|
OSELTAMIVIR CAP [75 MG]
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$44.20
|
| Rate for Payer: AETNA Commercial |
$49.40
|
| Rate for Payer: AETNA Medicare |
$46.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$49.40
|
| Rate for Payer: BCBS Healthlink |
$46.80
|
| Rate for Payer: BCBS HMK CHIP |
$46.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$46.80
|
| Rate for Payer: BCBS POS |
$49.40
|
| Rate for Payer: BCBS Traditional |
$52.00
|
| Rate for Payer: CASH_PRICE |
$41.60
|
| Rate for Payer: CIGNA Commercial |
$49.40
|
| Rate for Payer: CIGNA Medicare |
$46.80
|
| Rate for Payer: HUMANA Commercial |
$46.80
|
| Rate for Payer: MEDICAID Medicaid |
$47.84
|
| Rate for Payer: MEDICARE Medicare |
$36.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$49.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$50.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$49.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$49.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$41.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$41.60
|
|
|
OSELTAMIVIR SUSPENSION [ 6MG/ML ]
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$349.30 |
| Max. Negotiated Rate |
$499.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$424.15
|
| Rate for Payer: AETNA Commercial |
$474.05
|
| Rate for Payer: AETNA Medicare |
$449.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$474.05
|
| Rate for Payer: BCBS Healthlink |
$449.10
|
| Rate for Payer: BCBS HMK CHIP |
$449.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$449.10
|
| Rate for Payer: BCBS POS |
$474.05
|
| Rate for Payer: BCBS Traditional |
$499.00
|
| Rate for Payer: CASH_PRICE |
$399.20
|
| Rate for Payer: CIGNA Commercial |
$474.05
|
| Rate for Payer: CIGNA Medicare |
$449.10
|
| Rate for Payer: HUMANA Commercial |
$449.10
|
| Rate for Payer: MEDICAID Medicaid |
$459.08
|
| Rate for Payer: MEDICARE Medicare |
$349.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$474.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$484.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$474.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$474.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$399.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$399.20
|
|
|
OSELTAMIVIR SUSPENSION [ 6MG/ML ]
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$349.30 |
| Max. Negotiated Rate |
$499.00 |
| Rate for Payer: AETNA Commercial |
$474.05
|
| Rate for Payer: AETNA Medicare |
$449.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$474.05
|
| Rate for Payer: BCBS Healthlink |
$449.10
|
| Rate for Payer: BCBS HMK CHIP |
$449.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$449.10
|
| Rate for Payer: BCBS POS |
$474.05
|
| Rate for Payer: BCBS Traditional |
$499.00
|
| Rate for Payer: CASH_PRICE |
$399.20
|
| Rate for Payer: CIGNA Commercial |
$474.05
|
| Rate for Payer: CIGNA Medicare |
$449.10
|
| Rate for Payer: HUMANA Commercial |
$449.10
|
| Rate for Payer: MEDICAID Medicaid |
$459.08
|
| Rate for Payer: MEDICARE Medicare |
$349.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$474.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$484.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$474.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$474.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$424.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$399.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$399.20
|
|
|
OSMOLALITY, SERUM (002071)
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
OSMOLALITY, SERUM (002071)
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
OSMOLALITY, URINE (003442)
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
OSMOLALITY, URINE (003442)
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
OSTEO MANIPULATION 1-2 BODY REGIONS
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
OSTEO MANIPULATION 1-2 BODY REGIONS
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
OSTEO MANIPULATION 3-4 BODY REGIONS
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 98926
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
OSTEO MANIPULATION 3-4 BODY REGIONS
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 98926
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
OSTEO MANIPULATION 5-6 BODY REGIONS
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
OSTEO MANIPULATION 5-6 BODY REGIONS
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
OSTEO MANIPULATION 7-8 BODY REGIONS
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
OSTEO MANIPULATION 7-8 BODY REGIONS
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
OSTEO MANIPULATION 9-10 BODY REGIONS
|
Facility
OP
|
$186.00
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: AETNA Commercial |
$176.70
|
| Rate for Payer: AETNA Medicare |
$167.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$176.70
|
| Rate for Payer: BCBS Healthlink |
$167.40
|
| Rate for Payer: BCBS HMK CHIP |
$167.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$167.40
|
| Rate for Payer: BCBS POS |
$176.70
|
| Rate for Payer: BCBS Traditional |
$186.00
|
| Rate for Payer: CASH_PRICE |
$148.80
|
| Rate for Payer: CIGNA Commercial |
$176.70
|
| Rate for Payer: CIGNA Medicare |
$167.40
|
| Rate for Payer: HUMANA Commercial |
$167.40
|
| Rate for Payer: MEDICAID Medicaid |
$171.12
|
| Rate for Payer: MEDICARE Medicare |
$130.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$176.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$180.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$176.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$176.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.80
|
|
|
OSTEO MANIPULATION 9-10 BODY REGIONS
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: AETNA Commercial |
$176.70
|
| Rate for Payer: AETNA Medicare |
$167.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$176.70
|
| Rate for Payer: BCBS Healthlink |
$167.40
|
| Rate for Payer: BCBS HMK CHIP |
$167.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$167.40
|
| Rate for Payer: BCBS POS |
$176.70
|
| Rate for Payer: BCBS Traditional |
$186.00
|
| Rate for Payer: CASH_PRICE |
$148.80
|
| Rate for Payer: CIGNA Commercial |
$176.70
|
| Rate for Payer: CIGNA Medicare |
$167.40
|
| Rate for Payer: HUMANA Commercial |
$167.40
|
| Rate for Payer: MEDICAID Medicaid |
$171.12
|
| Rate for Payer: MEDICARE Medicare |
$130.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$176.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$180.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$176.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$176.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.80
|
|
|
OT APPLY MULTLAY COMPRS LWR LEG
|
Facility
OP
|
$664.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$464.80 |
| Max. Negotiated Rate |
$664.00 |
| Rate for Payer: AETNA Commercial |
$630.80
|
| Rate for Payer: AETNA Medicare |
$597.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$630.80
|
| Rate for Payer: BCBS Healthlink |
$597.60
|
| Rate for Payer: BCBS HMK CHIP |
$597.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$597.60
|
| Rate for Payer: BCBS POS |
$630.80
|
| Rate for Payer: BCBS Traditional |
$664.00
|
| Rate for Payer: CASH_PRICE |
$531.20
|
| Rate for Payer: CIGNA Commercial |
$630.80
|
| Rate for Payer: CIGNA Medicare |
$597.60
|
| Rate for Payer: HUMANA Commercial |
$597.60
|
| Rate for Payer: MEDICAID Medicaid |
$610.88
|
| Rate for Payer: MEDICARE Medicare |
$464.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$630.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$644.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$630.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$630.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$564.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$531.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$531.20
|
|
|
OT APPLY MULTLAY COMPRS LWR LEG
|
Facility
IP
|
$664.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$464.80 |
| Max. Negotiated Rate |
$664.00 |
| Rate for Payer: AETNA Commercial |
$630.80
|
| Rate for Payer: AETNA Medicare |
$597.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$630.80
|
| Rate for Payer: BCBS Healthlink |
$597.60
|
| Rate for Payer: BCBS HMK CHIP |
$597.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$597.60
|
| Rate for Payer: BCBS POS |
$630.80
|
| Rate for Payer: BCBS Traditional |
$664.00
|
| Rate for Payer: CASH_PRICE |
$531.20
|
| Rate for Payer: CIGNA Commercial |
$630.80
|
| Rate for Payer: CIGNA Medicare |
$597.60
|
| Rate for Payer: HUMANA Commercial |
$597.60
|
| Rate for Payer: MEDICAID Medicaid |
$610.88
|
| Rate for Payer: MEDICARE Medicare |
$464.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$630.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$644.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$630.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$630.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$564.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$531.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$531.20
|
|
|
OT APPLY MULTLAY COMPRS UPR ARM
|
Facility
IP
|
$664.00
|
|
|
Service Code
|
CPT 29584
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$464.80 |
| Max. Negotiated Rate |
$664.00 |
| Rate for Payer: AETNA Commercial |
$630.80
|
| Rate for Payer: AETNA Medicare |
$597.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$630.80
|
| Rate for Payer: BCBS Healthlink |
$597.60
|
| Rate for Payer: BCBS HMK CHIP |
$597.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$597.60
|
| Rate for Payer: BCBS POS |
$630.80
|
| Rate for Payer: BCBS Traditional |
$664.00
|
| Rate for Payer: CASH_PRICE |
$531.20
|
| Rate for Payer: CIGNA Commercial |
$630.80
|
| Rate for Payer: CIGNA Medicare |
$597.60
|
| Rate for Payer: HUMANA Commercial |
$597.60
|
| Rate for Payer: MEDICAID Medicaid |
$610.88
|
| Rate for Payer: MEDICARE Medicare |
$464.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$630.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$644.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$630.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$630.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$564.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$531.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$531.20
|
|
|
OT APPLY MULTLAY COMPRS UPR ARM
|
Facility
OP
|
$664.00
|
|
|
Service Code
|
CPT 29584
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$464.80 |
| Max. Negotiated Rate |
$664.00 |
| Rate for Payer: AETNA Commercial |
$630.80
|
| Rate for Payer: AETNA Medicare |
$597.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$630.80
|
| Rate for Payer: BCBS Healthlink |
$597.60
|
| Rate for Payer: BCBS HMK CHIP |
$597.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$597.60
|
| Rate for Payer: BCBS POS |
$630.80
|
| Rate for Payer: BCBS Traditional |
$664.00
|
| Rate for Payer: CASH_PRICE |
$531.20
|
| Rate for Payer: CIGNA Commercial |
$630.80
|
| Rate for Payer: CIGNA Medicare |
$597.60
|
| Rate for Payer: HUMANA Commercial |
$597.60
|
| Rate for Payer: MEDICAID Medicaid |
$610.88
|
| Rate for Payer: MEDICARE Medicare |
$464.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$630.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$644.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$630.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$630.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$564.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$531.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$531.20
|
|
|
OT COMMUNITY REINTEGRATION 15 MIN
|
Facility
OP
|
$81.00
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
|
|
OT COMMUNITY REINTEGRATION 15 MIN
|
Facility
IP
|
$81.00
|
|
|
Service Code
|
CPT 97537 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
|
|
OT CONTRAST BATHS 15 MIN
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
OT CONTRAST BATHS 15 MIN
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT 97034 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
