|
OP INJ RFA L/S 1ST JOINT 64635
|
Facility
OP
|
$2,441.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,708.70 |
| Max. Negotiated Rate |
$2,441.00 |
| Rate for Payer: AETNA Commercial |
$2,318.95
|
| Rate for Payer: AETNA Medicare |
$2,196.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,318.95
|
| Rate for Payer: BCBS Healthlink |
$2,196.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,196.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,196.90
|
| Rate for Payer: BCBS POS |
$2,318.95
|
| Rate for Payer: BCBS Traditional |
$2,441.00
|
| Rate for Payer: CASH_PRICE |
$1,952.80
|
| Rate for Payer: CIGNA Commercial |
$2,318.95
|
| Rate for Payer: CIGNA Medicare |
$2,196.90
|
| Rate for Payer: HUMANA Commercial |
$2,196.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,245.72
|
| Rate for Payer: MEDICARE Medicare |
$1,708.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,318.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,367.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,318.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,318.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,074.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,952.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,952.80
|
|
|
OP INJ RFA L/S EADD JOINT 64636
|
Facility
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$905.80 |
| Max. Negotiated Rate |
$1,294.00 |
| Rate for Payer: AETNA Commercial |
$1,229.30
|
| Rate for Payer: AETNA Medicare |
$1,164.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,229.30
|
| Rate for Payer: BCBS Healthlink |
$1,164.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,164.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,164.60
|
| Rate for Payer: BCBS POS |
$1,229.30
|
| Rate for Payer: BCBS Traditional |
$1,294.00
|
| Rate for Payer: CASH_PRICE |
$1,035.20
|
| Rate for Payer: CIGNA Commercial |
$1,229.30
|
| Rate for Payer: CIGNA Medicare |
$1,164.60
|
| Rate for Payer: HUMANA Commercial |
$1,164.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,190.48
|
| Rate for Payer: MEDICARE Medicare |
$905.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,255.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,229.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,099.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,035.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,035.20
|
|
|
OP INJ RFA L/S EADD JOINT 64636
|
Facility
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$905.80 |
| Max. Negotiated Rate |
$1,294.00 |
| Rate for Payer: AETNA Commercial |
$1,229.30
|
| Rate for Payer: AETNA Medicare |
$1,164.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,229.30
|
| Rate for Payer: BCBS Healthlink |
$1,164.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,164.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,164.60
|
| Rate for Payer: BCBS POS |
$1,229.30
|
| Rate for Payer: BCBS Traditional |
$1,294.00
|
| Rate for Payer: CASH_PRICE |
$1,035.20
|
| Rate for Payer: CIGNA Commercial |
$1,229.30
|
| Rate for Payer: CIGNA Medicare |
$1,164.60
|
| Rate for Payer: HUMANA Commercial |
$1,164.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,190.48
|
| Rate for Payer: MEDICARE Medicare |
$905.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,255.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,229.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,099.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,035.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,035.20
|
|
|
OP INJ SACROILLIAC W/IMAGE 27096
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
OP INJ SACROILLIAC W/IMAGE 27096
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
OP INJ SCIATIC NERVE BLOCK 64445
|
Facility
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$1,277.50 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: AETNA Commercial |
$1,733.75
|
| Rate for Payer: AETNA Medicare |
$1,642.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,733.75
|
| Rate for Payer: BCBS Healthlink |
$1,642.50
|
| Rate for Payer: BCBS HMK CHIP |
$1,642.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,642.50
|
| Rate for Payer: BCBS POS |
$1,733.75
|
| Rate for Payer: BCBS Traditional |
$1,825.00
|
| Rate for Payer: CASH_PRICE |
$1,460.00
|
| Rate for Payer: CIGNA Commercial |
$1,733.75
|
| Rate for Payer: CIGNA Medicare |
$1,642.50
|
| Rate for Payer: HUMANA Commercial |
$1,642.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,679.00
|
| Rate for Payer: MEDICARE Medicare |
$1,277.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,733.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,770.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,733.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,733.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,551.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,460.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,460.00
|
|
|
OP INJ SCIATIC NERVE BLOCK 64445
|
Facility
OP
|
$1,825.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$1,277.50 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: AETNA Commercial |
$1,733.75
|
| Rate for Payer: AETNA Medicare |
$1,642.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,733.75
|
| Rate for Payer: BCBS Healthlink |
$1,642.50
|
| Rate for Payer: BCBS HMK CHIP |
$1,642.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,642.50
|
| Rate for Payer: BCBS POS |
$1,733.75
|
| Rate for Payer: BCBS Traditional |
$1,825.00
|
| Rate for Payer: CASH_PRICE |
$1,460.00
|
| Rate for Payer: CIGNA Commercial |
$1,733.75
|
| Rate for Payer: CIGNA Medicare |
$1,642.50
|
| Rate for Payer: HUMANA Commercial |
$1,642.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,679.00
|
| Rate for Payer: MEDICARE Medicare |
$1,277.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,733.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,770.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,733.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,733.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,551.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,460.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,460.00
|
|
|
OP INJ SPHENOPALGANG BLOC 64505
|
Facility
OP
|
$614.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.80 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: AETNA Commercial |
$583.30
|
| Rate for Payer: AETNA Medicare |
$552.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$583.30
|
| Rate for Payer: BCBS Healthlink |
$552.60
|
| Rate for Payer: BCBS HMK CHIP |
$552.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$552.60
|
| Rate for Payer: BCBS POS |
$583.30
|
| Rate for Payer: BCBS Traditional |
$614.00
|
| Rate for Payer: CASH_PRICE |
$491.20
|
| Rate for Payer: CIGNA Commercial |
$583.30
|
| Rate for Payer: CIGNA Medicare |
$552.60
|
| Rate for Payer: HUMANA Commercial |
$552.60
|
| Rate for Payer: MEDICAID Medicaid |
$564.88
|
| Rate for Payer: MEDICARE Medicare |
$429.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$583.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$595.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$583.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$583.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$521.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$491.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$491.20
|
|
|
OP INJ SPHENOPALGANG BLOC 64505
|
Facility
IP
|
$614.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.80 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: AETNA Commercial |
$583.30
|
| Rate for Payer: AETNA Medicare |
$552.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$583.30
|
| Rate for Payer: BCBS Healthlink |
$552.60
|
| Rate for Payer: BCBS HMK CHIP |
$552.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$552.60
|
| Rate for Payer: BCBS POS |
$583.30
|
| Rate for Payer: BCBS Traditional |
$614.00
|
| Rate for Payer: CASH_PRICE |
$491.20
|
| Rate for Payer: CIGNA Commercial |
$583.30
|
| Rate for Payer: CIGNA Medicare |
$552.60
|
| Rate for Payer: HUMANA Commercial |
$552.60
|
| Rate for Payer: MEDICAID Medicaid |
$564.88
|
| Rate for Payer: MEDICARE Medicare |
$429.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$583.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$595.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$583.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$583.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$521.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$491.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$491.20
|
|
|
OP INJ STELLATE GANG BLOCK 64510
|
Facility
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$912.10 |
| Max. Negotiated Rate |
$1,303.00 |
| Rate for Payer: AETNA Commercial |
$1,237.85
|
| Rate for Payer: AETNA Medicare |
$1,172.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,237.85
|
| Rate for Payer: BCBS Healthlink |
$1,172.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,172.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,172.70
|
| Rate for Payer: BCBS POS |
$1,237.85
|
| Rate for Payer: BCBS Traditional |
$1,303.00
|
| Rate for Payer: CASH_PRICE |
$1,042.40
|
| Rate for Payer: CIGNA Commercial |
$1,237.85
|
| Rate for Payer: CIGNA Medicare |
$1,172.70
|
| Rate for Payer: HUMANA Commercial |
$1,172.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,198.76
|
| Rate for Payer: MEDICARE Medicare |
$912.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,237.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,263.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,237.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,237.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,107.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,042.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,042.40
|
|
|
OP INJ STELLATE GANG BLOCK 64510
|
Facility
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$912.10 |
| Max. Negotiated Rate |
$1,303.00 |
| Rate for Payer: AETNA Commercial |
$1,237.85
|
| Rate for Payer: AETNA Medicare |
$1,172.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,237.85
|
| Rate for Payer: BCBS Healthlink |
$1,172.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,172.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,172.70
|
| Rate for Payer: BCBS POS |
$1,237.85
|
| Rate for Payer: BCBS Traditional |
$1,303.00
|
| Rate for Payer: CASH_PRICE |
$1,042.40
|
| Rate for Payer: CIGNA Commercial |
$1,237.85
|
| Rate for Payer: CIGNA Medicare |
$1,172.70
|
| Rate for Payer: HUMANA Commercial |
$1,172.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,198.76
|
| Rate for Payer: MEDICARE Medicare |
$912.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,237.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,263.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,237.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,237.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,107.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,042.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,042.40
|
|
|
OP INJ SUP HYPOGSTRC PLX BL 64517
|
Facility
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: AETNA Commercial |
$1,179.90
|
| Rate for Payer: AETNA Medicare |
$1,117.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,179.90
|
| Rate for Payer: BCBS Healthlink |
$1,117.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,117.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,117.80
|
| Rate for Payer: BCBS POS |
$1,179.90
|
| Rate for Payer: BCBS Traditional |
$1,242.00
|
| Rate for Payer: CASH_PRICE |
$993.60
|
| Rate for Payer: CIGNA Commercial |
$1,179.90
|
| Rate for Payer: CIGNA Medicare |
$1,117.80
|
| Rate for Payer: HUMANA Commercial |
$1,117.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,142.64
|
| Rate for Payer: MEDICARE Medicare |
$869.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,179.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,204.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,179.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,179.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,055.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$993.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$993.60
|
|
|
OP INJ SUP HYPOGSTRC PLX BL 64517
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$869.40 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: AETNA Commercial |
$1,179.90
|
| Rate for Payer: AETNA Medicare |
$1,117.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,179.90
|
| Rate for Payer: BCBS Healthlink |
$1,117.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,117.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,117.80
|
| Rate for Payer: BCBS POS |
$1,179.90
|
| Rate for Payer: BCBS Traditional |
$1,242.00
|
| Rate for Payer: CASH_PRICE |
$993.60
|
| Rate for Payer: CIGNA Commercial |
$1,179.90
|
| Rate for Payer: CIGNA Medicare |
$1,117.80
|
| Rate for Payer: HUMANA Commercial |
$1,117.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,142.64
|
| Rate for Payer: MEDICARE Medicare |
$869.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,179.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,204.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,179.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,179.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,055.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$993.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$993.60
|
|
|
OP INJ SUPRASCAPULAR NERVE 64418
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: AETNA Commercial |
$760.00
|
| Rate for Payer: AETNA Medicare |
$720.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$760.00
|
| Rate for Payer: BCBS Healthlink |
$720.00
|
| Rate for Payer: BCBS HMK CHIP |
$720.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$720.00
|
| Rate for Payer: BCBS POS |
$760.00
|
| Rate for Payer: BCBS Traditional |
$800.00
|
| Rate for Payer: CASH_PRICE |
$640.00
|
| Rate for Payer: CIGNA Commercial |
$760.00
|
| Rate for Payer: CIGNA Medicare |
$720.00
|
| Rate for Payer: HUMANA Commercial |
$720.00
|
| Rate for Payer: MEDICAID Medicaid |
$736.00
|
| Rate for Payer: MEDICARE Medicare |
$560.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$760.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$776.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$760.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$760.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$680.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$640.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$640.00
|
|
|
OP INJ SUPRASCAPULAR NERVE 64418
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: AETNA Commercial |
$760.00
|
| Rate for Payer: AETNA Medicare |
$720.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$760.00
|
| Rate for Payer: BCBS Healthlink |
$720.00
|
| Rate for Payer: BCBS HMK CHIP |
$720.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$720.00
|
| Rate for Payer: BCBS POS |
$760.00
|
| Rate for Payer: BCBS Traditional |
$800.00
|
| Rate for Payer: CASH_PRICE |
$640.00
|
| Rate for Payer: CIGNA Commercial |
$760.00
|
| Rate for Payer: CIGNA Medicare |
$720.00
|
| Rate for Payer: HUMANA Commercial |
$720.00
|
| Rate for Payer: MEDICAID Medicaid |
$736.00
|
| Rate for Payer: MEDICARE Medicare |
$560.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$760.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$776.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$760.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$760.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$680.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$640.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$640.00
|
|
|
OP INJ TRANSFOR C/T 1ST 64479
|
Facility
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.80 |
| Max. Negotiated Rate |
$1,634.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,470.60
|
| Rate for Payer: AETNA Commercial |
$1,552.30
|
| Rate for Payer: AETNA Medicare |
$1,470.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,552.30
|
| Rate for Payer: BCBS Healthlink |
$1,470.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,470.60
|
| Rate for Payer: BCBS POS |
$1,552.30
|
| Rate for Payer: BCBS Traditional |
$1,634.00
|
| Rate for Payer: CASH_PRICE |
$1,307.20
|
| Rate for Payer: CIGNA Commercial |
$1,552.30
|
| Rate for Payer: CIGNA Medicare |
$1,470.60
|
| Rate for Payer: HUMANA Commercial |
$1,470.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,503.28
|
| Rate for Payer: MEDICARE Medicare |
$1,143.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,552.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,584.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,552.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,552.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,388.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,307.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,307.20
|
|
|
OP INJ TRANSFOR C/T 1ST 64479
|
Facility
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.80 |
| Max. Negotiated Rate |
$1,634.00 |
| Rate for Payer: AETNA Commercial |
$1,552.30
|
| Rate for Payer: AETNA Medicare |
$1,470.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,552.30
|
| Rate for Payer: BCBS Healthlink |
$1,470.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,470.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,470.60
|
| Rate for Payer: BCBS POS |
$1,552.30
|
| Rate for Payer: BCBS Traditional |
$1,634.00
|
| Rate for Payer: CASH_PRICE |
$1,307.20
|
| Rate for Payer: CIGNA Commercial |
$1,552.30
|
| Rate for Payer: CIGNA Medicare |
$1,470.60
|
| Rate for Payer: HUMANA Commercial |
$1,470.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,503.28
|
| Rate for Payer: MEDICARE Medicare |
$1,143.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,552.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,584.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,552.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,552.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,388.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,307.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,307.20
|
|
|
OP INJ TRANSFOR L/S ADD 64484
|
Facility
OP
|
$840.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: AETNA Commercial |
$798.00
|
| Rate for Payer: AETNA Medicare |
$756.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$798.00
|
| Rate for Payer: BCBS Healthlink |
$756.00
|
| Rate for Payer: BCBS HMK CHIP |
$756.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$756.00
|
| Rate for Payer: BCBS POS |
$798.00
|
| Rate for Payer: BCBS Traditional |
$840.00
|
| Rate for Payer: CASH_PRICE |
$672.00
|
| Rate for Payer: CIGNA Commercial |
$798.00
|
| Rate for Payer: CIGNA Medicare |
$756.00
|
| Rate for Payer: HUMANA Commercial |
$756.00
|
| Rate for Payer: MEDICAID Medicaid |
$772.80
|
| Rate for Payer: MEDICARE Medicare |
$588.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$798.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$814.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$798.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$798.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$714.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$672.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$672.00
|
|
|
OP INJ TRANSFOR L/S ADD 64484
|
Facility
IP
|
$840.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: AETNA Commercial |
$798.00
|
| Rate for Payer: AETNA Medicare |
$756.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$798.00
|
| Rate for Payer: BCBS Healthlink |
$756.00
|
| Rate for Payer: BCBS HMK CHIP |
$756.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$756.00
|
| Rate for Payer: BCBS POS |
$798.00
|
| Rate for Payer: BCBS Traditional |
$840.00
|
| Rate for Payer: CASH_PRICE |
$672.00
|
| Rate for Payer: CIGNA Commercial |
$798.00
|
| Rate for Payer: CIGNA Medicare |
$756.00
|
| Rate for Payer: HUMANA Commercial |
$756.00
|
| Rate for Payer: MEDICAID Medicaid |
$772.80
|
| Rate for Payer: MEDICARE Medicare |
$588.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$798.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$814.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$798.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$798.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$714.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$672.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$672.00
|
|
|
OP INJ TRIGEMINAL NERVE BLOCK 64400
|
Facility
IP
|
$496.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.20 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: AETNA Commercial |
$471.20
|
| Rate for Payer: AETNA Medicare |
$446.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$471.20
|
| Rate for Payer: BCBS Healthlink |
$446.40
|
| Rate for Payer: BCBS HMK CHIP |
$446.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$446.40
|
| Rate for Payer: BCBS POS |
$471.20
|
| Rate for Payer: BCBS Traditional |
$496.00
|
| Rate for Payer: CASH_PRICE |
$396.80
|
| Rate for Payer: CIGNA Commercial |
$471.20
|
| Rate for Payer: CIGNA Medicare |
$446.40
|
| Rate for Payer: HUMANA Commercial |
$446.40
|
| Rate for Payer: MEDICAID Medicaid |
$456.32
|
| Rate for Payer: MEDICARE Medicare |
$347.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$471.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$481.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$471.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$471.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$421.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$396.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$396.80
|
|
|
OP INJ TRIGEMINAL NERVE BLOCK 64400
|
Facility
OP
|
$496.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$347.20 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: AETNA Commercial |
$471.20
|
| Rate for Payer: AETNA Medicare |
$446.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$471.20
|
| Rate for Payer: BCBS Healthlink |
$446.40
|
| Rate for Payer: BCBS HMK CHIP |
$446.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$446.40
|
| Rate for Payer: BCBS POS |
$471.20
|
| Rate for Payer: BCBS Traditional |
$496.00
|
| Rate for Payer: CASH_PRICE |
$396.80
|
| Rate for Payer: CIGNA Commercial |
$471.20
|
| Rate for Payer: CIGNA Medicare |
$446.40
|
| Rate for Payer: HUMANA Commercial |
$446.40
|
| Rate for Payer: MEDICAID Medicaid |
$456.32
|
| Rate for Payer: MEDICARE Medicare |
$347.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$471.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$481.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$471.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$471.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$421.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$396.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$396.80
|
|
|
OP INTO/INJ GENICULAR NERVE BRANCH 64454
|
Facility
IP
|
$656.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: AETNA Commercial |
$623.20
|
| Rate for Payer: AETNA Medicare |
$590.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$623.20
|
| Rate for Payer: BCBS Healthlink |
$590.40
|
| Rate for Payer: BCBS HMK CHIP |
$590.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$590.40
|
| Rate for Payer: BCBS POS |
$623.20
|
| Rate for Payer: BCBS Traditional |
$656.00
|
| Rate for Payer: CASH_PRICE |
$524.80
|
| Rate for Payer: CIGNA Commercial |
$623.20
|
| Rate for Payer: CIGNA Medicare |
$590.40
|
| Rate for Payer: HUMANA Commercial |
$590.40
|
| Rate for Payer: MEDICAID Medicaid |
$603.52
|
| Rate for Payer: MEDICARE Medicare |
$459.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$623.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$636.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$623.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$623.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$557.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$524.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$524.80
|
|
|
OP INTO/INJ GENICULAR NERVE BRANCH 64454
|
Facility
OP
|
$656.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: AETNA Commercial |
$623.20
|
| Rate for Payer: AETNA Medicare |
$590.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$623.20
|
| Rate for Payer: BCBS Healthlink |
$590.40
|
| Rate for Payer: BCBS HMK CHIP |
$590.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$590.40
|
| Rate for Payer: BCBS POS |
$623.20
|
| Rate for Payer: BCBS Traditional |
$656.00
|
| Rate for Payer: CASH_PRICE |
$524.80
|
| Rate for Payer: CIGNA Commercial |
$623.20
|
| Rate for Payer: CIGNA Medicare |
$590.40
|
| Rate for Payer: HUMANA Commercial |
$590.40
|
| Rate for Payer: MEDICAID Medicaid |
$603.52
|
| Rate for Payer: MEDICARE Medicare |
$459.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$623.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$636.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$623.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$623.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$557.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$524.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$524.80
|
|
|
OP MAJOR JOINT INJ W/O US 20610
|
Facility
IP
|
$928.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$649.60 |
| Max. Negotiated Rate |
$928.00 |
| Rate for Payer: AETNA Commercial |
$881.60
|
| Rate for Payer: AETNA Medicare |
$835.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$881.60
|
| Rate for Payer: BCBS Healthlink |
$835.20
|
| Rate for Payer: BCBS HMK CHIP |
$835.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$835.20
|
| Rate for Payer: BCBS POS |
$881.60
|
| Rate for Payer: BCBS Traditional |
$928.00
|
| Rate for Payer: CASH_PRICE |
$742.40
|
| Rate for Payer: CIGNA Commercial |
$881.60
|
| Rate for Payer: CIGNA Medicare |
$835.20
|
| Rate for Payer: HUMANA Commercial |
$835.20
|
| Rate for Payer: MEDICAID Medicaid |
$853.76
|
| Rate for Payer: MEDICARE Medicare |
$649.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$881.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$900.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$881.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$881.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$788.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$742.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$742.40
|
|
|
OP MAJOR JOINT INJ W/O US 20610
|
Facility
OP
|
$928.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$649.60 |
| Max. Negotiated Rate |
$928.00 |
| Rate for Payer: AETNA Commercial |
$881.60
|
| Rate for Payer: AETNA Medicare |
$835.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$881.60
|
| Rate for Payer: BCBS Healthlink |
$835.20
|
| Rate for Payer: BCBS HMK CHIP |
$835.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$835.20
|
| Rate for Payer: BCBS POS |
$881.60
|
| Rate for Payer: BCBS Traditional |
$928.00
|
| Rate for Payer: CASH_PRICE |
$742.40
|
| Rate for Payer: CIGNA Commercial |
$881.60
|
| Rate for Payer: CIGNA Medicare |
$835.20
|
| Rate for Payer: HUMANA Commercial |
$835.20
|
| Rate for Payer: MEDICAID Medicaid |
$853.76
|
| Rate for Payer: MEDICARE Medicare |
$649.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$881.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$900.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$881.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$881.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$788.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$742.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$742.40
|
|
