|
OT WHEELCHAIR MANAGEMENT 15 MIN
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 97542 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
|
OT WHEELCHAIR MANAGEMENT 15 MIN
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 97542 GO
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
|
OUTPATIENT INJECTION INTRLAM C-T 62321
|
Facility
IP
|
$2,285.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,599.50 |
| Max. Negotiated Rate |
$2,285.00 |
| Rate for Payer: AETNA Commercial |
$2,170.75
|
| Rate for Payer: AETNA Medicare |
$2,056.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,170.75
|
| Rate for Payer: BCBS Healthlink |
$2,056.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,056.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,056.50
|
| Rate for Payer: BCBS POS |
$2,170.75
|
| Rate for Payer: BCBS Traditional |
$2,285.00
|
| Rate for Payer: CASH_PRICE |
$1,828.00
|
| Rate for Payer: CIGNA Commercial |
$2,170.75
|
| Rate for Payer: CIGNA Medicare |
$2,056.50
|
| Rate for Payer: HUMANA Commercial |
$2,056.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,102.20
|
| Rate for Payer: MEDICARE Medicare |
$1,599.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,170.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,216.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,170.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,170.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,942.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,828.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,828.00
|
|
|
OUTPATIENT INJECTION INTRLAM C-T 62321
|
Facility
OP
|
$2,285.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,599.50 |
| Max. Negotiated Rate |
$2,285.00 |
| Rate for Payer: AETNA Commercial |
$2,170.75
|
| Rate for Payer: AETNA Medicare |
$2,056.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,170.75
|
| Rate for Payer: BCBS Healthlink |
$2,056.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,056.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,056.50
|
| Rate for Payer: BCBS POS |
$2,170.75
|
| Rate for Payer: BCBS Traditional |
$2,285.00
|
| Rate for Payer: CASH_PRICE |
$1,828.00
|
| Rate for Payer: CIGNA Commercial |
$2,170.75
|
| Rate for Payer: CIGNA Medicare |
$2,056.50
|
| Rate for Payer: HUMANA Commercial |
$2,056.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,102.20
|
| Rate for Payer: MEDICARE Medicare |
$1,599.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,170.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,216.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,170.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,170.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,942.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,828.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,828.00
|
|
|
OUTPATIENT TREATMENT ALLERGY SHOT 1
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
OUTPATIENT TREATMENT ALLERGY SHOT 1
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
OUTPATIENT TREATMENT ALLERGY SHOT 2
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
OUTPATIENT TREATMENT ALLERGY SHOT 2
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
OUTPATIENT TREATMENT ESRD
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: AETNA Commercial |
$70.30
|
| Rate for Payer: AETNA Medicare |
$66.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$70.30
|
| Rate for Payer: BCBS Healthlink |
$66.60
|
| Rate for Payer: BCBS HMK CHIP |
$66.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$66.60
|
| Rate for Payer: BCBS POS |
$70.30
|
| Rate for Payer: BCBS Traditional |
$74.00
|
| Rate for Payer: CASH_PRICE |
$59.20
|
| Rate for Payer: CIGNA Commercial |
$70.30
|
| Rate for Payer: CIGNA Medicare |
$66.60
|
| Rate for Payer: HUMANA Commercial |
$66.60
|
| Rate for Payer: MEDICAID Medicaid |
$68.08
|
| Rate for Payer: MEDICARE Medicare |
$51.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$70.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$71.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$70.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$70.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$59.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$59.20
|
|
|
OUTPATIENT TREATMENT ESRD
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT G0257
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: AETNA Commercial |
$70.30
|
| Rate for Payer: AETNA Medicare |
$66.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$70.30
|
| Rate for Payer: BCBS Healthlink |
$66.60
|
| Rate for Payer: BCBS HMK CHIP |
$66.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$66.60
|
| Rate for Payer: BCBS POS |
$70.30
|
| Rate for Payer: BCBS Traditional |
$74.00
|
| Rate for Payer: CASH_PRICE |
$59.20
|
| Rate for Payer: CIGNA Commercial |
$70.30
|
| Rate for Payer: CIGNA Medicare |
$66.60
|
| Rate for Payer: HUMANA Commercial |
$66.60
|
| Rate for Payer: MEDICAID Medicaid |
$68.08
|
| Rate for Payer: MEDICARE Medicare |
$51.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$70.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$71.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$70.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$70.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$59.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$59.20
|
|
|
OUTPATIENT TRIGGER POINT INJ 1-2 GROUPS
|
Facility
OP
|
$440.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: AETNA Commercial |
$418.00
|
| Rate for Payer: AETNA Medicare |
$396.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$418.00
|
| Rate for Payer: BCBS Healthlink |
$396.00
|
| Rate for Payer: BCBS HMK CHIP |
$396.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$396.00
|
| Rate for Payer: BCBS POS |
$418.00
|
| Rate for Payer: BCBS Traditional |
$440.00
|
| Rate for Payer: CASH_PRICE |
$352.00
|
| Rate for Payer: CIGNA Commercial |
$418.00
|
| Rate for Payer: CIGNA Medicare |
$396.00
|
| Rate for Payer: HUMANA Commercial |
$396.00
|
| Rate for Payer: MEDICAID Medicaid |
$404.80
|
| Rate for Payer: MEDICARE Medicare |
$308.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$418.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$426.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$418.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$418.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$374.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$352.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$352.00
|
|
|
OUTPATIENT TRIGGER POINT INJ 1-2 GROUPS
|
Facility
IP
|
$440.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: AETNA Commercial |
$418.00
|
| Rate for Payer: AETNA Medicare |
$396.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$418.00
|
| Rate for Payer: BCBS Healthlink |
$396.00
|
| Rate for Payer: BCBS HMK CHIP |
$396.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$396.00
|
| Rate for Payer: BCBS POS |
$418.00
|
| Rate for Payer: BCBS Traditional |
$440.00
|
| Rate for Payer: CASH_PRICE |
$352.00
|
| Rate for Payer: CIGNA Commercial |
$418.00
|
| Rate for Payer: CIGNA Medicare |
$396.00
|
| Rate for Payer: HUMANA Commercial |
$396.00
|
| Rate for Payer: MEDICAID Medicaid |
$404.80
|
| Rate for Payer: MEDICARE Medicare |
$308.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$418.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$426.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$418.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$418.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$374.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$352.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$352.00
|
|
|
OUTPATIENT TRIGR PT INJECTION 3+ 20553
|
Facility
IP
|
$705.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: AETNA Commercial |
$669.75
|
| Rate for Payer: AETNA Medicare |
$634.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$669.75
|
| Rate for Payer: BCBS Healthlink |
$634.50
|
| Rate for Payer: BCBS HMK CHIP |
$634.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$634.50
|
| Rate for Payer: BCBS POS |
$669.75
|
| Rate for Payer: BCBS Traditional |
$705.00
|
| Rate for Payer: CASH_PRICE |
$564.00
|
| Rate for Payer: CIGNA Commercial |
$669.75
|
| Rate for Payer: CIGNA Medicare |
$634.50
|
| Rate for Payer: HUMANA Commercial |
$634.50
|
| Rate for Payer: MEDICAID Medicaid |
$648.60
|
| Rate for Payer: MEDICARE Medicare |
$493.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$669.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$683.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$669.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$669.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$599.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$564.00
|
|
|
OUTPATIENT TRIGR PT INJECTION 3+ 20553
|
Facility
OP
|
$705.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$493.50 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: AETNA Commercial |
$669.75
|
| Rate for Payer: AETNA Medicare |
$634.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$669.75
|
| Rate for Payer: BCBS Healthlink |
$634.50
|
| Rate for Payer: BCBS HMK CHIP |
$634.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$634.50
|
| Rate for Payer: BCBS POS |
$669.75
|
| Rate for Payer: BCBS Traditional |
$705.00
|
| Rate for Payer: CASH_PRICE |
$564.00
|
| Rate for Payer: CIGNA Commercial |
$669.75
|
| Rate for Payer: CIGNA Medicare |
$634.50
|
| Rate for Payer: HUMANA Commercial |
$634.50
|
| Rate for Payer: MEDICAID Medicaid |
$648.60
|
| Rate for Payer: MEDICARE Medicare |
$493.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$669.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$683.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$669.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$669.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$599.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$564.00
|
|
|
OVA & PARASITES EXAM (008623)
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
OVA & PARASITES EXAM (008623)
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
.OVA & PARASITES STAIN
|
Facility
IP
|
$94.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: BCBS HMK CHIP |
$84.60
|
| Rate for Payer: AETNA Commercial |
$89.30
|
| Rate for Payer: AETNA Medicare |
$84.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$89.30
|
| Rate for Payer: BCBS Healthlink |
$84.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$84.60
|
| Rate for Payer: BCBS POS |
$89.30
|
| Rate for Payer: BCBS Traditional |
$94.00
|
| Rate for Payer: CASH_PRICE |
$75.20
|
| Rate for Payer: CIGNA Commercial |
$89.30
|
| Rate for Payer: CIGNA Medicare |
$84.60
|
| Rate for Payer: HUMANA Commercial |
$84.60
|
| Rate for Payer: MEDICAID Medicaid |
$86.48
|
| Rate for Payer: MEDICARE Medicare |
$65.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$89.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$91.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$89.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$89.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$75.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$75.20
|
|
|
.OVA & PARASITES STAIN
|
Facility
OP
|
$94.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: AETNA Commercial |
$89.30
|
| Rate for Payer: AETNA Medicare |
$84.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$89.30
|
| Rate for Payer: BCBS Healthlink |
$84.60
|
| Rate for Payer: BCBS HMK CHIP |
$84.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$84.60
|
| Rate for Payer: BCBS POS |
$89.30
|
| Rate for Payer: BCBS Traditional |
$94.00
|
| Rate for Payer: CASH_PRICE |
$75.20
|
| Rate for Payer: CIGNA Commercial |
$89.30
|
| Rate for Payer: CIGNA Medicare |
$84.60
|
| Rate for Payer: HUMANA Commercial |
$84.60
|
| Rate for Payer: MEDICAID Medicaid |
$86.48
|
| Rate for Payer: MEDICARE Medicare |
$65.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$89.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$91.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$89.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$89.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$75.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$75.20
|
|
|
OV BRIEF ESTAB PATIENT (99212)
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
20230101
|
|
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
|
|
|
OV BRIEF ESTAB PATIENT (99212)
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
20230101
|
|
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
|
|
|
OV CERV/VAG CANCER SCREEN W/ PELV&BREAST
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
OV CERV/VAG CANCER SCREEN W/ PELV&BREAST
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
OV COMPREHENSIVE NEW PATIENT (99205)
|
Facility
OP
|
$447.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: AETNA Commercial |
$424.65
|
| Rate for Payer: AETNA Medicare |
$402.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$424.65
|
| Rate for Payer: BCBS Healthlink |
$402.30
|
| Rate for Payer: BCBS HMK CHIP |
$402.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$402.30
|
| Rate for Payer: BCBS POS |
$424.65
|
| Rate for Payer: BCBS Traditional |
$447.00
|
| Rate for Payer: CASH_PRICE |
$357.60
|
| Rate for Payer: CIGNA Commercial |
$424.65
|
| Rate for Payer: CIGNA Medicare |
$402.30
|
| Rate for Payer: HUMANA Commercial |
$402.30
|
| Rate for Payer: MEDICAID Medicaid |
$411.24
|
| Rate for Payer: MEDICARE Medicare |
$312.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$424.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$433.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$424.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$424.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$379.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$357.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$357.60
|
|
|
OV COMPREHENSIVE NEW PATIENT (99205)
|
Facility
IP
|
$447.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: AETNA Commercial |
$424.65
|
| Rate for Payer: AETNA Medicare |
$402.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$424.65
|
| Rate for Payer: BCBS Healthlink |
$402.30
|
| Rate for Payer: BCBS HMK CHIP |
$402.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$402.30
|
| Rate for Payer: BCBS POS |
$424.65
|
| Rate for Payer: BCBS Traditional |
$447.00
|
| Rate for Payer: CASH_PRICE |
$357.60
|
| Rate for Payer: CIGNA Commercial |
$424.65
|
| Rate for Payer: CIGNA Medicare |
$402.30
|
| Rate for Payer: HUMANA Commercial |
$402.30
|
| Rate for Payer: MEDICAID Medicaid |
$411.24
|
| Rate for Payer: MEDICARE Medicare |
$312.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$424.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$433.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$424.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$424.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$379.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$357.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$357.60
|
|
|
OV DISABILITY WC OR MEDICAL EVAL
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT 99455
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
