|
PRIVATE ROOM ISOLATION
|
Facility
IP
|
$1,769.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,238.30 |
| Max. Negotiated Rate |
$1,769.00 |
| Rate for Payer: AETNA Commercial |
$1,680.55
|
| Rate for Payer: AETNA Medicare |
$1,592.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,680.55
|
| Rate for Payer: BCBS Healthlink |
$1,592.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,592.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,592.10
|
| Rate for Payer: BCBS POS |
$1,680.55
|
| Rate for Payer: BCBS Traditional |
$1,769.00
|
| Rate for Payer: CASH_PRICE |
$1,415.20
|
| Rate for Payer: CIGNA Commercial |
$1,680.55
|
| Rate for Payer: CIGNA Medicare |
$1,592.10
|
| Rate for Payer: HUMANA Commercial |
$1,592.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,627.48
|
| Rate for Payer: MEDICARE Medicare |
$1,238.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,715.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,680.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,503.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,415.20
|
|
|
PRIVIGEN 10GM/100ML SDV NON-FORMULARY
|
Facility
IP
|
$2,868.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,007.60 |
| Max. Negotiated Rate |
$2,868.00 |
| Rate for Payer: AETNA Commercial |
$2,724.60
|
| Rate for Payer: AETNA Medicare |
$2,581.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,724.60
|
| Rate for Payer: BCBS Healthlink |
$2,581.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,581.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,581.20
|
| Rate for Payer: BCBS POS |
$2,724.60
|
| Rate for Payer: BCBS Traditional |
$2,868.00
|
| Rate for Payer: CASH_PRICE |
$2,294.40
|
| Rate for Payer: CIGNA Commercial |
$2,724.60
|
| Rate for Payer: CIGNA Medicare |
$2,581.20
|
| Rate for Payer: HUMANA Commercial |
$2,581.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,638.56
|
| Rate for Payer: MEDICARE Medicare |
$2,007.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,724.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,781.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,724.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,724.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,437.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,294.40
|
|
|
PRIVIGEN 10GM/100ML SDV NON-FORMULARY
|
Facility
OP
|
$2,868.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,007.60 |
| Max. Negotiated Rate |
$2,868.00 |
| Rate for Payer: AETNA Commercial |
$2,724.60
|
| Rate for Payer: AETNA Medicare |
$2,581.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,724.60
|
| Rate for Payer: BCBS Healthlink |
$2,581.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,581.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,581.20
|
| Rate for Payer: BCBS POS |
$2,724.60
|
| Rate for Payer: BCBS Traditional |
$2,868.00
|
| Rate for Payer: CASH_PRICE |
$2,294.40
|
| Rate for Payer: CIGNA Commercial |
$2,724.60
|
| Rate for Payer: CIGNA Medicare |
$2,581.20
|
| Rate for Payer: HUMANA Commercial |
$2,581.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,638.56
|
| Rate for Payer: MEDICARE Medicare |
$2,007.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,724.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,781.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,724.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,724.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,437.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,294.40
|
|
|
PRIVIGEN 20GM/200ML SDV NON-FORMULARY
|
Facility
IP
|
$5,736.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,015.20 |
| Max. Negotiated Rate |
$5,736.00 |
| Rate for Payer: AETNA Commercial |
$5,449.20
|
| Rate for Payer: AETNA Medicare |
$5,162.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$5,449.20
|
| Rate for Payer: BCBS Healthlink |
$5,162.40
|
| Rate for Payer: BCBS HMK CHIP |
$5,162.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$5,162.40
|
| Rate for Payer: BCBS POS |
$5,449.20
|
| Rate for Payer: BCBS Traditional |
$5,736.00
|
| Rate for Payer: CASH_PRICE |
$4,588.80
|
| Rate for Payer: CIGNA Commercial |
$5,449.20
|
| Rate for Payer: CIGNA Medicare |
$5,162.40
|
| Rate for Payer: HUMANA Commercial |
$5,162.40
|
| Rate for Payer: MEDICAID Medicaid |
$5,277.12
|
| Rate for Payer: MEDICARE Medicare |
$4,015.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$5,449.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$5,563.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$5,449.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$5,449.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4,875.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4,588.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4,588.80
|
|
|
PRIVIGEN 20GM/200ML SDV NON-FORMULARY
|
Facility
OP
|
$5,736.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,015.20 |
| Max. Negotiated Rate |
$5,736.00 |
| Rate for Payer: AETNA Commercial |
$5,449.20
|
| Rate for Payer: AETNA Medicare |
$5,162.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$5,449.20
|
| Rate for Payer: BCBS Healthlink |
$5,162.40
|
| Rate for Payer: BCBS HMK CHIP |
$5,162.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$5,162.40
|
| Rate for Payer: BCBS POS |
$5,449.20
|
| Rate for Payer: BCBS Traditional |
$5,736.00
|
| Rate for Payer: CASH_PRICE |
$4,588.80
|
| Rate for Payer: CIGNA Commercial |
$5,449.20
|
| Rate for Payer: CIGNA Medicare |
$5,162.40
|
| Rate for Payer: HUMANA Commercial |
$5,162.40
|
| Rate for Payer: MEDICAID Medicaid |
$5,277.12
|
| Rate for Payer: MEDICARE Medicare |
$4,015.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$5,449.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$5,563.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$5,449.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$5,449.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4,875.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4,588.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4,588.80
|
|
|
PRIVIGEN 40GM/400ML SDV NON-FORMULARY
|
Facility
OP
|
$11,472.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,030.40 |
| Max. Negotiated Rate |
$11,472.00 |
| Rate for Payer: AETNA Commercial |
$10,898.40
|
| Rate for Payer: AETNA Medicare |
$10,324.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10,898.40
|
| Rate for Payer: BCBS Healthlink |
$10,324.80
|
| Rate for Payer: BCBS HMK CHIP |
$10,324.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10,324.80
|
| Rate for Payer: BCBS POS |
$10,898.40
|
| Rate for Payer: BCBS Traditional |
$11,472.00
|
| Rate for Payer: CASH_PRICE |
$9,177.60
|
| Rate for Payer: CIGNA Commercial |
$10,898.40
|
| Rate for Payer: CIGNA Medicare |
$10,324.80
|
| Rate for Payer: HUMANA Commercial |
$10,324.80
|
| Rate for Payer: MEDICAID Medicaid |
$10,554.24
|
| Rate for Payer: MEDICARE Medicare |
$8,030.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10,898.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11,127.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10,898.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10,898.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9,751.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9,177.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9,177.60
|
|
|
PRIVIGEN 40GM/400ML SDV NON-FORMULARY
|
Facility
IP
|
$11,472.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,030.40 |
| Max. Negotiated Rate |
$11,472.00 |
| Rate for Payer: AETNA Commercial |
$10,898.40
|
| Rate for Payer: AETNA Medicare |
$10,324.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10,898.40
|
| Rate for Payer: BCBS Healthlink |
$10,324.80
|
| Rate for Payer: BCBS HMK CHIP |
$10,324.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10,324.80
|
| Rate for Payer: BCBS POS |
$10,898.40
|
| Rate for Payer: BCBS Traditional |
$11,472.00
|
| Rate for Payer: CASH_PRICE |
$9,177.60
|
| Rate for Payer: CIGNA Commercial |
$10,898.40
|
| Rate for Payer: CIGNA Medicare |
$10,324.80
|
| Rate for Payer: HUMANA Commercial |
$10,324.80
|
| Rate for Payer: MEDICAID Medicaid |
$10,554.24
|
| Rate for Payer: MEDICARE Medicare |
$8,030.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10,898.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11,127.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10,898.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10,898.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9,751.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9,177.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9,177.60
|
|
|
PRIVIGEN 5GM/50ML SDV NON-FORMUALRY
|
Facility
IP
|
$1,437.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,005.90 |
| Max. Negotiated Rate |
$1,437.00 |
| Rate for Payer: AETNA Commercial |
$1,365.15
|
| Rate for Payer: AETNA Medicare |
$1,293.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,365.15
|
| Rate for Payer: BCBS Healthlink |
$1,293.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,293.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,293.30
|
| Rate for Payer: BCBS POS |
$1,365.15
|
| Rate for Payer: BCBS Traditional |
$1,437.00
|
| Rate for Payer: CASH_PRICE |
$1,149.60
|
| Rate for Payer: CIGNA Commercial |
$1,365.15
|
| Rate for Payer: CIGNA Medicare |
$1,293.30
|
| Rate for Payer: HUMANA Commercial |
$1,293.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,322.04
|
| Rate for Payer: MEDICARE Medicare |
$1,005.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,365.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,393.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,365.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,365.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,221.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,149.60
|
|
|
PRIVIGEN 5GM/50ML SDV NON-FORMUALRY
|
Facility
OP
|
$1,437.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,005.90 |
| Max. Negotiated Rate |
$1,437.00 |
| Rate for Payer: AETNA Commercial |
$1,365.15
|
| Rate for Payer: AETNA Medicare |
$1,293.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,365.15
|
| Rate for Payer: BCBS Healthlink |
$1,293.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,293.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,293.30
|
| Rate for Payer: BCBS POS |
$1,365.15
|
| Rate for Payer: BCBS Traditional |
$1,437.00
|
| Rate for Payer: CASH_PRICE |
$1,149.60
|
| Rate for Payer: CIGNA Commercial |
$1,365.15
|
| Rate for Payer: CIGNA Medicare |
$1,293.30
|
| Rate for Payer: HUMANA Commercial |
$1,293.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,322.04
|
| Rate for Payer: MEDICARE Medicare |
$1,005.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,365.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,393.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,365.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,365.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,221.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,149.60
|
|
|
PROCALCITONIN (164750)
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: AETNA Commercial |
$532.95
|
| Rate for Payer: AETNA Medicare |
$504.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$532.95
|
| Rate for Payer: BCBS Healthlink |
$504.90
|
| Rate for Payer: BCBS HMK CHIP |
$504.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$504.90
|
| Rate for Payer: BCBS POS |
$532.95
|
| Rate for Payer: BCBS Traditional |
$561.00
|
| Rate for Payer: CASH_PRICE |
$448.80
|
| Rate for Payer: CIGNA Commercial |
$532.95
|
| Rate for Payer: CIGNA Medicare |
$504.90
|
| Rate for Payer: HUMANA Commercial |
$504.90
|
| Rate for Payer: MEDICAID Medicaid |
$516.12
|
| Rate for Payer: MEDICARE Medicare |
$392.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$532.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$544.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$532.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$532.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$476.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$448.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$448.80
|
|
|
PROCALCITONIN (164750)
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: AETNA Commercial |
$532.95
|
| Rate for Payer: AETNA Medicare |
$504.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$532.95
|
| Rate for Payer: BCBS Healthlink |
$504.90
|
| Rate for Payer: BCBS HMK CHIP |
$504.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$504.90
|
| Rate for Payer: BCBS POS |
$532.95
|
| Rate for Payer: BCBS Traditional |
$561.00
|
| Rate for Payer: CASH_PRICE |
$448.80
|
| Rate for Payer: CIGNA Commercial |
$532.95
|
| Rate for Payer: CIGNA Medicare |
$504.90
|
| Rate for Payer: HUMANA Commercial |
$504.90
|
| Rate for Payer: MEDICAID Medicaid |
$516.12
|
| Rate for Payer: MEDICARE Medicare |
$392.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$532.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$544.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$532.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$532.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$476.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$448.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$448.80
|
|
|
PROCHLORPERAZINE INJ [10 MG/2 ML] VIAL
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
PROCHLORPERAZINE INJ [10 MG/2 ML] VIAL
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J0780
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
PROCHLORPERAZINE TAB [5 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT Q0164
|
| 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
|
|
|
PROCHLORPERAZINE TAB [5 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT Q0164
|
| 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
|
|
|
PRO FEE APPLICATION OF FINGER SPLINT
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
PRO FEE APPLICATION OF FINGER SPLINT
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
PRO FEE CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 13151 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
PRO FEE CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 13151 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
PRO FEE CRITICAL CARE EA ADD 30 MIN
|
Facility
OP
|
$257.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
PRO FEE CRITICAL CARE EA ADD 30 MIN
|
Facility
IP
|
$257.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
PRO FEE DESTRUCTION NEUROLYTIC AGT GENI
|
Facility
OP
|
$428.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: AETNA Commercial |
$406.60
|
| Rate for Payer: AETNA Medicare |
$385.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$406.60
|
| Rate for Payer: BCBS Healthlink |
$385.20
|
| Rate for Payer: BCBS HMK CHIP |
$385.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$385.20
|
| Rate for Payer: BCBS POS |
$406.60
|
| Rate for Payer: BCBS Traditional |
$428.00
|
| Rate for Payer: CASH_PRICE |
$342.40
|
| Rate for Payer: CIGNA Commercial |
$406.60
|
| Rate for Payer: CIGNA Medicare |
$385.20
|
| Rate for Payer: HUMANA Commercial |
$385.20
|
| Rate for Payer: MEDICAID Medicaid |
$393.76
|
| Rate for Payer: MEDICARE Medicare |
$299.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$406.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$415.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$406.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$406.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$363.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$342.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$342.40
|
|
|
PRO FEE DESTRUCTION NEUROLYTIC AGT GENI
|
Facility
IP
|
$428.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: AETNA Commercial |
$406.60
|
| Rate for Payer: AETNA Medicare |
$385.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$406.60
|
| Rate for Payer: BCBS Healthlink |
$385.20
|
| Rate for Payer: BCBS HMK CHIP |
$385.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$385.20
|
| Rate for Payer: BCBS POS |
$406.60
|
| Rate for Payer: BCBS Traditional |
$428.00
|
| Rate for Payer: CASH_PRICE |
$342.40
|
| Rate for Payer: CIGNA Commercial |
$406.60
|
| Rate for Payer: CIGNA Medicare |
$385.20
|
| Rate for Payer: HUMANA Commercial |
$385.20
|
| Rate for Payer: MEDICAID Medicaid |
$393.76
|
| Rate for Payer: MEDICARE Medicare |
$299.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$406.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$415.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$406.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$406.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$363.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$342.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$342.40
|
|
|
PRO FEE DRAIN/INJ JOINT/BURSA W/US 20604
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: AETNA Commercial |
$97.85
|
| Rate for Payer: AETNA Medicare |
$92.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$97.85
|
| Rate for Payer: BCBS Healthlink |
$92.70
|
| Rate for Payer: BCBS HMK CHIP |
$92.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$92.70
|
| Rate for Payer: BCBS POS |
$97.85
|
| Rate for Payer: BCBS Traditional |
$103.00
|
| Rate for Payer: CASH_PRICE |
$82.40
|
| Rate for Payer: CIGNA Commercial |
$97.85
|
| Rate for Payer: CIGNA Medicare |
$92.70
|
| Rate for Payer: HUMANA Commercial |
$92.70
|
| Rate for Payer: MEDICAID Medicaid |
$94.76
|
| Rate for Payer: MEDICARE Medicare |
$72.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$97.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$99.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$97.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$97.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$87.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$82.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$82.40
|
|
|
PRO FEE DRAIN/INJ JOINT/BURSA W/US 20604
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: AETNA Commercial |
$97.85
|
| Rate for Payer: AETNA Medicare |
$92.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$97.85
|
| Rate for Payer: BCBS Healthlink |
$92.70
|
| Rate for Payer: BCBS HMK CHIP |
$92.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$92.70
|
| Rate for Payer: BCBS POS |
$97.85
|
| Rate for Payer: BCBS Traditional |
$103.00
|
| Rate for Payer: CASH_PRICE |
$82.40
|
| Rate for Payer: CIGNA Commercial |
$97.85
|
| Rate for Payer: CIGNA Medicare |
$92.70
|
| Rate for Payer: HUMANA Commercial |
$92.70
|
| Rate for Payer: MEDICAID Medicaid |
$94.76
|
| Rate for Payer: MEDICARE Medicare |
$72.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$97.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$99.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$97.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$97.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$87.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$82.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$82.40
|
|
