|
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 OXIMETRY OVERNIGHT
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: AETNA Commercial |
$399.95
|
| Rate for Payer: AETNA Medicare |
$378.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.95
|
| Rate for Payer: BCBS Healthlink |
$378.90
|
| Rate for Payer: BCBS HMK CHIP |
$378.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.90
|
| Rate for Payer: BCBS POS |
$399.95
|
| Rate for Payer: BCBS Traditional |
$421.00
|
| Rate for Payer: CASH_PRICE |
$336.80
|
| Rate for Payer: CIGNA Commercial |
$399.95
|
| Rate for Payer: CIGNA Medicare |
$378.90
|
| Rate for Payer: HUMANA Commercial |
$378.90
|
| Rate for Payer: MEDICAID Medicaid |
$387.32
|
| Rate for Payer: MEDICARE Medicare |
$294.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$408.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.80
|
|
|
OT OXIMETRY OVERNIGHT
|
Facility
IP
|
$421.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: AETNA Commercial |
$399.95
|
| Rate for Payer: AETNA Medicare |
$378.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.95
|
| Rate for Payer: BCBS Healthlink |
$378.90
|
| Rate for Payer: BCBS HMK CHIP |
$378.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.90
|
| Rate for Payer: BCBS POS |
$399.95
|
| Rate for Payer: BCBS Traditional |
$421.00
|
| Rate for Payer: CASH_PRICE |
$336.80
|
| Rate for Payer: CIGNA Commercial |
$399.95
|
| Rate for Payer: CIGNA Medicare |
$378.90
|
| Rate for Payer: HUMANA Commercial |
$378.90
|
| Rate for Payer: MEDICAID Medicaid |
$387.32
|
| Rate for Payer: MEDICARE Medicare |
$294.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$408.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.80
|
|
|
OT PARAFFIN
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: AETNA Commercial |
$60.80
|
| Rate for Payer: AETNA Medicare |
$57.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$60.80
|
| Rate for Payer: BCBS Healthlink |
$57.60
|
| Rate for Payer: BCBS HMK CHIP |
$57.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$57.60
|
| Rate for Payer: BCBS POS |
$60.80
|
| Rate for Payer: BCBS Traditional |
$64.00
|
| Rate for Payer: CASH_PRICE |
$51.20
|
| Rate for Payer: CIGNA Commercial |
$60.80
|
| Rate for Payer: CIGNA Medicare |
$57.60
|
| Rate for Payer: HUMANA Commercial |
$57.60
|
| Rate for Payer: MEDICAID Medicaid |
$58.88
|
| Rate for Payer: MEDICARE Medicare |
$44.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$60.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$62.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$60.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$51.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$51.20
|
|
|
OT PARAFFIN
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 97018 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: AETNA Commercial |
$60.80
|
| Rate for Payer: AETNA Medicare |
$57.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$60.80
|
| Rate for Payer: BCBS Healthlink |
$57.60
|
| Rate for Payer: BCBS HMK CHIP |
$57.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$57.60
|
| Rate for Payer: BCBS POS |
$60.80
|
| Rate for Payer: BCBS Traditional |
$64.00
|
| Rate for Payer: CASH_PRICE |
$51.20
|
| Rate for Payer: CIGNA Commercial |
$60.80
|
| Rate for Payer: CIGNA Medicare |
$57.60
|
| Rate for Payer: HUMANA Commercial |
$57.60
|
| Rate for Payer: MEDICAID Medicaid |
$58.88
|
| Rate for Payer: MEDICARE Medicare |
$44.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$60.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$62.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$60.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$51.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$51.20
|
|
|
OT PULMONARY FUNCTION (PRE)
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
OT PULMONARY FUNCTION (PRE)
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
OT PULMONARY FUNCTION (PRE & POST)
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: AETNA Commercial |
$399.95
|
| Rate for Payer: AETNA Medicare |
$378.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.95
|
| Rate for Payer: BCBS Healthlink |
$378.90
|
| Rate for Payer: BCBS HMK CHIP |
$378.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.90
|
| Rate for Payer: BCBS POS |
$399.95
|
| Rate for Payer: BCBS Traditional |
$421.00
|
| Rate for Payer: CASH_PRICE |
$336.80
|
| Rate for Payer: CIGNA Commercial |
$399.95
|
| Rate for Payer: CIGNA Medicare |
$378.90
|
| Rate for Payer: HUMANA Commercial |
$378.90
|
| Rate for Payer: MEDICAID Medicaid |
$387.32
|
| Rate for Payer: MEDICARE Medicare |
$294.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$408.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.80
|
|
|
OT PULMONARY FUNCTION (PRE & POST)
|
Facility
IP
|
$421.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: AETNA Commercial |
$399.95
|
| Rate for Payer: AETNA Medicare |
$378.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.95
|
| Rate for Payer: BCBS Healthlink |
$378.90
|
| Rate for Payer: BCBS HMK CHIP |
$378.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.90
|
| Rate for Payer: BCBS POS |
$399.95
|
| Rate for Payer: BCBS Traditional |
$421.00
|
| Rate for Payer: CASH_PRICE |
$336.80
|
| Rate for Payer: CIGNA Commercial |
$399.95
|
| Rate for Payer: CIGNA Medicare |
$378.90
|
| Rate for Payer: HUMANA Commercial |
$378.90
|
| Rate for Payer: MEDICAID Medicaid |
$387.32
|
| Rate for Payer: MEDICARE Medicare |
$294.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$408.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.80
|
|
|
OT RE-EVAL EST PLAN CAR
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: AETNA Commercial |
$316.35
|
| Rate for Payer: AETNA Medicare |
$299.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$316.35
|
| Rate for Payer: BCBS Healthlink |
$299.70
|
| Rate for Payer: BCBS HMK CHIP |
$299.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$299.70
|
| Rate for Payer: BCBS POS |
$316.35
|
| Rate for Payer: BCBS Traditional |
$333.00
|
| Rate for Payer: CASH_PRICE |
$266.40
|
| Rate for Payer: CIGNA Commercial |
$316.35
|
| Rate for Payer: CIGNA Medicare |
$299.70
|
| Rate for Payer: HUMANA Commercial |
$299.70
|
| Rate for Payer: MEDICAID Medicaid |
$306.36
|
| Rate for Payer: MEDICARE Medicare |
$233.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$316.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$316.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$316.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$266.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$266.40
|
|
|
OT RE-EVAL EST PLAN CAR
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 97168 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: AETNA Commercial |
$316.35
|
| Rate for Payer: AETNA Medicare |
$299.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$316.35
|
| Rate for Payer: BCBS Healthlink |
$299.70
|
| Rate for Payer: BCBS HMK CHIP |
$299.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$299.70
|
| Rate for Payer: BCBS POS |
$316.35
|
| Rate for Payer: BCBS Traditional |
$333.00
|
| Rate for Payer: CASH_PRICE |
$266.40
|
| Rate for Payer: CIGNA Commercial |
$316.35
|
| Rate for Payer: CIGNA Medicare |
$299.70
|
| Rate for Payer: HUMANA Commercial |
$299.70
|
| Rate for Payer: MEDICAID Medicaid |
$306.36
|
| Rate for Payer: MEDICARE Medicare |
$233.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$316.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$316.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$316.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$266.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$266.40
|
|
|
OT RESPIRATORY FLOW VOLUME LOOP
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: AETNA Commercial |
$88.35
|
| Rate for Payer: AETNA Medicare |
$83.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$88.35
|
| Rate for Payer: BCBS Healthlink |
$83.70
|
| Rate for Payer: BCBS HMK CHIP |
$83.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$83.70
|
| Rate for Payer: BCBS POS |
$88.35
|
| Rate for Payer: BCBS Traditional |
$93.00
|
| Rate for Payer: CASH_PRICE |
$74.40
|
| Rate for Payer: CIGNA Commercial |
$88.35
|
| Rate for Payer: CIGNA Medicare |
$83.70
|
| Rate for Payer: HUMANA Commercial |
$83.70
|
| Rate for Payer: MEDICAID Medicaid |
$85.56
|
| Rate for Payer: MEDICARE Medicare |
$65.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$88.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$90.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$88.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$88.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$74.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$74.40
|
|
|
OT RESPIRATORY FLOW VOLUME LOOP
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: AETNA Commercial |
$88.35
|
| Rate for Payer: AETNA Medicare |
$83.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$88.35
|
| Rate for Payer: BCBS Healthlink |
$83.70
|
| Rate for Payer: BCBS HMK CHIP |
$83.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$83.70
|
| Rate for Payer: BCBS POS |
$88.35
|
| Rate for Payer: BCBS Traditional |
$93.00
|
| Rate for Payer: CASH_PRICE |
$74.40
|
| Rate for Payer: CIGNA Commercial |
$88.35
|
| Rate for Payer: CIGNA Medicare |
$83.70
|
| Rate for Payer: HUMANA Commercial |
$83.70
|
| Rate for Payer: MEDICAID Medicaid |
$85.56
|
| Rate for Payer: MEDICARE Medicare |
$65.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$88.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$90.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$88.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$88.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$74.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$74.40
|
|
|
OT ROM MEASUREMENT HANDS
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 95852 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
OT ROM MEASUREMENT HANDS
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 95852 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
OT ROM MEASURE/REPORT EXCEPT HANDS
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 95851 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
OT ROM MEASURE/REPORT EXCEPT HANDS
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 95851 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
OT SELF CARE MANAGEMENT 15 MIN
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: AETNA Commercial |
$188.10
|
| Rate for Payer: AETNA Medicare |
$178.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$188.10
|
| Rate for Payer: BCBS Healthlink |
$178.20
|
| Rate for Payer: BCBS HMK CHIP |
$178.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$178.20
|
| Rate for Payer: BCBS POS |
$188.10
|
| Rate for Payer: BCBS Traditional |
$198.00
|
| Rate for Payer: CASH_PRICE |
$158.40
|
| Rate for Payer: CIGNA Commercial |
$188.10
|
| Rate for Payer: CIGNA Medicare |
$178.20
|
| Rate for Payer: HUMANA Commercial |
$178.20
|
| Rate for Payer: MEDICAID Medicaid |
$182.16
|
| Rate for Payer: MEDICARE Medicare |
$138.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$188.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$192.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$188.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$188.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$168.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$158.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$158.40
|
|
|
OT SELF CARE MANAGEMENT 15 MIN
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 97535 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: AETNA Commercial |
$188.10
|
| Rate for Payer: AETNA Medicare |
$178.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$188.10
|
| Rate for Payer: BCBS Healthlink |
$178.20
|
| Rate for Payer: BCBS HMK CHIP |
$178.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$178.20
|
| Rate for Payer: BCBS POS |
$188.10
|
| Rate for Payer: BCBS Traditional |
$198.00
|
| Rate for Payer: CASH_PRICE |
$158.40
|
| Rate for Payer: CIGNA Commercial |
$188.10
|
| Rate for Payer: CIGNA Medicare |
$178.20
|
| Rate for Payer: HUMANA Commercial |
$178.20
|
| Rate for Payer: MEDICAID Medicaid |
$182.16
|
| Rate for Payer: MEDICARE Medicare |
$138.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$188.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$192.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$188.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$188.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$168.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$158.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$158.40
|
|
|
OT THERAPEUTIC ACTIVITIES 15 MIN
|
Facility
IP
|
$205.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: AETNA Commercial |
$194.75
|
| Rate for Payer: AETNA Medicare |
$184.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$194.75
|
| Rate for Payer: BCBS Healthlink |
$184.50
|
| Rate for Payer: BCBS HMK CHIP |
$184.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$184.50
|
| Rate for Payer: BCBS POS |
$194.75
|
| Rate for Payer: BCBS Traditional |
$205.00
|
| Rate for Payer: CASH_PRICE |
$164.00
|
| Rate for Payer: CIGNA Commercial |
$194.75
|
| Rate for Payer: CIGNA Medicare |
$184.50
|
| Rate for Payer: HUMANA Commercial |
$184.50
|
| Rate for Payer: MEDICAID Medicaid |
$188.60
|
| Rate for Payer: MEDICARE Medicare |
$143.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$194.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$198.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$194.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$194.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$174.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.00
|
|
|
OT THERAPEUTIC ACTIVITIES 15 MIN
|
Facility
OP
|
$205.00
|
|
|
Service Code
|
CPT 97530 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: AETNA Commercial |
$194.75
|
| Rate for Payer: AETNA Medicare |
$184.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$194.75
|
| Rate for Payer: BCBS Healthlink |
$184.50
|
| Rate for Payer: BCBS HMK CHIP |
$184.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$184.50
|
| Rate for Payer: BCBS POS |
$194.75
|
| Rate for Payer: BCBS Traditional |
$205.00
|
| Rate for Payer: CASH_PRICE |
$164.00
|
| Rate for Payer: CIGNA Commercial |
$194.75
|
| Rate for Payer: CIGNA Medicare |
$184.50
|
| Rate for Payer: HUMANA Commercial |
$184.50
|
| Rate for Payer: MEDICAID Medicaid |
$188.60
|
| Rate for Payer: MEDICARE Medicare |
$143.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$194.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$198.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$194.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$194.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$174.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.00
|
|
|
OT THERAPEUTIC EXERCISE 15 MIN
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
OT THERAPEUTIC EXERCISE 15 MIN
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 97110 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
OT ULTRASOUND
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| 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 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 ULTRASOUND
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 97035 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
|
|
