|
PRO FEE EKG 12 LEAD
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 93010 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AETNA Commercial |
$48.45
|
| Rate for Payer: AETNA Medicare |
$45.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$48.45
|
| Rate for Payer: BCBS Healthlink |
$45.90
|
| Rate for Payer: BCBS HMK CHIP |
$45.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.90
|
| Rate for Payer: BCBS POS |
$48.45
|
| Rate for Payer: BCBS Traditional |
$51.00
|
| Rate for Payer: CASH_PRICE |
$40.80
|
| Rate for Payer: CIGNA Commercial |
$48.45
|
| Rate for Payer: CIGNA Medicare |
$45.90
|
| Rate for Payer: HUMANA Commercial |
$45.90
|
| Rate for Payer: MEDICAID Medicaid |
$46.92
|
| Rate for Payer: MEDICARE Medicare |
$35.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$48.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$49.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$48.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$43.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.80
|
|
|
PRO FEE EKG 12 LEAD
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 93010 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$43.35
|
| Rate for Payer: AETNA Commercial |
$48.45
|
| Rate for Payer: AETNA Medicare |
$45.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$48.45
|
| Rate for Payer: BCBS Healthlink |
$45.90
|
| Rate for Payer: BCBS HMK CHIP |
$45.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.90
|
| Rate for Payer: BCBS POS |
$48.45
|
| Rate for Payer: BCBS Traditional |
$51.00
|
| Rate for Payer: CASH_PRICE |
$40.80
|
| Rate for Payer: CIGNA Commercial |
$48.45
|
| Rate for Payer: CIGNA Medicare |
$45.90
|
| Rate for Payer: HUMANA Commercial |
$45.90
|
| Rate for Payer: MEDICAID Medicaid |
$46.92
|
| Rate for Payer: MEDICARE Medicare |
$35.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$48.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$49.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$48.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.80
|
|
|
PRO FEE EPISTAXIS, COMPLEX
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
20230301
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
PRO FEE EPISTAXIS, COMPLEX
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
20230301
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
PRO FEE EPISTAXIS, INITIAL
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
PRO FEE EPISTAXIS, INITIAL
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
PRO FEE EPISTAXIS, SIMPLE
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
PRO FEE EPISTAXIS, SIMPLE
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
PRO FEE ER APPLICATION OF SHORT LEG SPLI
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
PRO FEE ER APPLICATION OF SHORT LEG SPLI
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
PRO FEE ER APPL OF LONG LEG SPLINT
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
20230404
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: AETNA Commercial |
$85.50
|
| Rate for Payer: AETNA Medicare |
$81.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$85.50
|
| Rate for Payer: BCBS Healthlink |
$81.00
|
| Rate for Payer: BCBS HMK CHIP |
$81.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.00
|
| Rate for Payer: BCBS POS |
$85.50
|
| Rate for Payer: BCBS Traditional |
$90.00
|
| Rate for Payer: CASH_PRICE |
$72.00
|
| Rate for Payer: CIGNA Commercial |
$85.50
|
| Rate for Payer: CIGNA Medicare |
$81.00
|
| Rate for Payer: HUMANA Commercial |
$81.00
|
| Rate for Payer: MEDICAID Medicaid |
$82.80
|
| Rate for Payer: MEDICARE Medicare |
$63.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$85.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$87.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$85.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$85.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$76.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.00
|
|
|
PRO FEE ER APPL OF LONG LEG SPLINT
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
20230404
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: AETNA Commercial |
$85.50
|
| Rate for Payer: AETNA Medicare |
$81.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$85.50
|
| Rate for Payer: BCBS Healthlink |
$81.00
|
| Rate for Payer: BCBS HMK CHIP |
$81.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.00
|
| Rate for Payer: BCBS POS |
$85.50
|
| Rate for Payer: BCBS Traditional |
$90.00
|
| Rate for Payer: CASH_PRICE |
$72.00
|
| Rate for Payer: CIGNA Commercial |
$85.50
|
| Rate for Payer: CIGNA Medicare |
$81.00
|
| Rate for Payer: HUMANA Commercial |
$81.00
|
| Rate for Payer: MEDICAID Medicaid |
$82.80
|
| Rate for Payer: MEDICARE Medicare |
$63.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$85.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$87.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$85.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$85.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$76.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.00
|
|
|
PRO FEE ER BRIEF 99281
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 99281 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
PRO FEE ER BRIEF 99281
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 99281 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
PRO FEE ER CLOSED TRT NOSE FX W/O STAB
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
PRO FEE ER CLOSED TRT NOSE FX W/O STAB
|
Facility
OP
|
$137.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
PRO FEE ER COMPREHENSIVE 99285
|
Facility
IP
|
$385.00
|
|
|
Service Code
|
CPT 99285 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: AETNA Commercial |
$365.75
|
| Rate for Payer: AETNA Medicare |
$346.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$365.75
|
| Rate for Payer: BCBS Healthlink |
$346.50
|
| Rate for Payer: BCBS HMK CHIP |
$346.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$346.50
|
| Rate for Payer: BCBS POS |
$365.75
|
| Rate for Payer: BCBS Traditional |
$385.00
|
| Rate for Payer: CASH_PRICE |
$308.00
|
| Rate for Payer: CIGNA Commercial |
$365.75
|
| Rate for Payer: CIGNA Medicare |
$346.50
|
| Rate for Payer: HUMANA Commercial |
$346.50
|
| Rate for Payer: MEDICAID Medicaid |
$354.20
|
| Rate for Payer: MEDICARE Medicare |
$269.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$365.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$373.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$365.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$365.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$327.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$308.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$308.00
|
|
|
PRO FEE ER COMPREHENSIVE 99285
|
Facility
OP
|
$385.00
|
|
|
Service Code
|
CPT 99285 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: AETNA Commercial |
$365.75
|
| Rate for Payer: AETNA Medicare |
$346.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$365.75
|
| Rate for Payer: BCBS Healthlink |
$346.50
|
| Rate for Payer: BCBS HMK CHIP |
$346.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$346.50
|
| Rate for Payer: BCBS POS |
$365.75
|
| Rate for Payer: BCBS Traditional |
$385.00
|
| Rate for Payer: CASH_PRICE |
$308.00
|
| Rate for Payer: CIGNA Commercial |
$365.75
|
| Rate for Payer: CIGNA Medicare |
$346.50
|
| Rate for Payer: HUMANA Commercial |
$346.50
|
| Rate for Payer: MEDICAID Medicaid |
$354.20
|
| Rate for Payer: MEDICARE Medicare |
$269.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$365.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$373.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$365.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$365.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$327.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$308.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$308.00
|
|
|
PRO FEE ER CRITICAL CARE 1HR 99291
|
Facility
OP
|
$572.00
|
|
|
Service Code
|
CPT 99291 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: AETNA Commercial |
$543.40
|
| Rate for Payer: AETNA Medicare |
$514.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$543.40
|
| Rate for Payer: BCBS Healthlink |
$514.80
|
| Rate for Payer: BCBS HMK CHIP |
$514.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$514.80
|
| Rate for Payer: BCBS POS |
$543.40
|
| Rate for Payer: BCBS Traditional |
$572.00
|
| Rate for Payer: CASH_PRICE |
$457.60
|
| Rate for Payer: CIGNA Commercial |
$543.40
|
| Rate for Payer: CIGNA Medicare |
$514.80
|
| Rate for Payer: HUMANA Commercial |
$514.80
|
| Rate for Payer: MEDICAID Medicaid |
$526.24
|
| Rate for Payer: MEDICARE Medicare |
$400.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$543.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$554.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$543.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$543.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$486.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$457.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$457.60
|
|
|
PRO FEE ER CRITICAL CARE 1HR 99291
|
Facility
IP
|
$572.00
|
|
|
Service Code
|
CPT 99291 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: AETNA Commercial |
$543.40
|
| Rate for Payer: AETNA Medicare |
$514.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$543.40
|
| Rate for Payer: BCBS Healthlink |
$514.80
|
| Rate for Payer: BCBS HMK CHIP |
$514.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$514.80
|
| Rate for Payer: BCBS POS |
$543.40
|
| Rate for Payer: BCBS Traditional |
$572.00
|
| Rate for Payer: CASH_PRICE |
$457.60
|
| Rate for Payer: CIGNA Commercial |
$543.40
|
| Rate for Payer: CIGNA Medicare |
$514.80
|
| Rate for Payer: HUMANA Commercial |
$514.80
|
| Rate for Payer: MEDICAID Medicaid |
$526.24
|
| Rate for Payer: MEDICARE Medicare |
$400.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$543.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$554.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$543.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$543.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$486.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$457.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$457.60
|
|
|
PRO FEE ER CRITICAL CARE E ADD 30m 99292
|
Facility
IP
|
$257.00
|
|
|
Service Code
|
CPT 99292 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
PRO FEE ER CRITICAL CARE E ADD 30m 99292
|
Facility
OP
|
$257.00
|
|
|
Service Code
|
CPT 99292 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
PRO FEE ER EXTENDED 99284
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT 99284 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: AETNA Commercial |
$247.95
|
| Rate for Payer: AETNA Medicare |
$234.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$247.95
|
| Rate for Payer: BCBS Healthlink |
$234.90
|
| Rate for Payer: BCBS HMK CHIP |
$234.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$234.90
|
| Rate for Payer: BCBS POS |
$247.95
|
| Rate for Payer: BCBS Traditional |
$261.00
|
| Rate for Payer: CASH_PRICE |
$208.80
|
| Rate for Payer: CIGNA Commercial |
$247.95
|
| Rate for Payer: CIGNA Medicare |
$234.90
|
| Rate for Payer: HUMANA Commercial |
$234.90
|
| Rate for Payer: MEDICAID Medicaid |
$240.12
|
| Rate for Payer: MEDICARE Medicare |
$182.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$247.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$253.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$247.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$247.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$221.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$208.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$208.80
|
|
|
PRO FEE ER EXTENDED 99284
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT 99284 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: AETNA Commercial |
$247.95
|
| Rate for Payer: AETNA Medicare |
$234.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$247.95
|
| Rate for Payer: BCBS Healthlink |
$234.90
|
| Rate for Payer: BCBS HMK CHIP |
$234.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$234.90
|
| Rate for Payer: BCBS POS |
$247.95
|
| Rate for Payer: BCBS Traditional |
$261.00
|
| Rate for Payer: CASH_PRICE |
$208.80
|
| Rate for Payer: CIGNA Commercial |
$247.95
|
| Rate for Payer: CIGNA Medicare |
$234.90
|
| Rate for Payer: HUMANA Commercial |
$234.90
|
| Rate for Payer: MEDICAID Medicaid |
$240.12
|
| Rate for Payer: MEDICARE Medicare |
$182.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$247.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$253.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$247.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$247.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$221.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$208.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$208.80
|
|
|
PRO FEE ER INTERMEDIATE 99283
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 99283 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$132.05
|
| Rate for Payer: AETNA Commercial |
$132.05
|
| Rate for Payer: AETNA Medicare |
$125.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$132.05
|
| Rate for Payer: BCBS Healthlink |
$125.10
|
| Rate for Payer: BCBS HMK CHIP |
$125.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$125.10
|
| Rate for Payer: BCBS POS |
$132.05
|
| Rate for Payer: BCBS Traditional |
$139.00
|
| Rate for Payer: CASH_PRICE |
$111.20
|
| Rate for Payer: CIGNA Commercial |
$132.05
|
| Rate for Payer: CIGNA Medicare |
$125.10
|
| Rate for Payer: HUMANA Commercial |
$125.10
|
| Rate for Payer: MEDICAID Medicaid |
$127.88
|
| Rate for Payer: MEDICARE Medicare |
$97.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$134.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$132.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$132.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
