|
PRO FEE OP INJ PERIPHERAL NERVE BLOCK
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
PRO FEE OP INJ PERIPHERAL NERVE BLOCK
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
PRO FEE OP INJ PLANTAR NERVE BLOCK 64455
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
PRO FEE OP INJ PLANTAR NERVE BLOCK 64455
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
PRO FEE OP INJ RFA L/S 1ST JOINT 64635
|
Facility
OP
|
$733.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$513.10 |
| Max. Negotiated Rate |
$733.00 |
| Rate for Payer: AETNA Commercial |
$696.35
|
| Rate for Payer: AETNA Medicare |
$659.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$696.35
|
| Rate for Payer: BCBS Healthlink |
$659.70
|
| Rate for Payer: BCBS HMK CHIP |
$659.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$659.70
|
| Rate for Payer: BCBS POS |
$696.35
|
| Rate for Payer: BCBS Traditional |
$733.00
|
| Rate for Payer: CASH_PRICE |
$586.40
|
| Rate for Payer: CIGNA Commercial |
$696.35
|
| Rate for Payer: CIGNA Medicare |
$659.70
|
| Rate for Payer: HUMANA Commercial |
$659.70
|
| Rate for Payer: MEDICAID Medicaid |
$674.36
|
| Rate for Payer: MEDICARE Medicare |
$513.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$696.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$711.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$696.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$696.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$623.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$586.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$586.40
|
|
|
PRO FEE OP INJ RFA L/S 1ST JOINT 64635
|
Facility
IP
|
$733.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$513.10 |
| Max. Negotiated Rate |
$733.00 |
| Rate for Payer: AETNA Commercial |
$696.35
|
| Rate for Payer: AETNA Medicare |
$659.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$696.35
|
| Rate for Payer: BCBS Healthlink |
$659.70
|
| Rate for Payer: BCBS HMK CHIP |
$659.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$659.70
|
| Rate for Payer: BCBS POS |
$696.35
|
| Rate for Payer: BCBS Traditional |
$733.00
|
| Rate for Payer: CASH_PRICE |
$586.40
|
| Rate for Payer: CIGNA Commercial |
$696.35
|
| Rate for Payer: CIGNA Medicare |
$659.70
|
| Rate for Payer: HUMANA Commercial |
$659.70
|
| Rate for Payer: MEDICAID Medicaid |
$674.36
|
| Rate for Payer: MEDICARE Medicare |
$513.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$696.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$711.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$696.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$696.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$623.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$586.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$586.40
|
|
|
PRO FEE OP INJ RFA L/S EADD JOINT 64636
|
Facility
IP
|
$389.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$272.30 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: AETNA Commercial |
$369.55
|
| Rate for Payer: AETNA Medicare |
$350.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$369.55
|
| Rate for Payer: BCBS Healthlink |
$350.10
|
| Rate for Payer: BCBS HMK CHIP |
$350.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$350.10
|
| Rate for Payer: BCBS POS |
$369.55
|
| Rate for Payer: BCBS Traditional |
$389.00
|
| Rate for Payer: CASH_PRICE |
$311.20
|
| Rate for Payer: CIGNA Commercial |
$369.55
|
| Rate for Payer: CIGNA Medicare |
$350.10
|
| Rate for Payer: HUMANA Commercial |
$350.10
|
| Rate for Payer: MEDICAID Medicaid |
$357.88
|
| Rate for Payer: MEDICARE Medicare |
$272.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$369.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$377.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$369.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$369.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$330.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$311.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$311.20
|
|
|
PRO FEE OP INJ RFA L/S EADD JOINT 64636
|
Facility
OP
|
$389.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$272.30 |
| Max. Negotiated Rate |
$389.00 |
| Rate for Payer: AETNA Commercial |
$369.55
|
| Rate for Payer: AETNA Medicare |
$350.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$369.55
|
| Rate for Payer: BCBS Healthlink |
$350.10
|
| Rate for Payer: BCBS HMK CHIP |
$350.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$350.10
|
| Rate for Payer: BCBS POS |
$369.55
|
| Rate for Payer: BCBS Traditional |
$389.00
|
| Rate for Payer: CASH_PRICE |
$311.20
|
| Rate for Payer: CIGNA Commercial |
$369.55
|
| Rate for Payer: CIGNA Medicare |
$350.10
|
| Rate for Payer: HUMANA Commercial |
$350.10
|
| Rate for Payer: MEDICAID Medicaid |
$357.88
|
| Rate for Payer: MEDICARE Medicare |
$272.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$369.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$377.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$369.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$369.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$330.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$311.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$311.20
|
|
|
PRO FEE OP INJ SCIATIC NERVE BLOCK 64445
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
PRO FEE OP INJ SCIATIC NERVE BLOCK 64445
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
PRO FEE OP INJ SI JOINT W/IMAGE 27096
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 27096 GF
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
PRO FEE OP INJ SI JOINT W/IMAGE 27096
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 27096 GF
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
PRO FEE OP INJ SPHENOPALGANG BLOC 64505
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
PRO FEE OP INJ SPHENOPALGANG BLOC 64505
|
Facility
IP
|
$185.00
|
|
|
Service Code
|
CPT 64505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
PRO FEE OP INJ STELLATE GANG BLOCK 64510
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$273.70 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: AETNA Commercial |
$371.45
|
| Rate for Payer: AETNA Medicare |
$351.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$371.45
|
| Rate for Payer: BCBS Healthlink |
$351.90
|
| Rate for Payer: BCBS HMK CHIP |
$351.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$351.90
|
| Rate for Payer: BCBS POS |
$371.45
|
| Rate for Payer: BCBS Traditional |
$391.00
|
| Rate for Payer: CASH_PRICE |
$312.80
|
| Rate for Payer: CIGNA Commercial |
$371.45
|
| Rate for Payer: CIGNA Medicare |
$351.90
|
| Rate for Payer: HUMANA Commercial |
$351.90
|
| Rate for Payer: MEDICAID Medicaid |
$359.72
|
| Rate for Payer: MEDICARE Medicare |
$273.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$371.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$379.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$371.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$371.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$332.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$312.80
|
|
|
PRO FEE OP INJ STELLATE GANG BLOCK 64510
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$273.70 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: AETNA Commercial |
$371.45
|
| Rate for Payer: AETNA Medicare |
$351.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$371.45
|
| Rate for Payer: BCBS Healthlink |
$351.90
|
| Rate for Payer: BCBS HMK CHIP |
$351.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$351.90
|
| Rate for Payer: BCBS POS |
$371.45
|
| Rate for Payer: BCBS Traditional |
$391.00
|
| Rate for Payer: CASH_PRICE |
$312.80
|
| Rate for Payer: CIGNA Commercial |
$371.45
|
| Rate for Payer: CIGNA Medicare |
$351.90
|
| Rate for Payer: HUMANA Commercial |
$351.90
|
| Rate for Payer: MEDICAID Medicaid |
$359.72
|
| Rate for Payer: MEDICARE Medicare |
$273.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$371.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$379.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$371.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$371.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$332.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$312.80
|
|
|
PRO FEE OP INJ SUPER HYPOGSTRC PLX 64517
|
Facility
IP
|
$373.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$261.10 |
| Max. Negotiated Rate |
$373.00 |
| Rate for Payer: AETNA Commercial |
$354.35
|
| Rate for Payer: AETNA Medicare |
$335.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$354.35
|
| Rate for Payer: BCBS Healthlink |
$335.70
|
| Rate for Payer: BCBS HMK CHIP |
$335.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$335.70
|
| Rate for Payer: BCBS POS |
$354.35
|
| Rate for Payer: BCBS Traditional |
$373.00
|
| Rate for Payer: CASH_PRICE |
$298.40
|
| Rate for Payer: CIGNA Commercial |
$354.35
|
| Rate for Payer: CIGNA Medicare |
$335.70
|
| Rate for Payer: HUMANA Commercial |
$335.70
|
| Rate for Payer: MEDICAID Medicaid |
$343.16
|
| Rate for Payer: MEDICARE Medicare |
$261.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$354.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$361.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$354.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$354.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$317.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$298.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$298.40
|
|
|
PRO FEE OP INJ SUPER HYPOGSTRC PLX 64517
|
Facility
OP
|
$373.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$261.10 |
| Max. Negotiated Rate |
$373.00 |
| Rate for Payer: AETNA Commercial |
$354.35
|
| Rate for Payer: AETNA Medicare |
$335.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$354.35
|
| Rate for Payer: BCBS Healthlink |
$335.70
|
| Rate for Payer: BCBS HMK CHIP |
$335.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$335.70
|
| Rate for Payer: BCBS POS |
$354.35
|
| Rate for Payer: BCBS Traditional |
$373.00
|
| Rate for Payer: CASH_PRICE |
$298.40
|
| Rate for Payer: CIGNA Commercial |
$354.35
|
| Rate for Payer: CIGNA Medicare |
$335.70
|
| Rate for Payer: HUMANA Commercial |
$335.70
|
| Rate for Payer: MEDICAID Medicaid |
$343.16
|
| Rate for Payer: MEDICARE Medicare |
$261.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$354.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$361.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$354.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$354.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$317.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$298.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$298.40
|
|
|
PRO FEE OP INJ SUPRASCAP NERVE 764418
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 64418
|
| 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 OP INJ SUPRASCAP NERVE 764418
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 64418
|
| 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 OP INJ TRANFOR C/T ADDTL 64480
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
PRO FEE OP INJ TRANFOR C/T ADDTL 64480
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
PRO FEE OP INJ TRANSFORA L/S 1 64483
|
Facility
IP
|
$704.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$492.80 |
| Max. Negotiated Rate |
$704.00 |
| Rate for Payer: AETNA Commercial |
$668.80
|
| Rate for Payer: AETNA Medicare |
$633.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$668.80
|
| Rate for Payer: BCBS Healthlink |
$633.60
|
| Rate for Payer: BCBS HMK CHIP |
$633.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$633.60
|
| Rate for Payer: BCBS POS |
$668.80
|
| Rate for Payer: BCBS Traditional |
$704.00
|
| Rate for Payer: CASH_PRICE |
$563.20
|
| Rate for Payer: CIGNA Commercial |
$668.80
|
| Rate for Payer: CIGNA Medicare |
$633.60
|
| Rate for Payer: HUMANA Commercial |
$633.60
|
| Rate for Payer: MEDICAID Medicaid |
$647.68
|
| Rate for Payer: MEDICARE Medicare |
$492.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$668.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$682.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$668.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$668.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$598.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$563.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$563.20
|
|
|
PRO FEE OP INJ TRANSFORA L/S 1 64483
|
Facility
OP
|
$704.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$492.80 |
| Max. Negotiated Rate |
$704.00 |
| Rate for Payer: AETNA Commercial |
$668.80
|
| Rate for Payer: AETNA Medicare |
$633.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$668.80
|
| Rate for Payer: BCBS Healthlink |
$633.60
|
| Rate for Payer: BCBS HMK CHIP |
$633.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$633.60
|
| Rate for Payer: BCBS POS |
$668.80
|
| Rate for Payer: BCBS Traditional |
$704.00
|
| Rate for Payer: CASH_PRICE |
$563.20
|
| Rate for Payer: CIGNA Commercial |
$668.80
|
| Rate for Payer: CIGNA Medicare |
$633.60
|
| Rate for Payer: HUMANA Commercial |
$633.60
|
| Rate for Payer: MEDICAID Medicaid |
$647.68
|
| Rate for Payer: MEDICARE Medicare |
$492.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$668.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$682.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$668.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$668.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$598.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$563.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$563.20
|
|
|
PRO FEE OP INJ TRIGEM NERVE BLOCK 64400
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: AETNA Commercial |
$141.55
|
| Rate for Payer: AETNA Medicare |
$134.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$141.55
|
| Rate for Payer: BCBS Healthlink |
$134.10
|
| Rate for Payer: BCBS HMK CHIP |
$134.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$134.10
|
| Rate for Payer: BCBS POS |
$141.55
|
| Rate for Payer: BCBS Traditional |
$149.00
|
| Rate for Payer: CASH_PRICE |
$119.20
|
| Rate for Payer: CIGNA Commercial |
$141.55
|
| Rate for Payer: CIGNA Medicare |
$134.10
|
| Rate for Payer: HUMANA Commercial |
$134.10
|
| Rate for Payer: MEDICAID Medicaid |
$137.08
|
| Rate for Payer: MEDICARE Medicare |
$104.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$141.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$144.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$141.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$141.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$126.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$119.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$119.20
|
|
