Rate for Payer: Medicare All Medicare |
$52.50
|
| Rate for Payer: Monida Allegiance |
$71.25
|
| Rate for Payer: Monida First Choice Health |
$72.75
|
| Rate for Payer: Monida Montana Health Co-op |
$71.25
|
| Rate for Payer: Monida PacificSource |
$71.25
|
|
|
INJ ADMIN ALLERGY/SINGLE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
8095115
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: BCBS MT CHIP |
$36.00
|
| Rate for Payer: BCBS MT Closed Plan Network |
$38.00
|
| Rate for Payer: BCBS MT HealthLink |
$36.00
|
| Rate for Payer: BCBS MT Medicare |
$36.00
|
| Rate for Payer: BCBS MT POS |
$38.00
|
| Rate for Payer: BCBS MT Traditional |
$40.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: Cigna Medicare |
$36.00
|
| Rate for Payer: Medicaid All Medicaid |
$36.80
|
| Rate for Payer: Medicare All Medicare |
$28.00
|
| Rate for Payer: Monida Allegiance |
$38.00
|
| Rate for Payer: Monida First Choice Health |
$38.80
|
| Rate for Payer: Monida Montana Health Co-op |
$38.00
|
| Rate for Payer: Monida PacificSource |
$38.00
|
|
|
INJ ADMIN ALLERGY/SINGLE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
8095115
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: BCBS MT CHIP |
$36.00
|
| Rate for Payer: BCBS MT Closed Plan Network |
$38.00
|
| Rate for Payer: BCBS MT HealthLink |
$36.00
|
| Rate for Payer: BCBS MT Medicare |
$36.00
|
| Rate for Payer: BCBS MT POS |
$38.00
|
| Rate for Payer: BCBS MT Traditional |
$40.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: Cigna Medicare |
$36.00
|
| Rate for Payer: Medicaid All Medicaid |
$36.80
|
| Rate for Payer: Medicare All Medicare |
$28.00
|
| Rate for Payer: Monida Allegiance |
$38.00
|
| Rate for Payer: Monida First Choice Health |
$38.80
|
| Rate for Payer: Monida Montana Health Co-op |
$38.00
|
| Rate for Payer: Monida PacificSource |
$38.00
|
|
|
INJ ADMIN BEYFORTUS IM w/ counseling
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
8096380
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN BEYFORTUS IM w/ counseling
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
8096380
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN BEYFORTUS IM w/o counseling
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
8096381
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN BEYFORTUS IM w/o counseling
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
8096381
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN IMM EA ADDTL SNGL/CMB (90472)
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8090472
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
INJ ADMIN IMM EA ADDTL SNGL/CMB (90472)
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
8090472
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
INJ ADMIN IMMUNIZ INITIAL-CLINIC(90471)
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8090471
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN IMMUNIZ INITIAL-CLINIC(90471)
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8090471
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN INFLUENZA-MEDICARE 90471
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
8000010
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN INFLUENZA-MEDICARE 90471
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
8000010
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN INFLUENZA VACCINE 90471
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8000008
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN INFLUENZA VACCINE 90471
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8000008
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN IV MED
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 90784
|
| Hospital Charge Code |
8090784
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
INJ ADMIN IV MED
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 90784
|
| Hospital Charge Code |
8090784
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
INJ ADMIN OF PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8000009
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN OF PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8000009
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN OF PNEUMOCOCCAL VAC-MEDICARE
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
8000007
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN OF PNEUMOCOCCAL VAC-MEDICARE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
8000007
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Medicare |
$65.70
|
| Rate for Payer: BCBS MT CHIP |
$65.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$69.35
|
| Rate for Payer: BCBS MT HealthLink |
$65.70
|
| Rate for Payer: BCBS MT Medicare |
$65.70
|
| Rate for Payer: BCBS MT POS |
$69.35
|
| Rate for Payer: BCBS MT Traditional |
$73.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cigna Medicare |
$65.70
|
| Rate for Payer: Medicaid All Medicaid |
$67.16
|
| Rate for Payer: Medicare All Medicare |
$51.10
|
| Rate for Payer: Monida Allegiance |
$69.35
|
| Rate for Payer: Monida First Choice Health |
$70.81
|
| Rate for Payer: Monida Montana Health Co-op |
$69.35
|
| Rate for Payer: Monida PacificSource |
$69.35
|
|
|
INJ ADMIN OF STATE VACCINE SINGLE
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
8090470
|
|
Hospital Revenue Code
|
521
|
| 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 MT CHIP |
$13.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$14.25
|
| Rate for Payer: BCBS MT HealthLink |
$13.50
|
| Rate for Payer: BCBS MT Medicare |
$13.50
|
| Rate for Payer: BCBS MT POS |
$14.25
|
| Rate for Payer: BCBS MT Traditional |
$15.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$14.25
|
| Rate for Payer: Cigna Medicare |
$13.50
|
| Rate for Payer: Medicaid All Medicaid |
$13.80
|
| Rate for Payer: Medicare All Medicare |
$10.50
|
| Rate for Payer: Monida Allegiance |
$14.25
|
| Rate for Payer: Monida First Choice Health |
$14.55
|
| Rate for Payer: Monida Montana Health Co-op |
$14.25
|
| Rate for Payer: Monida PacificSource |
$14.25
|
|
|
INJ ADMIN OF STATE VACCINE SINGLE
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
8090470
|
|
Hospital Revenue Code
|
521
|
| 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 MT CHIP |
$13.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$14.25
|
| Rate for Payer: BCBS MT HealthLink |
$13.50
|
| Rate for Payer: BCBS MT Medicare |
$13.50
|
| Rate for Payer: BCBS MT POS |
$14.25
|
| Rate for Payer: BCBS MT Traditional |
$15.00
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$14.25
|
| Rate for Payer: Cigna Medicare |
$13.50
|
| Rate for Payer: Medicaid All Medicaid |
$13.80
|
| Rate for Payer: Medicare All Medicare |
$10.50
|
| Rate for Payer: Monida Allegiance |
$14.25
|
| Rate for Payer: Monida First Choice Health |
$14.55
|
| Rate for Payer: Monida Montana Health Co-op |
$14.25
|
| Rate for Payer: Monida PacificSource |
$14.25
|
|
