|
OT DEBRIDEMENT
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
OT DEBRIDEMENT
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
OT DEVELOPMTL TEST EXTENDED/REPT PER HR
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT 96111 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
OT DEVELOPMTL TEST EXTENDED/REPT PER HR
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT 96111 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
OT EVAL HIGH COMPLEX
|
Facility
OP
|
$609.00
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$426.30 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: AETNA Commercial |
$578.55
|
| Rate for Payer: AETNA Medicare |
$548.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$578.55
|
| Rate for Payer: BCBS Healthlink |
$548.10
|
| Rate for Payer: BCBS HMK CHIP |
$548.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$548.10
|
| Rate for Payer: BCBS POS |
$578.55
|
| Rate for Payer: BCBS Traditional |
$609.00
|
| Rate for Payer: CASH_PRICE |
$487.20
|
| Rate for Payer: CIGNA Commercial |
$578.55
|
| Rate for Payer: CIGNA Medicare |
$548.10
|
| Rate for Payer: HUMANA Commercial |
$548.10
|
| Rate for Payer: MEDICAID Medicaid |
$560.28
|
| Rate for Payer: MEDICARE Medicare |
$426.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$578.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$590.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$578.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$578.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$517.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$487.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$487.20
|
|
|
OT EVAL HIGH COMPLEX
|
Facility
IP
|
$609.00
|
|
|
Service Code
|
CPT 97167 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$426.30 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$578.55
|
| Rate for Payer: AETNA Commercial |
$578.55
|
| Rate for Payer: AETNA Medicare |
$548.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$578.55
|
| Rate for Payer: BCBS Healthlink |
$548.10
|
| Rate for Payer: BCBS HMK CHIP |
$548.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$548.10
|
| Rate for Payer: BCBS POS |
$578.55
|
| Rate for Payer: BCBS Traditional |
$609.00
|
| Rate for Payer: CASH_PRICE |
$487.20
|
| Rate for Payer: CIGNA Commercial |
$578.55
|
| Rate for Payer: CIGNA Medicare |
$548.10
|
| Rate for Payer: HUMANA Commercial |
$548.10
|
| Rate for Payer: MEDICAID Medicaid |
$560.28
|
| Rate for Payer: MEDICARE Medicare |
$426.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$590.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$578.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$578.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$517.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$487.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$487.20
|
|
|
OT EVAL LOW COMPLEX
|
Facility
OP
|
$445.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: AETNA Commercial |
$422.75
|
| Rate for Payer: AETNA Medicare |
$400.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$422.75
|
| Rate for Payer: BCBS Healthlink |
$400.50
|
| Rate for Payer: BCBS HMK CHIP |
$400.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$400.50
|
| Rate for Payer: BCBS POS |
$422.75
|
| Rate for Payer: BCBS Traditional |
$445.00
|
| Rate for Payer: CASH_PRICE |
$356.00
|
| Rate for Payer: CIGNA Commercial |
$422.75
|
| Rate for Payer: CIGNA Medicare |
$400.50
|
| Rate for Payer: HUMANA Commercial |
$400.50
|
| Rate for Payer: MEDICAID Medicaid |
$409.40
|
| Rate for Payer: MEDICARE Medicare |
$311.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$422.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$431.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$422.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$422.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$378.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$356.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$356.00
|
|
|
OT EVAL LOW COMPLEX
|
Facility
IP
|
$445.00
|
|
|
Service Code
|
CPT 97165 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: AETNA Commercial |
$422.75
|
| Rate for Payer: AETNA Medicare |
$400.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$422.75
|
| Rate for Payer: BCBS Healthlink |
$400.50
|
| Rate for Payer: BCBS HMK CHIP |
$400.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$400.50
|
| Rate for Payer: BCBS POS |
$422.75
|
| Rate for Payer: BCBS Traditional |
$445.00
|
| Rate for Payer: CASH_PRICE |
$356.00
|
| Rate for Payer: CIGNA Commercial |
$422.75
|
| Rate for Payer: CIGNA Medicare |
$400.50
|
| Rate for Payer: HUMANA Commercial |
$400.50
|
| Rate for Payer: MEDICAID Medicaid |
$409.40
|
| Rate for Payer: MEDICARE Medicare |
$311.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$422.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$431.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$422.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$422.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$378.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$356.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$356.00
|
|
|
OT EVAL MODERATE COMPLEX
|
Facility
IP
|
$526.00
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: AETNA Commercial |
$499.70
|
| Rate for Payer: AETNA Medicare |
$473.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$499.70
|
| Rate for Payer: BCBS Healthlink |
$473.40
|
| Rate for Payer: BCBS HMK CHIP |
$473.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$473.40
|
| Rate for Payer: BCBS POS |
$499.70
|
| Rate for Payer: BCBS Traditional |
$526.00
|
| Rate for Payer: CASH_PRICE |
$420.80
|
| Rate for Payer: CIGNA Commercial |
$499.70
|
| Rate for Payer: CIGNA Medicare |
$473.40
|
| Rate for Payer: HUMANA Commercial |
$473.40
|
| Rate for Payer: MEDICAID Medicaid |
$483.92
|
| Rate for Payer: MEDICARE Medicare |
$368.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$499.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$510.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$499.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$499.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$447.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.80
|
|
|
OT EVAL MODERATE COMPLEX
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
CPT 97166 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: AETNA Commercial |
$499.70
|
| Rate for Payer: AETNA Medicare |
$473.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$499.70
|
| Rate for Payer: BCBS Healthlink |
$473.40
|
| Rate for Payer: BCBS HMK CHIP |
$473.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$473.40
|
| Rate for Payer: BCBS POS |
$499.70
|
| Rate for Payer: BCBS Traditional |
$526.00
|
| Rate for Payer: CASH_PRICE |
$420.80
|
| Rate for Payer: CIGNA Commercial |
$499.70
|
| Rate for Payer: CIGNA Medicare |
$473.40
|
| Rate for Payer: HUMANA Commercial |
$473.40
|
| Rate for Payer: MEDICAID Medicaid |
$483.92
|
| Rate for Payer: MEDICARE Medicare |
$368.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$499.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$510.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$499.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$499.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$447.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.80
|
|
|
OT MANUAL THERAPY 15 MIN
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
OT MANUAL THERAPY 15 MIN
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
OT MASSAGE 15 MIN
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
OT MASSAGE 15 MIN
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
OT MUSCLE TEST EXCLUDES HAND WITH REPOR
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 95831 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
OT MUSCLE TEST EXCLUDES HAND WITH REPOR
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 95831 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
OT MUSCLE TESTING HAND
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT 95832 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
OT MUSCLE TESTING HAND
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 95832 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
OT MYOFASCIAL RELEASE
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
OT MYOFASCIAL RELEASE
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
OT NEUROMUSCULAR REEDUCATION 15 MIN
|
Facility
OP
|
$206.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: AETNA Commercial |
$195.70
|
| Rate for Payer: AETNA Medicare |
$185.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$195.70
|
| Rate for Payer: BCBS Healthlink |
$185.40
|
| Rate for Payer: BCBS HMK CHIP |
$185.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$185.40
|
| Rate for Payer: BCBS POS |
$195.70
|
| Rate for Payer: BCBS Traditional |
$206.00
|
| Rate for Payer: CASH_PRICE |
$164.80
|
| Rate for Payer: CIGNA Commercial |
$195.70
|
| Rate for Payer: CIGNA Medicare |
$185.40
|
| Rate for Payer: HUMANA Commercial |
$185.40
|
| Rate for Payer: MEDICAID Medicaid |
$189.52
|
| Rate for Payer: MEDICARE Medicare |
$144.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$195.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$199.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$195.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$195.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.80
|
|
|
OT NEUROMUSCULAR REEDUCATION 15 MIN
|
Facility
IP
|
$206.00
|
|
|
Service Code
|
CPT 97112 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: AETNA Commercial |
$195.70
|
| Rate for Payer: AETNA Medicare |
$185.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$195.70
|
| Rate for Payer: BCBS Healthlink |
$185.40
|
| Rate for Payer: BCBS HMK CHIP |
$185.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$185.40
|
| Rate for Payer: BCBS POS |
$195.70
|
| Rate for Payer: BCBS Traditional |
$206.00
|
| Rate for Payer: CASH_PRICE |
$164.80
|
| Rate for Payer: CIGNA Commercial |
$195.70
|
| Rate for Payer: CIGNA Medicare |
$185.40
|
| Rate for Payer: HUMANA Commercial |
$185.40
|
| Rate for Payer: MEDICAID Medicaid |
$189.52
|
| Rate for Payer: MEDICARE Medicare |
$144.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$195.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$199.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$195.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$195.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.80
|
|
|
OT ORTHOTICS FITTING AND TRAINING 15MIN
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 97116 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
OT ORTHOTICS FITTING AND TRAINING 15MIN
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 97116 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
OT ORTHOTICS FITTING AND TRAINING 15MIN
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 97116 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
