|
OBSV CARE SAME DAY LOW COMPLEX 99234
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
OBSV CARE SAME DAY MOD COMPLEX 99235
|
Facility
OP
|
$352.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: AETNA Commercial |
$334.40
|
| Rate for Payer: AETNA Medicare |
$316.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$334.40
|
| Rate for Payer: BCBS Healthlink |
$316.80
|
| Rate for Payer: BCBS HMK CHIP |
$316.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$316.80
|
| Rate for Payer: BCBS POS |
$334.40
|
| Rate for Payer: BCBS Traditional |
$352.00
|
| Rate for Payer: CASH_PRICE |
$281.60
|
| Rate for Payer: CIGNA Commercial |
$334.40
|
| Rate for Payer: CIGNA Medicare |
$316.80
|
| Rate for Payer: HUMANA Commercial |
$316.80
|
| Rate for Payer: MEDICAID Medicaid |
$323.84
|
| Rate for Payer: MEDICARE Medicare |
$246.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$334.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$341.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$334.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$334.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$299.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$281.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$281.60
|
|
|
OBSV CARE SAME DAY MOD COMPLEX 99235
|
Facility
IP
|
$352.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: AETNA Commercial |
$334.40
|
| Rate for Payer: AETNA Medicare |
$316.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$334.40
|
| Rate for Payer: BCBS Healthlink |
$316.80
|
| Rate for Payer: BCBS HMK CHIP |
$316.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$316.80
|
| Rate for Payer: BCBS POS |
$334.40
|
| Rate for Payer: BCBS Traditional |
$352.00
|
| Rate for Payer: CASH_PRICE |
$281.60
|
| Rate for Payer: CIGNA Commercial |
$334.40
|
| Rate for Payer: CIGNA Medicare |
$316.80
|
| Rate for Payer: HUMANA Commercial |
$316.80
|
| Rate for Payer: MEDICAID Medicaid |
$323.84
|
| Rate for Payer: MEDICARE Medicare |
$246.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$334.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$341.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$334.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$334.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$299.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$281.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$281.60
|
|
|
OBSV CARE SEP DAY ADMIT HIGH COMP 99223
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: AETNA Commercial |
$329.65
|
| Rate for Payer: AETNA Medicare |
$312.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$329.65
|
| Rate for Payer: BCBS Healthlink |
$312.30
|
| Rate for Payer: BCBS HMK CHIP |
$312.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$312.30
|
| Rate for Payer: BCBS POS |
$329.65
|
| Rate for Payer: BCBS Traditional |
$347.00
|
| Rate for Payer: CASH_PRICE |
$277.60
|
| Rate for Payer: CIGNA Commercial |
$329.65
|
| Rate for Payer: CIGNA Medicare |
$312.30
|
| Rate for Payer: HUMANA Commercial |
$312.30
|
| Rate for Payer: MEDICAID Medicaid |
$319.24
|
| Rate for Payer: MEDICARE Medicare |
$242.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$329.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$336.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$329.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$329.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$294.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$277.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$277.60
|
|
|
OBSV CARE SEP DAY ADMIT HIGH COMP 99223
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: AETNA Commercial |
$329.65
|
| Rate for Payer: AETNA Medicare |
$312.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$329.65
|
| Rate for Payer: BCBS Healthlink |
$312.30
|
| Rate for Payer: BCBS HMK CHIP |
$312.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$312.30
|
| Rate for Payer: BCBS POS |
$329.65
|
| Rate for Payer: BCBS Traditional |
$347.00
|
| Rate for Payer: CASH_PRICE |
$277.60
|
| Rate for Payer: CIGNA Commercial |
$329.65
|
| Rate for Payer: CIGNA Medicare |
$312.30
|
| Rate for Payer: HUMANA Commercial |
$312.30
|
| Rate for Payer: MEDICAID Medicaid |
$319.24
|
| Rate for Payer: MEDICARE Medicare |
$242.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$329.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$336.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$329.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$329.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$294.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$277.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$277.60
|
|
|
OBSV CARE SEP DAY ADMIT LOW COMPL 99221
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
OBSV CARE SEP DAY ADMIT LOW COMPL 99221
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
OBSV CARE SEP DAY ADMIT MOD COMPL 99222
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
OBSV CARE SEP DAY ADMIT MOD COMPL 99222
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
OBSV CARE SEP DAY DISCHARGE 99217
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 99217
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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 CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
OBSV CARE SEP DAY DISCHARGE 99217
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT 99217
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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 CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
OBSV CARE SEP DISCHARGE 30 MIN/LESS
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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 CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
OBSV CARE SEP DISCHARGE 30 MIN/LESS
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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 CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
OBSV CARE SUBSEQUENT CARE HIGH COMPLE
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
CPT 99233 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: AETNA Commercial |
$215.65
|
| Rate for Payer: AETNA Medicare |
$204.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$215.65
|
| Rate for Payer: BCBS Healthlink |
$204.30
|
| Rate for Payer: BCBS HMK CHIP |
$204.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$204.30
|
| Rate for Payer: BCBS POS |
$215.65
|
| Rate for Payer: BCBS Traditional |
$227.00
|
| Rate for Payer: CASH_PRICE |
$181.60
|
| Rate for Payer: CIGNA Commercial |
$215.65
|
| Rate for Payer: CIGNA Medicare |
$204.30
|
| Rate for Payer: HUMANA Commercial |
$204.30
|
| Rate for Payer: MEDICAID Medicaid |
$208.84
|
| Rate for Payer: MEDICARE Medicare |
$158.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$215.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$220.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$215.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$215.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$181.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$181.60
|
|
|
OBSV CARE SUBSEQUENT CARE HIGH COMPLE
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
CPT 99233 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: AETNA Commercial |
$215.65
|
| Rate for Payer: AETNA Medicare |
$204.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$215.65
|
| Rate for Payer: BCBS Healthlink |
$204.30
|
| Rate for Payer: BCBS HMK CHIP |
$204.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$204.30
|
| Rate for Payer: BCBS POS |
$215.65
|
| Rate for Payer: BCBS Traditional |
$227.00
|
| Rate for Payer: CASH_PRICE |
$181.60
|
| Rate for Payer: CIGNA Commercial |
$215.65
|
| Rate for Payer: CIGNA Medicare |
$204.30
|
| Rate for Payer: HUMANA Commercial |
$204.30
|
| Rate for Payer: MEDICAID Medicaid |
$208.84
|
| Rate for Payer: MEDICARE Medicare |
$158.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$215.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$220.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$215.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$215.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$181.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$181.60
|
|
|
OBSV CARE SUBSEQUENT CARE LOW COMPLEX
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 99231 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: AETNA Commercial |
$95.00
|
| Rate for Payer: AETNA Medicare |
$90.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$95.00
|
| Rate for Payer: BCBS Healthlink |
$90.00
|
| Rate for Payer: BCBS HMK CHIP |
$90.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$90.00
|
| Rate for Payer: BCBS POS |
$95.00
|
| Rate for Payer: BCBS Traditional |
$100.00
|
| Rate for Payer: CASH_PRICE |
$80.00
|
| Rate for Payer: CIGNA Commercial |
$95.00
|
| Rate for Payer: CIGNA Medicare |
$90.00
|
| Rate for Payer: HUMANA Commercial |
$90.00
|
| Rate for Payer: MEDICAID Medicaid |
$92.00
|
| Rate for Payer: MEDICARE Medicare |
$70.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$95.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$97.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$95.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$95.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$85.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$80.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$80.00
|
|
|
OBSV CARE SUBSEQUENT CARE LOW COMPLEX
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 99231 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: AETNA Commercial |
$95.00
|
| Rate for Payer: AETNA Medicare |
$90.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$95.00
|
| Rate for Payer: BCBS Healthlink |
$90.00
|
| Rate for Payer: BCBS HMK CHIP |
$90.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$90.00
|
| Rate for Payer: BCBS POS |
$95.00
|
| Rate for Payer: BCBS Traditional |
$100.00
|
| Rate for Payer: CASH_PRICE |
$80.00
|
| Rate for Payer: CIGNA Commercial |
$95.00
|
| Rate for Payer: CIGNA Medicare |
$90.00
|
| Rate for Payer: HUMANA Commercial |
$90.00
|
| Rate for Payer: MEDICAID Medicaid |
$92.00
|
| Rate for Payer: MEDICARE Medicare |
$70.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$95.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$97.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$95.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$95.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$85.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$80.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$80.00
|
|
|
OBSV CARE SUBSEQUENT CARE MED COMPLEX
|
Facility
IP
|
$163.00
|
|
|
Service Code
|
CPT 99232 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: AETNA Commercial |
$154.85
|
| Rate for Payer: AETNA Medicare |
$146.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$154.85
|
| Rate for Payer: BCBS Healthlink |
$146.70
|
| Rate for Payer: BCBS HMK CHIP |
$146.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$146.70
|
| Rate for Payer: BCBS POS |
$154.85
|
| Rate for Payer: BCBS Traditional |
$163.00
|
| Rate for Payer: CASH_PRICE |
$130.40
|
| Rate for Payer: CIGNA Commercial |
$154.85
|
| Rate for Payer: CIGNA Medicare |
$146.70
|
| Rate for Payer: HUMANA Commercial |
$146.70
|
| Rate for Payer: MEDICAID Medicaid |
$149.96
|
| Rate for Payer: MEDICARE Medicare |
$114.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$154.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$158.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$154.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$154.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$138.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$130.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$130.40
|
|
|
OBSV CARE SUBSEQUENT CARE MED COMPLEX
|
Facility
OP
|
$163.00
|
|
|
Service Code
|
CPT 99232 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$114.10 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: AETNA Commercial |
$154.85
|
| Rate for Payer: AETNA Medicare |
$146.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$154.85
|
| Rate for Payer: BCBS Healthlink |
$146.70
|
| Rate for Payer: BCBS HMK CHIP |
$146.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$146.70
|
| Rate for Payer: BCBS POS |
$154.85
|
| Rate for Payer: BCBS Traditional |
$163.00
|
| Rate for Payer: CASH_PRICE |
$130.40
|
| Rate for Payer: CIGNA Commercial |
$154.85
|
| Rate for Payer: CIGNA Medicare |
$146.70
|
| Rate for Payer: HUMANA Commercial |
$146.70
|
| Rate for Payer: MEDICAID Medicaid |
$149.96
|
| Rate for Payer: MEDICARE Medicare |
$114.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$154.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$158.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$154.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$154.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$138.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$130.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$130.40
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
OCCULT BLOOD, FECAL X 1
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
OCCULT BLOOD, FECAL X 1
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
OCCULT BLOOD, FECAL X 3
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: AETNA Commercial |
$41.80
|
| Rate for Payer: AETNA Medicare |
$39.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$41.80
|
| Rate for Payer: BCBS Healthlink |
$39.60
|
| Rate for Payer: BCBS HMK CHIP |
$39.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.60
|
| Rate for Payer: BCBS POS |
$41.80
|
| Rate for Payer: BCBS Traditional |
$44.00
|
| Rate for Payer: CASH_PRICE |
$35.20
|
| Rate for Payer: CIGNA Commercial |
$41.80
|
| Rate for Payer: CIGNA Medicare |
$39.60
|
| Rate for Payer: HUMANA Commercial |
$39.60
|
| Rate for Payer: MEDICAID Medicaid |
$40.48
|
| Rate for Payer: MEDICARE Medicare |
$30.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$41.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$42.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$41.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$41.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.20
|
|
|
OCCULT BLOOD, FECAL X 3
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: AETNA Commercial |
$41.80
|
| Rate for Payer: AETNA Medicare |
$39.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$41.80
|
| Rate for Payer: BCBS Healthlink |
$39.60
|
| Rate for Payer: BCBS HMK CHIP |
$39.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.60
|
| Rate for Payer: BCBS POS |
$41.80
|
| Rate for Payer: BCBS Traditional |
$44.00
|
| Rate for Payer: CASH_PRICE |
$35.20
|
| Rate for Payer: CIGNA Commercial |
$41.80
|
| Rate for Payer: CIGNA Medicare |
$39.60
|
| Rate for Payer: HUMANA Commercial |
$39.60
|
| Rate for Payer: MEDICAID Medicaid |
$40.48
|
| Rate for Payer: MEDICARE Medicare |
$30.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$41.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$42.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$41.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$41.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.20
|
|
