|
PRO FEE ER INTERMEDIATE 99283
|
Facility
IP
|
$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: 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 - ALLEGIANCE Commercial |
$132.05
|
| 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
|
|
|
PRO FEE ER LIMITED 99282
|
Facility
IP
|
$95.00
|
|
|
Service Code
|
CPT 99282 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
PRO FEE ER LIMITED 99282
|
Facility
OP
|
$95.00
|
|
|
Service Code
|
CPT 99282 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
PRO FEE ER STRAPPING OF WRIST
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
PRO FEE ER STRAPPING OF WRIST
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
PRO FEE EXC MALIGNANT LESION INC MARGINS
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
CPT 11602 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: AETNA Commercial |
$170.05
|
| Rate for Payer: AETNA Medicare |
$161.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$170.05
|
| Rate for Payer: BCBS Healthlink |
$161.10
|
| Rate for Payer: BCBS HMK CHIP |
$161.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$161.10
|
| Rate for Payer: BCBS POS |
$170.05
|
| Rate for Payer: BCBS Traditional |
$179.00
|
| Rate for Payer: CASH_PRICE |
$143.20
|
| Rate for Payer: CIGNA Commercial |
$170.05
|
| Rate for Payer: CIGNA Medicare |
$161.10
|
| Rate for Payer: HUMANA Commercial |
$161.10
|
| Rate for Payer: MEDICAID Medicaid |
$164.68
|
| Rate for Payer: MEDICARE Medicare |
$125.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$170.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$173.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$170.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$170.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$152.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$143.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$143.20
|
|
|
PRO FEE EXC MALIGNANT LESION INC MARGINS
|
Facility
IP
|
$179.00
|
|
|
Service Code
|
CPT 11602 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: AETNA Commercial |
$170.05
|
| Rate for Payer: AETNA Medicare |
$161.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$170.05
|
| Rate for Payer: BCBS Healthlink |
$161.10
|
| Rate for Payer: BCBS HMK CHIP |
$161.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$161.10
|
| Rate for Payer: BCBS POS |
$170.05
|
| Rate for Payer: BCBS Traditional |
$179.00
|
| Rate for Payer: CASH_PRICE |
$143.20
|
| Rate for Payer: CIGNA Commercial |
$170.05
|
| Rate for Payer: CIGNA Medicare |
$161.10
|
| Rate for Payer: HUMANA Commercial |
$161.10
|
| Rate for Payer: MEDICAID Medicaid |
$164.68
|
| Rate for Payer: MEDICARE Medicare |
$125.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$170.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$173.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$170.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$170.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$152.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$143.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$143.20
|
|
|
PRO FEE I&D ABCESS/CYST SIMPLE
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.00
|
| Rate for Payer: AETNA Commercial |
$114.00
|
| Rate for Payer: AETNA Medicare |
$108.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.00
|
| Rate for Payer: BCBS Healthlink |
$108.00
|
| Rate for Payer: BCBS HMK CHIP |
$108.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.00
|
| Rate for Payer: BCBS POS |
$114.00
|
| Rate for Payer: BCBS Traditional |
$120.00
|
| Rate for Payer: CASH_PRICE |
$96.00
|
| Rate for Payer: CIGNA Commercial |
$114.00
|
| Rate for Payer: CIGNA Medicare |
$108.00
|
| Rate for Payer: HUMANA Commercial |
$108.00
|
| Rate for Payer: MEDICAID Medicaid |
$110.40
|
| Rate for Payer: MEDICARE Medicare |
$84.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$116.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.00
|
|
|
PRO FEE I&D ABCESS/CYST SIMPLE
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: AETNA Commercial |
$114.00
|
| Rate for Payer: AETNA Medicare |
$108.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.00
|
| Rate for Payer: BCBS Healthlink |
$108.00
|
| Rate for Payer: BCBS HMK CHIP |
$108.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.00
|
| Rate for Payer: BCBS POS |
$114.00
|
| Rate for Payer: BCBS Traditional |
$120.00
|
| Rate for Payer: CASH_PRICE |
$96.00
|
| Rate for Payer: CIGNA Commercial |
$114.00
|
| Rate for Payer: CIGNA Medicare |
$108.00
|
| Rate for Payer: HUMANA Commercial |
$108.00
|
| Rate for Payer: MEDICAID Medicaid |
$110.40
|
| Rate for Payer: MEDICARE Medicare |
$84.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$116.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.00
|
|
|
PRO FEE INC&REMOVAL FOREIGN BODY-SIMPLE
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: AETNA Commercial |
$145.35
|
| Rate for Payer: AETNA Medicare |
$137.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$145.35
|
| Rate for Payer: BCBS Healthlink |
$137.70
|
| Rate for Payer: BCBS HMK CHIP |
$137.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$137.70
|
| Rate for Payer: BCBS POS |
$145.35
|
| Rate for Payer: BCBS Traditional |
$153.00
|
| Rate for Payer: CASH_PRICE |
$122.40
|
| Rate for Payer: CIGNA Commercial |
$145.35
|
| Rate for Payer: CIGNA Medicare |
$137.70
|
| Rate for Payer: HUMANA Commercial |
$137.70
|
| Rate for Payer: MEDICAID Medicaid |
$140.76
|
| Rate for Payer: MEDICARE Medicare |
$107.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$145.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$148.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$145.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$130.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$122.40
|
|
|
PRO FEE INC&REMOVAL FOREIGN BODY-SIMPLE
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: AETNA Commercial |
$145.35
|
| Rate for Payer: AETNA Medicare |
$137.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$145.35
|
| Rate for Payer: BCBS Healthlink |
$137.70
|
| Rate for Payer: BCBS HMK CHIP |
$137.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$137.70
|
| Rate for Payer: BCBS POS |
$145.35
|
| Rate for Payer: BCBS Traditional |
$153.00
|
| Rate for Payer: CASH_PRICE |
$122.40
|
| Rate for Payer: CIGNA Commercial |
$145.35
|
| Rate for Payer: CIGNA Medicare |
$137.70
|
| Rate for Payer: HUMANA Commercial |
$137.70
|
| Rate for Payer: MEDICAID Medicaid |
$140.76
|
| Rate for Payer: MEDICARE Medicare |
$107.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$145.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$148.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$145.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$130.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$122.40
|
|
|
PRO FEE INJECTION, THERAPEUTIC CARPAL TN
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| 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
|
|
|
PRO FEE INJECTION, THERAPEUTIC CARPAL TN
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| 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
|
|
|
PRO FEE INJ FACET JNT C/T 2L W/IMA 64491
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: AETNA Commercial |
$215.65
|
| Rate for Payer: AETNA Medicare |
$204.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$215.65
|
| Rate for Payer: BCBS Healthlink |
$204.30
|
| Rate for Payer: BCBS HMK CHIP |
$204.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$204.30
|
| Rate for Payer: BCBS POS |
$215.65
|
| Rate for Payer: BCBS Traditional |
$227.00
|
| Rate for Payer: CASH_PRICE |
$181.60
|
| Rate for Payer: CIGNA Commercial |
$215.65
|
| Rate for Payer: CIGNA Medicare |
$204.30
|
| Rate for Payer: HUMANA Commercial |
$204.30
|
| Rate for Payer: MEDICAID Medicaid |
$208.84
|
| Rate for Payer: MEDICARE Medicare |
$158.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$215.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$220.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$215.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$215.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$181.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$181.60
|
|
|
PRO FEE INJ FACET JNT C/T 2L W/IMA 64491
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$227.00 |
| Rate for Payer: AETNA Commercial |
$215.65
|
| Rate for Payer: AETNA Medicare |
$204.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$215.65
|
| Rate for Payer: BCBS Healthlink |
$204.30
|
| Rate for Payer: BCBS HMK CHIP |
$204.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$204.30
|
| Rate for Payer: BCBS POS |
$215.65
|
| Rate for Payer: BCBS Traditional |
$227.00
|
| Rate for Payer: CASH_PRICE |
$181.60
|
| Rate for Payer: CIGNA Commercial |
$215.65
|
| Rate for Payer: CIGNA Medicare |
$204.30
|
| Rate for Payer: HUMANA Commercial |
$204.30
|
| Rate for Payer: MEDICAID Medicaid |
$208.84
|
| Rate for Payer: MEDICARE Medicare |
$158.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$215.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$220.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$215.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$215.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$181.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$181.60
|
|
|
PRO FEE INTERCOSTAL NV BLK EA ADD 64421
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
PRO FEE INTERCOSTAL NV BLK EA ADD 64421
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
PRO FEE INT/INJ GENICULAR NERVE 64454
|
Facility
IP
|
$197.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: AETNA Commercial |
$187.15
|
| Rate for Payer: AETNA Medicare |
$177.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$187.15
|
| Rate for Payer: BCBS Healthlink |
$177.30
|
| Rate for Payer: BCBS HMK CHIP |
$177.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$177.30
|
| Rate for Payer: BCBS POS |
$187.15
|
| Rate for Payer: BCBS Traditional |
$197.00
|
| Rate for Payer: CASH_PRICE |
$157.60
|
| Rate for Payer: CIGNA Commercial |
$187.15
|
| Rate for Payer: CIGNA Medicare |
$177.30
|
| Rate for Payer: HUMANA Commercial |
$177.30
|
| Rate for Payer: MEDICAID Medicaid |
$181.24
|
| Rate for Payer: MEDICARE Medicare |
$137.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$187.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$191.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$187.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$187.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$167.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$157.60
|
|
|
PRO FEE INT/INJ GENICULAR NERVE 64454
|
Facility
OP
|
$197.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: AETNA Commercial |
$187.15
|
| Rate for Payer: AETNA Medicare |
$177.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$187.15
|
| Rate for Payer: BCBS Healthlink |
$177.30
|
| Rate for Payer: BCBS HMK CHIP |
$177.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$177.30
|
| Rate for Payer: BCBS POS |
$187.15
|
| Rate for Payer: BCBS Traditional |
$197.00
|
| Rate for Payer: CASH_PRICE |
$157.60
|
| Rate for Payer: CIGNA Commercial |
$187.15
|
| Rate for Payer: CIGNA Medicare |
$177.30
|
| Rate for Payer: HUMANA Commercial |
$177.30
|
| Rate for Payer: MEDICAID Medicaid |
$181.24
|
| Rate for Payer: MEDICARE Medicare |
$137.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$187.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$191.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$187.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$187.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$167.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$157.60
|
|
|
PRO FEE INTRCOST NRVE BLOCK SINGLE 64420
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
PRO FEE INTRCOST NRVE BLOCK SINGLE 64420
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
PRO FEE LAC REPAIR CMPL FC/HNADD ON =>5C
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
CPT 13133 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: AETNA Commercial |
$153.90
|
| Rate for Payer: AETNA Medicare |
$145.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$153.90
|
| Rate for Payer: BCBS Healthlink |
$145.80
|
| Rate for Payer: BCBS HMK CHIP |
$145.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$145.80
|
| Rate for Payer: BCBS POS |
$153.90
|
| Rate for Payer: BCBS Traditional |
$162.00
|
| Rate for Payer: CASH_PRICE |
$129.60
|
| Rate for Payer: CIGNA Commercial |
$153.90
|
| Rate for Payer: CIGNA Medicare |
$145.80
|
| Rate for Payer: HUMANA Commercial |
$145.80
|
| Rate for Payer: MEDICAID Medicaid |
$149.04
|
| Rate for Payer: MEDICARE Medicare |
$113.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$153.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$157.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$153.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$153.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$137.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$129.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$129.60
|
|
|
PRO FEE LAC REPAIR CMPL FC/HNADD ON =>5C
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 13133 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: AETNA Commercial |
$153.90
|
| Rate for Payer: AETNA Medicare |
$145.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$153.90
|
| Rate for Payer: BCBS Healthlink |
$145.80
|
| Rate for Payer: BCBS HMK CHIP |
$145.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$145.80
|
| Rate for Payer: BCBS POS |
$153.90
|
| Rate for Payer: BCBS Traditional |
$162.00
|
| Rate for Payer: CASH_PRICE |
$129.60
|
| Rate for Payer: CIGNA Commercial |
$153.90
|
| Rate for Payer: CIGNA Medicare |
$145.80
|
| Rate for Payer: HUMANA Commercial |
$145.80
|
| Rate for Payer: MEDICAID Medicaid |
$149.04
|
| Rate for Payer: MEDICARE Medicare |
$113.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$153.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$157.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$153.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$153.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$137.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$129.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$129.60
|
|
|
PRO FEE LAC REPAIR COMPLEX 2.6-7.5CM
|
Facility
IP
|
$294.00
|
|
|
Service Code
|
CPT 13121 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: AETNA Commercial |
$279.30
|
| Rate for Payer: AETNA Medicare |
$264.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$279.30
|
| Rate for Payer: BCBS Healthlink |
$264.60
|
| Rate for Payer: BCBS HMK CHIP |
$264.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$264.60
|
| Rate for Payer: BCBS POS |
$279.30
|
| Rate for Payer: BCBS Traditional |
$294.00
|
| Rate for Payer: CASH_PRICE |
$235.20
|
| Rate for Payer: CIGNA Commercial |
$279.30
|
| Rate for Payer: CIGNA Medicare |
$264.60
|
| Rate for Payer: HUMANA Commercial |
$264.60
|
| Rate for Payer: MEDICAID Medicaid |
$270.48
|
| Rate for Payer: MEDICARE Medicare |
$205.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$279.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$285.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$279.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$279.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$249.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$235.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$235.20
|
|
|
PRO FEE LAC REPAIR COMPLEX 2.6-7.5CM
|
Facility
OP
|
$352.00
|
|
|
Service Code
|
CPT 13132 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: AETNA Commercial |
$334.40
|
| Rate for Payer: AETNA Medicare |
$316.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$334.40
|
| Rate for Payer: BCBS Healthlink |
$316.80
|
| Rate for Payer: BCBS HMK CHIP |
$316.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$316.80
|
| Rate for Payer: BCBS POS |
$334.40
|
| Rate for Payer: BCBS Traditional |
$352.00
|
| Rate for Payer: CASH_PRICE |
$281.60
|
| Rate for Payer: CIGNA Commercial |
$334.40
|
| Rate for Payer: CIGNA Medicare |
$316.80
|
| Rate for Payer: HUMANA Commercial |
$316.80
|
| Rate for Payer: MEDICAID Medicaid |
$323.84
|
| Rate for Payer: MEDICARE Medicare |
$246.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$334.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$341.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$334.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$334.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$299.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$281.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$281.60
|
|
