|
PRO FEE ER CRITICAL CARE 1HR 99291
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
799291
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$443.10 |
| Max. Negotiated Rate |
$633.00 |
| Rate for Payer: Aetna Commercial |
$601.35
|
| Rate for Payer: Aetna Medicare |
$569.70
|
| Rate for Payer: BCBS MT CHIP |
$569.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$601.35
|
| Rate for Payer: BCBS MT HealthLink |
$569.70
|
| Rate for Payer: BCBS MT Medicare |
$569.70
|
| Rate for Payer: BCBS MT POS |
$601.35
|
| Rate for Payer: BCBS MT Traditional |
$633.00
|
| Rate for Payer: Cash Price |
$569.70
|
| Rate for Payer: Cigna Commercial |
$601.35
|
| Rate for Payer: Cigna Medicare |
$569.70
|
| Rate for Payer: Medicaid All Medicaid |
$582.36
|
| Rate for Payer: Medicare All Medicare |
$443.10
|
| Rate for Payer: Monida Allegiance |
$601.35
|
| Rate for Payer: Monida First Choice Health |
$614.01
|
| Rate for Payer: Monida Montana Health Co-op |
$601.35
|
| Rate for Payer: Monida PacificSource |
$601.35
|
|
|
PRO FEE ER CRITICAL CARE E ADD 30m 99292
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
799292
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Medicare |
$284.40
|
| Rate for Payer: BCBS MT CHIP |
$284.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$300.20
|
| Rate for Payer: BCBS MT HealthLink |
$284.40
|
| Rate for Payer: BCBS MT Medicare |
$284.40
|
| Rate for Payer: BCBS MT POS |
$300.20
|
| Rate for Payer: BCBS MT Traditional |
$316.00
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cigna Medicare |
$284.40
|
| Rate for Payer: Medicaid All Medicaid |
$290.72
|
| Rate for Payer: Medicare All Medicare |
$221.20
|
| Rate for Payer: Monida Allegiance |
$300.20
|
| Rate for Payer: Monida First Choice Health |
$306.52
|
| Rate for Payer: Monida Montana Health Co-op |
$300.20
|
| Rate for Payer: Monida PacificSource |
$300.20
|
|
|
PRO FEE ER EXTENDED 99284
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
799284
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$219.10 |
| Max. Negotiated Rate |
$313.00 |
| Rate for Payer: Aetna Commercial |
$297.35
|
| Rate for Payer: Aetna Medicare |
$281.70
|
| Rate for Payer: BCBS MT CHIP |
$281.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$297.35
|
| Rate for Payer: BCBS MT HealthLink |
$281.70
|
| Rate for Payer: BCBS MT Medicare |
$281.70
|
| Rate for Payer: BCBS MT POS |
$297.35
|
| Rate for Payer: BCBS MT Traditional |
$313.00
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$297.35
|
| Rate for Payer: Cigna Medicare |
$281.70
|
| Rate for Payer: Medicaid All Medicaid |
$287.96
|
| Rate for Payer: Medicare All Medicare |
$219.10
|
| Rate for Payer: Monida Allegiance |
$297.35
|
| Rate for Payer: Monida First Choice Health |
$303.61
|
| Rate for Payer: Monida Montana Health Co-op |
$297.35
|
| Rate for Payer: Monida PacificSource |
$297.35
|
|
|
PRO FEE ER INTERMEDIATE 99283
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
799283
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna Commercial |
$158.65
|
| Rate for Payer: Aetna Medicare |
$150.30
|
| Rate for Payer: BCBS MT CHIP |
$150.30
|
| Rate for Payer: BCBS MT Closed Plan Network |
$158.65
|
| Rate for Payer: BCBS MT HealthLink |
$150.30
|
| Rate for Payer: BCBS MT Medicare |
$150.30
|
| Rate for Payer: BCBS MT POS |
$158.65
|
| Rate for Payer: BCBS MT Traditional |
$167.00
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$158.65
|
| Rate for Payer: Cigna Medicare |
$150.30
|
| Rate for Payer: Medicaid All Medicaid |
$153.64
|
| Rate for Payer: Medicare All Medicare |
$116.90
|
| Rate for Payer: Monida Allegiance |
$158.65
|
| Rate for Payer: Monida First Choice Health |
$161.99
|
| Rate for Payer: Monida Montana Health Co-op |
$158.65
|
| Rate for Payer: Monida PacificSource |
$158.65
|
|
|
PRO FEE ER INTUBATION ENDOTRACHEAL 31500
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
731500
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Medicare |
$284.40
|
| Rate for Payer: BCBS MT CHIP |
$284.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$300.20
|
| Rate for Payer: BCBS MT HealthLink |
$284.40
|
| Rate for Payer: BCBS MT Medicare |
$284.40
|
| Rate for Payer: BCBS MT POS |
$300.20
|
| Rate for Payer: BCBS MT Traditional |
$316.00
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cigna Medicare |
$284.40
|
| Rate for Payer: Medicaid All Medicaid |
$290.72
|
| Rate for Payer: Medicare All Medicare |
$221.20
|
| Rate for Payer: Monida Allegiance |
$300.20
|
| Rate for Payer: Monida First Choice Health |
$306.52
|
| Rate for Payer: Monida Montana Health Co-op |
$300.20
|
| Rate for Payer: Monida PacificSource |
$300.20
|
|
|
PRO FEE ER LIMITED 99282
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
799282
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Medicare |
$116.10
|
| Rate for Payer: BCBS MT CHIP |
$116.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$122.55
|
| Rate for Payer: BCBS MT HealthLink |
$116.10
|
| Rate for Payer: BCBS MT Medicare |
$116.10
|
| Rate for Payer: BCBS MT POS |
$122.55
|
| Rate for Payer: BCBS MT Traditional |
$129.00
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$122.55
|
| Rate for Payer: Cigna Medicare |
$116.10
|
| Rate for Payer: Medicaid All Medicaid |
$118.68
|
| Rate for Payer: Medicare All Medicare |
$90.30
|
| Rate for Payer: Monida Allegiance |
$122.55
|
| Rate for Payer: Monida First Choice Health |
$125.13
|
| Rate for Payer: Monida Montana Health Co-op |
$122.55
|
| Rate for Payer: Monida PacificSource |
$122.55
|
|
|
PRO FEE ER OP INJ TRIGEM NRV BLC 64400
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
764401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Medicare |
$243.90
|
| Rate for Payer: BCBS MT CHIP |
$243.90
|
| Rate for Payer: BCBS MT Closed Plan Network |
$257.45
|
| Rate for Payer: BCBS MT HealthLink |
$243.90
|
| Rate for Payer: BCBS MT Medicare |
$243.90
|
| Rate for Payer: BCBS MT POS |
$257.45
|
| Rate for Payer: BCBS MT Traditional |
$271.00
|
| Rate for Payer: Cash Price |
$243.90
|
| Rate for Payer: Cigna Commercial |
$257.45
|
| Rate for Payer: Cigna Medicare |
$243.90
|
| Rate for Payer: Medicaid All Medicaid |
$249.32
|
| Rate for Payer: Medicare All Medicare |
$189.70
|
| Rate for Payer: Monida Allegiance |
$257.45
|
| Rate for Payer: Monida First Choice Health |
$262.87
|
| Rate for Payer: Monida Montana Health Co-op |
$257.45
|
| Rate for Payer: Monida PacificSource |
$257.45
|
|
|
PRO FEE ER REMOVAL FB-INTRANASAL (30300)
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
730300
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Medicare |
$284.40
|
| Rate for Payer: BCBS MT CHIP |
$284.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$300.20
|
| Rate for Payer: BCBS MT HealthLink |
$284.40
|
| Rate for Payer: BCBS MT Medicare |
$284.40
|
| Rate for Payer: BCBS MT POS |
$300.20
|
| Rate for Payer: BCBS MT Traditional |
$316.00
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cigna Medicare |
$284.40
|
| Rate for Payer: Medicaid All Medicaid |
$290.72
|
| Rate for Payer: Medicare All Medicare |
$221.20
|
| Rate for Payer: Monida Allegiance |
$300.20
|
| Rate for Payer: Monida First Choice Health |
$306.52
|
| Rate for Payer: Monida Montana Health Co-op |
$300.20
|
| Rate for Payer: Monida PacificSource |
$300.20
|
|
|
PRO FEE ER STRAPPING OF WRIST
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
729260
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Medicare |
$86.40
|
| Rate for Payer: BCBS MT CHIP |
$86.40
|
| Rate for Payer: BCBS MT Closed Plan Network |
$91.20
|
| Rate for Payer: BCBS MT HealthLink |
$86.40
|
| Rate for Payer: BCBS MT Medicare |
$86.40
|
| Rate for Payer: BCBS MT POS |
$91.20
|
| Rate for Payer: BCBS MT Traditional |
$96.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cigna Medicare |
$86.40
|
| Rate for Payer: Medicaid All Medicaid |
$88.32
|
| Rate for Payer: Medicare All Medicare |
$67.20
|
| Rate for Payer: Monida Allegiance |
$91.20
|
| Rate for Payer: Monida First Choice Health |
$93.12
|
| Rate for Payer: Monida Montana Health Co-op |
$91.20
|
| Rate for Payer: Monida PacificSource |
$91.20
|
|
|
PRO FEE ER TX OF TOE FRACTURE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
728515
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$30.40
|
| Rate for Payer: Aetna Medicare |
$28.80
|
| Rate for Payer: BCBS MT CHIP |
$28.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$30.40
|
| Rate for Payer: BCBS MT HealthLink |
$28.80
|
| Rate for Payer: BCBS MT Medicare |
$28.80
|
| Rate for Payer: BCBS MT POS |
$30.40
|
| Rate for Payer: BCBS MT Traditional |
$32.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$30.40
|
| Rate for Payer: Cigna Medicare |
$28.80
|
| Rate for Payer: Medicaid All Medicaid |
$29.44
|
| Rate for Payer: Medicare All Medicare |
$22.40
|
| Rate for Payer: Monida Allegiance |
$30.40
|
| Rate for Payer: Monida First Choice Health |
$31.04
|
| Rate for Payer: Monida Montana Health Co-op |
$30.40
|
| Rate for Payer: Monida PacificSource |
$30.40
|
|
|
PRO FEE EXC MALIGNANT LESION INC MARGINS
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
711602
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$299.73 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Medicare |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Medicaid All Medicaid |
$284.28
|
| Rate for Payer: Medicare All Medicare |
$216.30
|
| Rate for Payer: Monida Allegiance |
$293.55
|
| Rate for Payer: Monida First Choice Health |
$299.73
|
| Rate for Payer: Monida Montana Health Co-op |
$293.55
|
| Rate for Payer: Monida PacificSource |
$293.55
|
|
|
PROFEE FETAL BIOPHYS PROFIL W/O NST
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
50002400
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Aetna Commercial |
$133.95
|
| Rate for Payer: Aetna Medicare |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Medicaid All Medicaid |
$129.72
|
| Rate for Payer: Medicare All Medicare |
$98.70
|
| Rate for Payer: Monida Allegiance |
$133.95
|
| Rate for Payer: Monida First Choice Health |
$136.77
|
| Rate for Payer: Monida Montana Health Co-op |
$133.95
|
| Rate for Payer: Monida PacificSource |
$133.95
|
|
|
PRO FEE FOREIGN BODY REMOVAL-EAR 69200
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
769200
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.85
|
| Rate for Payer: Aetna Medicare |
$56.70
|
| Rate for Payer: BCBS MT CHIP |
$56.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$59.85
|
| Rate for Payer: BCBS MT HealthLink |
$56.70
|
| Rate for Payer: BCBS MT Medicare |
$56.70
|
| Rate for Payer: BCBS MT POS |
$59.85
|
| Rate for Payer: BCBS MT Traditional |
$63.00
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$59.85
|
| Rate for Payer: Cigna Medicare |
$56.70
|
| Rate for Payer: Medicaid All Medicaid |
$57.96
|
| Rate for Payer: Medicare All Medicare |
$44.10
|
| Rate for Payer: Monida Allegiance |
$59.85
|
| Rate for Payer: Monida First Choice Health |
$61.11
|
| Rate for Payer: Monida Montana Health Co-op |
$59.85
|
| Rate for Payer: Monida PacificSource |
$59.85
|
|
|
PRO FEE FOREIGN BODY REMOVAL EYE
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
765205
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Medicare |
$81.00
|
| Rate for Payer: BCBS MT CHIP |
$81.00
|
| Rate for Payer: BCBS MT Closed Plan Network |
$85.50
|
| Rate for Payer: BCBS MT HealthLink |
$81.00
|
| Rate for Payer: BCBS MT Medicare |
$81.00
|
| Rate for Payer: BCBS MT POS |
$85.50
|
| Rate for Payer: BCBS MT Traditional |
$90.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cigna Medicare |
$81.00
|
| Rate for Payer: Medicaid All Medicaid |
$82.80
|
| Rate for Payer: Medicare All Medicare |
$63.00
|
| Rate for Payer: Monida Allegiance |
$85.50
|
| Rate for Payer: Monida First Choice Health |
$87.30
|
| Rate for Payer: Monida Montana Health Co-op |
$85.50
|
| Rate for Payer: Monida PacificSource |
$85.50
|
|
|
PROFEE FXR FULL SPINE W SKULL 2 OR 3 VIE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
50002255
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Medicaid All Medicaid |
$40.48
|
| Rate for Payer: Medicare All Medicare |
$30.80
|
| Rate for Payer: Monida Allegiance |
$41.80
|
| Rate for Payer: Monida First Choice Health |
$42.68
|
| Rate for Payer: Monida Montana Health Co-op |
$41.80
|
| Rate for Payer: Monida PacificSource |
$41.80
|
|
|
PRO FEE I&D ABCESS/CYST SIMPLE
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
710060
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$200.79 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: Aetna Medicare |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Medicaid All Medicaid |
$190.44
|
| Rate for Payer: Medicare All Medicare |
$144.90
|
| Rate for Payer: Monida Allegiance |
$196.65
|
| Rate for Payer: Monida First Choice Health |
$200.79
|
| Rate for Payer: Monida Montana Health Co-op |
$196.65
|
| Rate for Payer: Monida PacificSource |
$196.65
|
|
|
PRO FEE INC&REMOVAL FOREIGN BODY-SIMPLE
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
710120
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$183.60
|
| Rate for Payer: BCBS MT CHIP |
$183.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$193.80
|
| Rate for Payer: BCBS MT HealthLink |
$183.60
|
| Rate for Payer: BCBS MT Medicare |
$183.60
|
| Rate for Payer: BCBS MT POS |
$193.80
|
| Rate for Payer: BCBS MT Traditional |
$204.00
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: Cigna Medicare |
$183.60
|
| Rate for Payer: Medicaid All Medicaid |
$187.68
|
| Rate for Payer: Medicare All Medicare |
$142.80
|
| Rate for Payer: Monida Allegiance |
$193.80
|
| Rate for Payer: Monida First Choice Health |
$197.88
|
| Rate for Payer: Monida Montana Health Co-op |
$193.80
|
| Rate for Payer: Monida PacificSource |
$193.80
|
|
|
PROFEE INJ ASPIR JOINT INJ INTERM 20605
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
7620605
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Medicare |
$170.10
|
| Rate for Payer: BCBS MT CHIP |
$170.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$179.55
|
| Rate for Payer: BCBS MT HealthLink |
$170.10
|
| Rate for Payer: BCBS MT Medicare |
$170.10
|
| Rate for Payer: BCBS MT POS |
$179.55
|
| Rate for Payer: BCBS MT Traditional |
$189.00
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cigna Medicare |
$170.10
|
| Rate for Payer: Medicaid All Medicaid |
$173.88
|
| Rate for Payer: Medicare All Medicare |
$132.30
|
| Rate for Payer: Monida Allegiance |
$179.55
|
| Rate for Payer: Monida First Choice Health |
$183.33
|
| Rate for Payer: Monida Montana Health Co-op |
$179.55
|
| Rate for Payer: Monida PacificSource |
$179.55
|
|
|
PRO FEE INJECTION, THERAPEUTIC CARPAL TN
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
720526
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$279.30
|
| Rate for Payer: Aetna Medicare |
$264.60
|
| Rate for Payer: BCBS MT CHIP |
$264.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$279.30
|
| Rate for Payer: BCBS MT HealthLink |
$264.60
|
| Rate for Payer: BCBS MT Medicare |
$264.60
|
| Rate for Payer: BCBS MT POS |
$279.30
|
| Rate for Payer: BCBS MT Traditional |
$294.00
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$279.30
|
| Rate for Payer: Cigna Medicare |
$264.60
|
| Rate for Payer: Medicaid All Medicaid |
$270.48
|
| Rate for Payer: Medicare All Medicare |
$205.80
|
| Rate for Payer: Monida Allegiance |
$279.30
|
| Rate for Payer: Monida First Choice Health |
$285.18
|
| Rate for Payer: Monida Montana Health Co-op |
$279.30
|
| Rate for Payer: Monida PacificSource |
$279.30
|
|
|
PRO FEE INJ FACET JNT C/T 2L W/IMA 64491
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
764491
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna Commercial |
$289.75
|
| Rate for Payer: Aetna Medicare |
$274.50
|
| Rate for Payer: BCBS MT CHIP |
$274.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$289.75
|
| Rate for Payer: BCBS MT HealthLink |
$274.50
|
| Rate for Payer: BCBS MT Medicare |
$274.50
|
| Rate for Payer: BCBS MT POS |
$289.75
|
| Rate for Payer: BCBS MT Traditional |
$305.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$289.75
|
| Rate for Payer: Cigna Medicare |
$274.50
|
| Rate for Payer: Medicaid All Medicaid |
$280.60
|
| Rate for Payer: Medicare All Medicare |
$213.50
|
| Rate for Payer: Monida Allegiance |
$289.75
|
| Rate for Payer: Monida First Choice Health |
$295.85
|
| Rate for Payer: Monida Montana Health Co-op |
$289.75
|
| Rate for Payer: Monida PacificSource |
$289.75
|
|
|
PRO FEE INTERCOSTAL NV BLK EA ADD 64421
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
764421
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$118.75
|
| Rate for Payer: Aetna Medicare |
$112.50
|
| Rate for Payer: BCBS MT CHIP |
$112.50
|
| Rate for Payer: BCBS MT Closed Plan Network |
$118.75
|
| Rate for Payer: BCBS MT HealthLink |
$112.50
|
| Rate for Payer: BCBS MT Medicare |
$112.50
|
| Rate for Payer: BCBS MT POS |
$118.75
|
| Rate for Payer: BCBS MT Traditional |
$125.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$118.75
|
| Rate for Payer: Cigna Medicare |
$112.50
|
| Rate for Payer: Medicaid All Medicaid |
$115.00
|
| Rate for Payer: Medicare All Medicare |
$87.50
|
| Rate for Payer: Monida Allegiance |
$118.75
|
| Rate for Payer: Monida First Choice Health |
$121.25
|
| Rate for Payer: Monida Montana Health Co-op |
$118.75
|
| Rate for Payer: Monida PacificSource |
$118.75
|
|
|
PRO FEE INTERMED JOINT INJ W/O US 20605
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
720605
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Medicare |
$170.10
|
| Rate for Payer: BCBS MT CHIP |
$170.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$179.55
|
| Rate for Payer: BCBS MT HealthLink |
$170.10
|
| Rate for Payer: BCBS MT Medicare |
$170.10
|
| Rate for Payer: BCBS MT POS |
$179.55
|
| Rate for Payer: BCBS MT Traditional |
$189.00
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cigna Medicare |
$170.10
|
| Rate for Payer: Medicaid All Medicaid |
$173.88
|
| Rate for Payer: Medicare All Medicare |
$132.30
|
| Rate for Payer: Monida Allegiance |
$179.55
|
| Rate for Payer: Monida First Choice Health |
$183.33
|
| Rate for Payer: Monida Montana Health Co-op |
$179.55
|
| Rate for Payer: Monida PacificSource |
$179.55
|
|
|
PRO FEE INT/INJ GENICULAR NERVE 64454
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
764454
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$296.80 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$402.80
|
| Rate for Payer: Aetna Medicare |
$381.60
|
| Rate for Payer: BCBS MT CHIP |
$381.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$402.80
|
| Rate for Payer: BCBS MT HealthLink |
$381.60
|
| Rate for Payer: BCBS MT Medicare |
$381.60
|
| Rate for Payer: BCBS MT POS |
$402.80
|
| Rate for Payer: BCBS MT Traditional |
$424.00
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Cigna Commercial |
$402.80
|
| Rate for Payer: Cigna Medicare |
$381.60
|
| Rate for Payer: Medicaid All Medicaid |
$390.08
|
| Rate for Payer: Medicare All Medicare |
$296.80
|
| Rate for Payer: Monida Allegiance |
$402.80
|
| Rate for Payer: Monida First Choice Health |
$411.28
|
| Rate for Payer: Monida Montana Health Co-op |
$402.80
|
| Rate for Payer: Monida PacificSource |
$402.80
|
|
|
PRO FEE INTRCOST NRVE BLOCK SINGLE 64420
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
764420
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Aetna Medicare |
$271.80
|
| Rate for Payer: BCBS MT CHIP |
$271.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$286.90
|
| Rate for Payer: BCBS MT HealthLink |
$271.80
|
| Rate for Payer: BCBS MT Medicare |
$271.80
|
| Rate for Payer: BCBS MT POS |
$286.90
|
| Rate for Payer: BCBS MT Traditional |
$302.00
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna Commercial |
$286.90
|
| Rate for Payer: Cigna Medicare |
$271.80
|
| Rate for Payer: Medicaid All Medicaid |
$277.84
|
| Rate for Payer: Medicare All Medicare |
$211.40
|
| Rate for Payer: Monida Allegiance |
$286.90
|
| Rate for Payer: Monida First Choice Health |
$292.94
|
| Rate for Payer: Monida Montana Health Co-op |
$286.90
|
| Rate for Payer: Monida PacificSource |
$286.90
|
|
|
PRO FEE IP/OPO SEPARATE DAY DISCHG 30MI
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
799238
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: Aetna Commercial |
$215.65
|
| Rate for Payer: Aetna Medicare |
$204.30
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Medicaid All Medicaid |
$208.84
|
| Rate for Payer: Medicare All Medicare |
$158.90
|
| Rate for Payer: Monida Allegiance |
$215.65
|
| Rate for Payer: Monida First Choice Health |
$220.19
|
| Rate for Payer: Monida Montana Health Co-op |
$215.65
|
| Rate for Payer: Monida PacificSource |
$215.65
|
|
