|
PRO FEE OP IJ TRANSFOR L/S ADD 64484
|
Facility
IP
|
$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: 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 HMK CHIP |
$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
|
|
|
PRO FEE OP INJ BRACHIAL PLEX W/IMG 64415
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 64415
|
| 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 INJ BRACHIAL PLEX W/IMG 64415
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT 64415
|
| 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 INJ CELIAC PLEX BLOCK 64530
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: AETNA Commercial |
$494.00
|
| Rate for Payer: AETNA Medicare |
$468.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$494.00
|
| Rate for Payer: BCBS Healthlink |
$468.00
|
| Rate for Payer: BCBS HMK CHIP |
$468.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$468.00
|
| Rate for Payer: BCBS POS |
$494.00
|
| Rate for Payer: BCBS Traditional |
$520.00
|
| Rate for Payer: CASH_PRICE |
$416.00
|
| Rate for Payer: CIGNA Commercial |
$494.00
|
| Rate for Payer: CIGNA Medicare |
$468.00
|
| Rate for Payer: HUMANA Commercial |
$468.00
|
| Rate for Payer: MEDICAID Medicaid |
$478.40
|
| Rate for Payer: MEDICARE Medicare |
$364.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$494.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$504.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$494.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$494.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$442.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$416.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$416.00
|
|
|
PRO FEE OP INJ CELIAC PLEX BLOCK 64530
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: AETNA Commercial |
$494.00
|
| Rate for Payer: AETNA Medicare |
$468.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$494.00
|
| Rate for Payer: BCBS Healthlink |
$468.00
|
| Rate for Payer: BCBS HMK CHIP |
$468.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$468.00
|
| Rate for Payer: BCBS POS |
$494.00
|
| Rate for Payer: BCBS Traditional |
$520.00
|
| Rate for Payer: CASH_PRICE |
$416.00
|
| Rate for Payer: CIGNA Commercial |
$494.00
|
| Rate for Payer: CIGNA Medicare |
$468.00
|
| Rate for Payer: HUMANA Commercial |
$468.00
|
| Rate for Payer: MEDICAID Medicaid |
$478.40
|
| Rate for Payer: MEDICARE Medicare |
$364.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$494.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$504.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$494.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$494.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$442.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$416.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$416.00
|
|
|
PRO FEE OP INJ DEST OF FACIAL NER 64612
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
PRO FEE OP INJ DEST OF FACIAL NER 64612
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 64612
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
PRO FEE OP INJ FACET JNT C/T 1L 64490
|
Facility
OP
|
$449.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$314.30 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: AETNA Commercial |
$426.55
|
| Rate for Payer: AETNA Medicare |
$404.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$426.55
|
| Rate for Payer: BCBS Healthlink |
$404.10
|
| Rate for Payer: BCBS HMK CHIP |
$404.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$404.10
|
| Rate for Payer: BCBS POS |
$426.55
|
| Rate for Payer: BCBS Traditional |
$449.00
|
| Rate for Payer: CASH_PRICE |
$359.20
|
| Rate for Payer: CIGNA Commercial |
$426.55
|
| Rate for Payer: CIGNA Medicare |
$404.10
|
| Rate for Payer: HUMANA Commercial |
$404.10
|
| Rate for Payer: MEDICAID Medicaid |
$413.08
|
| Rate for Payer: MEDICARE Medicare |
$314.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$426.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$435.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$426.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$426.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$381.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$359.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$359.20
|
|
|
PRO FEE OP INJ FACET JNT C/T 1L 64490
|
Facility
IP
|
$449.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$314.30 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: AETNA Commercial |
$426.55
|
| Rate for Payer: AETNA Medicare |
$404.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$426.55
|
| Rate for Payer: BCBS Healthlink |
$404.10
|
| Rate for Payer: BCBS HMK CHIP |
$404.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$404.10
|
| Rate for Payer: BCBS POS |
$426.55
|
| Rate for Payer: BCBS Traditional |
$449.00
|
| Rate for Payer: CASH_PRICE |
$359.20
|
| Rate for Payer: CIGNA Commercial |
$426.55
|
| Rate for Payer: CIGNA Medicare |
$404.10
|
| Rate for Payer: HUMANA Commercial |
$404.10
|
| Rate for Payer: MEDICAID Medicaid |
$413.08
|
| Rate for Payer: MEDICARE Medicare |
$314.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$426.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$435.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$426.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$426.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$381.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$359.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$359.20
|
|
|
PRO FEE OP INJ FACET JNT C/T 3RDL 64492
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
PRO FEE OP INJ FACET JNT C/T 3RDL 64492
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
PRO FEE OP INJ FACET JNT L/S 1 L64493
|
Facility
OP
|
$457.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$319.90 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: AETNA Commercial |
$434.15
|
| Rate for Payer: AETNA Medicare |
$411.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$434.15
|
| Rate for Payer: BCBS Healthlink |
$411.30
|
| Rate for Payer: BCBS HMK CHIP |
$411.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$411.30
|
| Rate for Payer: BCBS POS |
$434.15
|
| Rate for Payer: BCBS Traditional |
$457.00
|
| Rate for Payer: CASH_PRICE |
$365.60
|
| Rate for Payer: CIGNA Commercial |
$434.15
|
| Rate for Payer: CIGNA Medicare |
$411.30
|
| Rate for Payer: HUMANA Commercial |
$411.30
|
| Rate for Payer: MEDICAID Medicaid |
$420.44
|
| Rate for Payer: MEDICARE Medicare |
$319.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$434.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$443.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$434.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$434.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$388.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$365.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$365.60
|
|
|
PRO FEE OP INJ FACET JNT L/S 1 L64493
|
Facility
IP
|
$457.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$319.90 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: AETNA Commercial |
$434.15
|
| Rate for Payer: AETNA Medicare |
$411.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$434.15
|
| Rate for Payer: BCBS Healthlink |
$411.30
|
| Rate for Payer: BCBS HMK CHIP |
$411.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$411.30
|
| Rate for Payer: BCBS POS |
$434.15
|
| Rate for Payer: BCBS Traditional |
$457.00
|
| Rate for Payer: CASH_PRICE |
$365.60
|
| Rate for Payer: CIGNA Commercial |
$434.15
|
| Rate for Payer: CIGNA Medicare |
$411.30
|
| Rate for Payer: HUMANA Commercial |
$411.30
|
| Rate for Payer: MEDICAID Medicaid |
$420.44
|
| Rate for Payer: MEDICARE Medicare |
$319.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$434.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$443.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$434.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$434.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$388.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$365.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$365.60
|
|
|
PRO FEE OP INJ FACET JNT L/S 2 L 64494
|
Facility
IP
|
$236.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: AETNA Commercial |
$224.20
|
| Rate for Payer: AETNA Medicare |
$212.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$224.20
|
| Rate for Payer: BCBS Healthlink |
$212.40
|
| Rate for Payer: BCBS HMK CHIP |
$212.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$212.40
|
| Rate for Payer: BCBS POS |
$224.20
|
| Rate for Payer: BCBS Traditional |
$236.00
|
| Rate for Payer: CASH_PRICE |
$188.80
|
| Rate for Payer: CIGNA Commercial |
$224.20
|
| Rate for Payer: CIGNA Medicare |
$212.40
|
| Rate for Payer: HUMANA Commercial |
$212.40
|
| Rate for Payer: MEDICAID Medicaid |
$217.12
|
| Rate for Payer: MEDICARE Medicare |
$165.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$224.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$228.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$224.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$224.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$200.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.80
|
|
|
PRO FEE OP INJ FACET JNT L/S 2 L 64494
|
Facility
OP
|
$236.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: AETNA Commercial |
$224.20
|
| Rate for Payer: AETNA Medicare |
$212.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$224.20
|
| Rate for Payer: BCBS Healthlink |
$212.40
|
| Rate for Payer: BCBS HMK CHIP |
$212.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$212.40
|
| Rate for Payer: BCBS POS |
$224.20
|
| Rate for Payer: BCBS Traditional |
$236.00
|
| Rate for Payer: CASH_PRICE |
$188.80
|
| Rate for Payer: CIGNA Commercial |
$224.20
|
| Rate for Payer: CIGNA Medicare |
$212.40
|
| Rate for Payer: HUMANA Commercial |
$212.40
|
| Rate for Payer: MEDICAID Medicaid |
$217.12
|
| Rate for Payer: MEDICARE Medicare |
$165.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$224.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$228.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$224.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$224.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$200.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.80
|
|
|
PRO FEE OP INJ FACET JNT L/S 3L 64495
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: AETNA Commercial |
$213.75
|
| Rate for Payer: AETNA Medicare |
$202.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$213.75
|
| Rate for Payer: BCBS Healthlink |
$202.50
|
| Rate for Payer: BCBS HMK CHIP |
$202.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$202.50
|
| Rate for Payer: BCBS POS |
$213.75
|
| Rate for Payer: BCBS Traditional |
$225.00
|
| Rate for Payer: CASH_PRICE |
$180.00
|
| Rate for Payer: CIGNA Commercial |
$213.75
|
| Rate for Payer: CIGNA Medicare |
$202.50
|
| Rate for Payer: HUMANA Commercial |
$202.50
|
| Rate for Payer: MEDICAID Medicaid |
$207.00
|
| Rate for Payer: MEDICARE Medicare |
$157.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$213.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$218.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$213.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$213.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$191.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.00
|
|
|
PRO FEE OP INJ FACET JNT L/S 3L 64495
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: AETNA Commercial |
$213.75
|
| Rate for Payer: AETNA Medicare |
$202.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$213.75
|
| Rate for Payer: BCBS Healthlink |
$202.50
|
| Rate for Payer: BCBS HMK CHIP |
$202.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$202.50
|
| Rate for Payer: BCBS POS |
$213.75
|
| Rate for Payer: BCBS Traditional |
$225.00
|
| Rate for Payer: CASH_PRICE |
$180.00
|
| Rate for Payer: CIGNA Commercial |
$213.75
|
| Rate for Payer: CIGNA Medicare |
$202.50
|
| Rate for Payer: HUMANA Commercial |
$202.50
|
| Rate for Payer: MEDICAID Medicaid |
$207.00
|
| Rate for Payer: MEDICARE Medicare |
$157.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$213.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$218.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$213.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$213.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$191.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.00
|
|
|
PRO FEE OP INJ FEMORAL NERVE BLOCK 64447
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$396.90 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: AETNA Commercial |
$538.65
|
| Rate for Payer: AETNA Medicare |
$510.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$538.65
|
| Rate for Payer: BCBS Healthlink |
$510.30
|
| Rate for Payer: BCBS HMK CHIP |
$510.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$510.30
|
| Rate for Payer: BCBS POS |
$538.65
|
| Rate for Payer: BCBS Traditional |
$567.00
|
| Rate for Payer: CASH_PRICE |
$453.60
|
| Rate for Payer: CIGNA Commercial |
$538.65
|
| Rate for Payer: CIGNA Medicare |
$510.30
|
| Rate for Payer: HUMANA Commercial |
$510.30
|
| Rate for Payer: MEDICAID Medicaid |
$521.64
|
| Rate for Payer: MEDICARE Medicare |
$396.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$538.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$549.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$538.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$538.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$481.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$453.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$453.60
|
|
|
PRO FEE OP INJ FEMORAL NERVE BLOCK 64447
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$396.90 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: AETNA Commercial |
$538.65
|
| Rate for Payer: AETNA Medicare |
$510.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$538.65
|
| Rate for Payer: BCBS Healthlink |
$510.30
|
| Rate for Payer: BCBS HMK CHIP |
$510.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$510.30
|
| Rate for Payer: BCBS POS |
$538.65
|
| Rate for Payer: BCBS Traditional |
$567.00
|
| Rate for Payer: CASH_PRICE |
$453.60
|
| Rate for Payer: CIGNA Commercial |
$538.65
|
| Rate for Payer: CIGNA Medicare |
$510.30
|
| Rate for Payer: HUMANA Commercial |
$510.30
|
| Rate for Payer: MEDICAID Medicaid |
$521.64
|
| Rate for Payer: MEDICARE Medicare |
$396.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$538.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$549.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$538.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$538.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$481.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$453.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$453.60
|
|
|
PRO FEE OP INJ ILIOING/ILIOHYPOG 64425
|
Facility
OP
|
$233.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
PRO FEE OP INJ ILIOING/ILIOHYPOG 64425
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
PROFEE OP INJ INTERLAM C-T6 762321
|
Facility
OP
|
$686.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$480.20 |
| Max. Negotiated Rate |
$686.00 |
| Rate for Payer: AETNA Commercial |
$651.70
|
| Rate for Payer: AETNA Medicare |
$617.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$651.70
|
| Rate for Payer: BCBS Healthlink |
$617.40
|
| Rate for Payer: BCBS HMK CHIP |
$617.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$617.40
|
| Rate for Payer: BCBS POS |
$651.70
|
| Rate for Payer: BCBS Traditional |
$686.00
|
| Rate for Payer: CASH_PRICE |
$548.80
|
| Rate for Payer: CIGNA Commercial |
$651.70
|
| Rate for Payer: CIGNA Medicare |
$617.40
|
| Rate for Payer: HUMANA Commercial |
$617.40
|
| Rate for Payer: MEDICAID Medicaid |
$631.12
|
| Rate for Payer: MEDICARE Medicare |
$480.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$651.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$665.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$651.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$651.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$583.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$548.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$548.80
|
|
|
PROFEE OP INJ INTERLAM C-T6 762321
|
Facility
IP
|
$686.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$480.20 |
| Max. Negotiated Rate |
$686.00 |
| Rate for Payer: AETNA Commercial |
$651.70
|
| Rate for Payer: AETNA Medicare |
$617.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$651.70
|
| Rate for Payer: BCBS Healthlink |
$617.40
|
| Rate for Payer: BCBS HMK CHIP |
$617.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$617.40
|
| Rate for Payer: BCBS POS |
$651.70
|
| Rate for Payer: BCBS Traditional |
$686.00
|
| Rate for Payer: CASH_PRICE |
$548.80
|
| Rate for Payer: CIGNA Commercial |
$651.70
|
| Rate for Payer: CIGNA Medicare |
$617.40
|
| Rate for Payer: HUMANA Commercial |
$617.40
|
| Rate for Payer: MEDICAID Medicaid |
$631.12
|
| Rate for Payer: MEDICARE Medicare |
$480.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$651.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$665.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$651.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$651.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$583.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$548.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$548.80
|
|
|
PRO FEE OP INJ INTERLAM LUMB W/IMA 62323
|
Facility
IP
|
$665.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$465.50 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: AETNA Commercial |
$631.75
|
| Rate for Payer: AETNA Medicare |
$598.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$631.75
|
| Rate for Payer: BCBS Healthlink |
$598.50
|
| Rate for Payer: BCBS HMK CHIP |
$598.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$598.50
|
| Rate for Payer: BCBS POS |
$631.75
|
| Rate for Payer: BCBS Traditional |
$665.00
|
| Rate for Payer: CASH_PRICE |
$532.00
|
| Rate for Payer: CIGNA Commercial |
$631.75
|
| Rate for Payer: CIGNA Medicare |
$598.50
|
| Rate for Payer: HUMANA Commercial |
$598.50
|
| Rate for Payer: MEDICAID Medicaid |
$611.80
|
| Rate for Payer: MEDICARE Medicare |
$465.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$631.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$645.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$631.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$631.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$565.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$532.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$532.00
|
|
|
PRO FEE OP INJ INTERLAM LUMB W/IMA 62323
|
Facility
OP
|
$665.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$465.50 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: AETNA Commercial |
$631.75
|
| Rate for Payer: AETNA Medicare |
$598.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$631.75
|
| Rate for Payer: BCBS Healthlink |
$598.50
|
| Rate for Payer: BCBS HMK CHIP |
$598.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$598.50
|
| Rate for Payer: BCBS POS |
$631.75
|
| Rate for Payer: BCBS Traditional |
$665.00
|
| Rate for Payer: CASH_PRICE |
$532.00
|
| Rate for Payer: CIGNA Commercial |
$631.75
|
| Rate for Payer: CIGNA Medicare |
$598.50
|
| Rate for Payer: HUMANA Commercial |
$598.50
|
| Rate for Payer: MEDICAID Medicaid |
$611.80
|
| Rate for Payer: MEDICARE Medicare |
$465.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$631.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$645.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$631.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$631.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$565.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$532.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$532.00
|
|
