|
PRO FEE LAC REPAIR COMPLEX 2.6-7.5CM
|
Facility
IP
|
$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
|
|
|
PRO FEE LAC REPAIR COMPLEX 2.6-7.5CM
|
Facility
OP
|
$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 SIMPLE=<2.5CM
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 12001 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
PRO FEE LAC REPAIR SIMPLE=<2.5CM
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 12001 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
PRO FEE LAC REPAIR SIMPLE 2.6-7.5CM
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 12002 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
PRO FEE LAC REPAIR SIMPLE 2.6-7.5CM
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 12002 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
PRO FEE LAC REPAIR SIMPLE 7.6-12.5CM
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 12004 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
PRO FEE LAC REPAIR SIMPLE 7.6-12.5CM
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 12004 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
PRO FEE MAJOR JOINT INJ W/O US 20610
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: AETNA Commercial |
$119.70
|
| Rate for Payer: AETNA Medicare |
$113.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$119.70
|
| Rate for Payer: BCBS Healthlink |
$113.40
|
| Rate for Payer: BCBS HMK CHIP |
$113.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$113.40
|
| Rate for Payer: BCBS POS |
$119.70
|
| Rate for Payer: BCBS Traditional |
$126.00
|
| Rate for Payer: CASH_PRICE |
$100.80
|
| Rate for Payer: CIGNA Commercial |
$119.70
|
| Rate for Payer: CIGNA Medicare |
$113.40
|
| Rate for Payer: HUMANA Commercial |
$113.40
|
| Rate for Payer: MEDICAID Medicaid |
$115.92
|
| Rate for Payer: MEDICARE Medicare |
$88.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$119.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$122.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$119.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$119.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.80
|
|
|
PRO FEE MAJOR JOINT INJ W/O US 20610
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: AETNA Commercial |
$119.70
|
| Rate for Payer: AETNA Medicare |
$113.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$119.70
|
| Rate for Payer: BCBS Healthlink |
$113.40
|
| Rate for Payer: BCBS HMK CHIP |
$113.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$113.40
|
| Rate for Payer: BCBS POS |
$119.70
|
| Rate for Payer: BCBS Traditional |
$126.00
|
| Rate for Payer: CASH_PRICE |
$100.80
|
| Rate for Payer: CIGNA Commercial |
$119.70
|
| Rate for Payer: CIGNA Medicare |
$113.40
|
| Rate for Payer: HUMANA Commercial |
$113.40
|
| Rate for Payer: MEDICAID Medicaid |
$115.92
|
| Rate for Payer: MEDICARE Medicare |
$88.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$119.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$122.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$119.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$119.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.80
|
|
|
PRO FEE OP IJ DESTR, PLANTAR NERV 64632
|
Facility
OP
|
$127.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
20230701
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: AETNA Commercial |
$120.65
|
| Rate for Payer: AETNA Medicare |
$114.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$120.65
|
| Rate for Payer: BCBS Healthlink |
$114.30
|
| Rate for Payer: BCBS HMK CHIP |
$114.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$114.30
|
| Rate for Payer: BCBS POS |
$120.65
|
| Rate for Payer: BCBS Traditional |
$127.00
|
| Rate for Payer: CASH_PRICE |
$101.60
|
| Rate for Payer: CIGNA Commercial |
$120.65
|
| Rate for Payer: CIGNA Medicare |
$114.30
|
| Rate for Payer: HUMANA Commercial |
$114.30
|
| Rate for Payer: MEDICAID Medicaid |
$116.84
|
| Rate for Payer: MEDICARE Medicare |
$88.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$120.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$123.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$120.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$120.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$101.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$101.60
|
|
|
PRO FEE OP IJ DESTR, PLANTAR NERV 64632
|
Facility
IP
|
$127.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
20230701
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: AETNA Commercial |
$120.65
|
| Rate for Payer: AETNA Medicare |
$114.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$120.65
|
| Rate for Payer: BCBS Healthlink |
$114.30
|
| Rate for Payer: BCBS HMK CHIP |
$114.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$114.30
|
| Rate for Payer: BCBS POS |
$120.65
|
| Rate for Payer: BCBS Traditional |
$127.00
|
| Rate for Payer: CASH_PRICE |
$101.60
|
| Rate for Payer: CIGNA Commercial |
$120.65
|
| Rate for Payer: CIGNA Medicare |
$114.30
|
| Rate for Payer: HUMANA Commercial |
$114.30
|
| Rate for Payer: MEDICAID Medicaid |
$116.84
|
| Rate for Payer: MEDICARE Medicare |
$88.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$120.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$123.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$120.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$120.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$101.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$101.60
|
|
|
PRO FEE OP IJ DESTR, PUDENDAL NERV 64630
|
Facility
OP
|
$831.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
20230701
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$581.70 |
| Max. Negotiated Rate |
$831.00 |
| Rate for Payer: AETNA Commercial |
$789.45
|
| Rate for Payer: AETNA Medicare |
$747.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$789.45
|
| Rate for Payer: BCBS Healthlink |
$747.90
|
| Rate for Payer: BCBS HMK CHIP |
$747.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$747.90
|
| Rate for Payer: BCBS POS |
$789.45
|
| Rate for Payer: BCBS Traditional |
$831.00
|
| Rate for Payer: CASH_PRICE |
$664.80
|
| Rate for Payer: CIGNA Commercial |
$789.45
|
| Rate for Payer: CIGNA Medicare |
$747.90
|
| Rate for Payer: HUMANA Commercial |
$747.90
|
| Rate for Payer: MEDICAID Medicaid |
$764.52
|
| Rate for Payer: MEDICARE Medicare |
$581.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$789.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$806.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$789.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$789.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$706.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$664.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$664.80
|
|
|
PRO FEE OP IJ DESTR, PUDENDAL NERV 64630
|
Facility
IP
|
$831.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
20230701
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$581.70 |
| Max. Negotiated Rate |
$831.00 |
| Rate for Payer: AETNA Commercial |
$789.45
|
| Rate for Payer: AETNA Medicare |
$747.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$789.45
|
| Rate for Payer: BCBS Healthlink |
$747.90
|
| Rate for Payer: BCBS HMK CHIP |
$747.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$747.90
|
| Rate for Payer: BCBS POS |
$789.45
|
| Rate for Payer: BCBS Traditional |
$831.00
|
| Rate for Payer: CASH_PRICE |
$664.80
|
| Rate for Payer: CIGNA Commercial |
$789.45
|
| Rate for Payer: CIGNA Medicare |
$747.90
|
| Rate for Payer: HUMANA Commercial |
$747.90
|
| Rate for Payer: MEDICAID Medicaid |
$764.52
|
| Rate for Payer: MEDICARE Medicare |
$581.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$789.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$806.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$789.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$789.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$706.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$664.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$664.80
|
|
|
PRO FEE OP IJ DST. F NER MIGRN TRT 64615
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: AETNA Commercial |
$156.75
|
| Rate for Payer: AETNA Medicare |
$148.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$156.75
|
| Rate for Payer: BCBS Healthlink |
$148.50
|
| Rate for Payer: BCBS HMK CHIP |
$148.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$148.50
|
| Rate for Payer: BCBS POS |
$156.75
|
| Rate for Payer: BCBS Traditional |
$165.00
|
| Rate for Payer: CASH_PRICE |
$132.00
|
| Rate for Payer: CIGNA Commercial |
$156.75
|
| Rate for Payer: CIGNA Medicare |
$148.50
|
| Rate for Payer: HUMANA Commercial |
$148.50
|
| Rate for Payer: MEDICAID Medicaid |
$151.80
|
| Rate for Payer: MEDICARE Medicare |
$115.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$156.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$160.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$156.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$156.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$140.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$132.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$132.00
|
|
|
PRO FEE OP IJ DST. F NER MIGRN TRT 64615
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: AETNA Commercial |
$156.75
|
| Rate for Payer: AETNA Medicare |
$148.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$156.75
|
| Rate for Payer: BCBS Healthlink |
$148.50
|
| Rate for Payer: BCBS HMK CHIP |
$148.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$148.50
|
| Rate for Payer: BCBS POS |
$156.75
|
| Rate for Payer: BCBS Traditional |
$165.00
|
| Rate for Payer: CASH_PRICE |
$132.00
|
| Rate for Payer: CIGNA Commercial |
$156.75
|
| Rate for Payer: CIGNA Medicare |
$148.50
|
| Rate for Payer: HUMANA Commercial |
$148.50
|
| Rate for Payer: MEDICAID Medicaid |
$151.80
|
| Rate for Payer: MEDICARE Medicare |
$115.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$156.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$160.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$156.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$156.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$140.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$132.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$132.00
|
|
|
PRO FEE OP IJ GREATER OCCIP NV BLK 64405
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: AETNA Commercial |
$179.55
|
| Rate for Payer: AETNA Medicare |
$170.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
PRO FEE OP IJ GREATER OCCIP NV BLK 64405
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: AETNA Commercial |
$179.55
|
| Rate for Payer: AETNA Medicare |
$170.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
PRO FEE OP IJ RFA C/T 1ST JOINT 64633
|
Facility
OP
|
$659.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$461.30 |
| Max. Negotiated Rate |
$659.00 |
| Rate for Payer: AETNA Commercial |
$626.05
|
| Rate for Payer: AETNA Medicare |
$593.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$626.05
|
| Rate for Payer: BCBS Healthlink |
$593.10
|
| Rate for Payer: BCBS HMK CHIP |
$593.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$593.10
|
| Rate for Payer: BCBS POS |
$626.05
|
| Rate for Payer: BCBS Traditional |
$659.00
|
| Rate for Payer: CASH_PRICE |
$527.20
|
| Rate for Payer: CIGNA Commercial |
$626.05
|
| Rate for Payer: CIGNA Medicare |
$593.10
|
| Rate for Payer: HUMANA Commercial |
$593.10
|
| Rate for Payer: MEDICAID Medicaid |
$606.28
|
| Rate for Payer: MEDICARE Medicare |
$461.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$626.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$639.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$626.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$626.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$560.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$527.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$527.20
|
|
|
PRO FEE OP IJ RFA C/T 1ST JOINT 64633
|
Facility
IP
|
$659.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$461.30 |
| Max. Negotiated Rate |
$659.00 |
| Rate for Payer: AETNA Commercial |
$626.05
|
| Rate for Payer: AETNA Medicare |
$593.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$626.05
|
| Rate for Payer: BCBS Healthlink |
$593.10
|
| Rate for Payer: BCBS HMK CHIP |
$593.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$593.10
|
| Rate for Payer: BCBS POS |
$626.05
|
| Rate for Payer: BCBS Traditional |
$659.00
|
| Rate for Payer: CASH_PRICE |
$527.20
|
| Rate for Payer: CIGNA Commercial |
$626.05
|
| Rate for Payer: CIGNA Medicare |
$593.10
|
| Rate for Payer: HUMANA Commercial |
$593.10
|
| Rate for Payer: MEDICAID Medicaid |
$606.28
|
| Rate for Payer: MEDICARE Medicare |
$461.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$626.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$639.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$626.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$626.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$560.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$527.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$527.20
|
|
|
PRO FEE OP IJ RFA C/T EA AD ON JT 64634
|
Facility
OP
|
$277.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: AETNA Commercial |
$263.15
|
| Rate for Payer: AETNA Medicare |
$249.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$263.15
|
| Rate for Payer: BCBS Healthlink |
$249.30
|
| Rate for Payer: BCBS HMK CHIP |
$249.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$249.30
|
| Rate for Payer: BCBS POS |
$263.15
|
| Rate for Payer: BCBS Traditional |
$277.00
|
| Rate for Payer: CASH_PRICE |
$221.60
|
| Rate for Payer: CIGNA Commercial |
$263.15
|
| Rate for Payer: CIGNA Medicare |
$249.30
|
| Rate for Payer: HUMANA Commercial |
$249.30
|
| Rate for Payer: MEDICAID Medicaid |
$254.84
|
| Rate for Payer: MEDICARE Medicare |
$193.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$263.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$268.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$263.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$263.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$235.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$221.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$221.60
|
|
|
PRO FEE OP IJ RFA C/T EA AD ON JT 64634
|
Facility
IP
|
$277.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$193.90 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: AETNA Commercial |
$263.15
|
| Rate for Payer: AETNA Medicare |
$249.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$263.15
|
| Rate for Payer: BCBS Healthlink |
$249.30
|
| Rate for Payer: BCBS HMK CHIP |
$249.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$249.30
|
| Rate for Payer: BCBS POS |
$263.15
|
| Rate for Payer: BCBS Traditional |
$277.00
|
| Rate for Payer: CASH_PRICE |
$221.60
|
| Rate for Payer: CIGNA Commercial |
$263.15
|
| Rate for Payer: CIGNA Medicare |
$249.30
|
| Rate for Payer: HUMANA Commercial |
$249.30
|
| Rate for Payer: MEDICAID Medicaid |
$254.84
|
| Rate for Payer: MEDICARE Medicare |
$193.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$263.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$268.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$263.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$263.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$235.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$221.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$221.60
|
|
|
PRO FEE OP IJ RFA PERPH NV/SUPSCAP 64640
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: AETNA Commercial |
$441.75
|
| Rate for Payer: AETNA Medicare |
$418.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$441.75
|
| Rate for Payer: BCBS Healthlink |
$418.50
|
| Rate for Payer: BCBS HMK CHIP |
$418.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$418.50
|
| Rate for Payer: BCBS POS |
$441.75
|
| Rate for Payer: BCBS Traditional |
$465.00
|
| Rate for Payer: CASH_PRICE |
$372.00
|
| Rate for Payer: CIGNA Commercial |
$441.75
|
| Rate for Payer: CIGNA Medicare |
$418.50
|
| Rate for Payer: HUMANA Commercial |
$418.50
|
| Rate for Payer: MEDICAID Medicaid |
$427.80
|
| Rate for Payer: MEDICARE Medicare |
$325.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$441.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$451.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$441.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$441.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$395.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$372.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$372.00
|
|
|
PRO FEE OP IJ RFA PERPH NV/SUPSCAP 64640
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: AETNA Commercial |
$441.75
|
| Rate for Payer: AETNA Medicare |
$418.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$441.75
|
| Rate for Payer: BCBS Healthlink |
$418.50
|
| Rate for Payer: BCBS HMK CHIP |
$418.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$418.50
|
| Rate for Payer: BCBS POS |
$441.75
|
| Rate for Payer: BCBS Traditional |
$465.00
|
| Rate for Payer: CASH_PRICE |
$372.00
|
| Rate for Payer: CIGNA Commercial |
$441.75
|
| Rate for Payer: CIGNA Medicare |
$418.50
|
| Rate for Payer: HUMANA Commercial |
$418.50
|
| Rate for Payer: MEDICAID Medicaid |
$427.80
|
| Rate for Payer: MEDICARE Medicare |
$325.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$441.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$451.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$441.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$441.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$395.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$372.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$372.00
|
|
|
PRO FEE OP IJ TRANSFOR L/S ADD 64484
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: BCBS HMK CHIP |
$226.80
|
| Rate for Payer: AETNA Commercial |
$239.40
|
| Rate for Payer: AETNA Medicare |
$226.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$239.40
|
| Rate for Payer: BCBS Healthlink |
$226.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$226.80
|
| Rate for Payer: BCBS POS |
$239.40
|
| Rate for Payer: BCBS Traditional |
$252.00
|
| Rate for Payer: CASH_PRICE |
$201.60
|
| Rate for Payer: CIGNA Commercial |
$239.40
|
| Rate for Payer: CIGNA Medicare |
$226.80
|
| Rate for Payer: HUMANA Commercial |
$226.80
|
| Rate for Payer: MEDICAID Medicaid |
$231.84
|
| Rate for Payer: MEDICARE Medicare |
$176.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$239.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$244.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$239.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$239.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$214.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$201.60
|
|
