|
PRO FEE OP INJ TRIGEM NERVE BLOCK 64400
|
Facility
OP
|
$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
|
|
|
PRO FEE OP MAJOR JOINT INJ W/US 20611
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
CPT 20611 GF
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AETNA Commercial |
$184.30
|
| Rate for Payer: AETNA Medicare |
$174.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$184.30
|
| Rate for Payer: BCBS Healthlink |
$174.60
|
| Rate for Payer: BCBS HMK CHIP |
$174.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$174.60
|
| Rate for Payer: BCBS POS |
$184.30
|
| Rate for Payer: BCBS Traditional |
$194.00
|
| Rate for Payer: CASH_PRICE |
$155.20
|
| Rate for Payer: CIGNA Commercial |
$184.30
|
| Rate for Payer: CIGNA Medicare |
$174.60
|
| Rate for Payer: HUMANA Commercial |
$174.60
|
| Rate for Payer: MEDICAID Medicaid |
$178.48
|
| Rate for Payer: MEDICARE Medicare |
$135.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$184.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$188.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$184.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$184.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$155.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$155.20
|
|
|
PRO FEE OP MAJOR JOINT INJ W/US 20611
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 20611 GF
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AETNA Commercial |
$184.30
|
| Rate for Payer: AETNA Medicare |
$174.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$184.30
|
| Rate for Payer: BCBS Healthlink |
$174.60
|
| Rate for Payer: BCBS HMK CHIP |
$174.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$174.60
|
| Rate for Payer: BCBS POS |
$184.30
|
| Rate for Payer: BCBS Traditional |
$194.00
|
| Rate for Payer: CASH_PRICE |
$155.20
|
| Rate for Payer: CIGNA Commercial |
$184.30
|
| Rate for Payer: CIGNA Medicare |
$174.60
|
| Rate for Payer: HUMANA Commercial |
$174.60
|
| Rate for Payer: MEDICAID Medicaid |
$178.48
|
| Rate for Payer: MEDICARE Medicare |
$135.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$184.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$188.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$184.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$184.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$155.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$155.20
|
|
|
PRO FEE OPO HIGH
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 99223 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: AETNA Commercial |
$329.65
|
| Rate for Payer: AETNA Medicare |
$312.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$329.65
|
| Rate for Payer: BCBS Healthlink |
$312.30
|
| Rate for Payer: BCBS HMK CHIP |
$312.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$312.30
|
| Rate for Payer: BCBS POS |
$329.65
|
| Rate for Payer: BCBS Traditional |
$347.00
|
| Rate for Payer: CASH_PRICE |
$277.60
|
| Rate for Payer: CIGNA Commercial |
$329.65
|
| Rate for Payer: CIGNA Medicare |
$312.30
|
| Rate for Payer: HUMANA Commercial |
$312.30
|
| Rate for Payer: MEDICAID Medicaid |
$319.24
|
| Rate for Payer: MEDICARE Medicare |
$242.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$329.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$336.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$329.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$329.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$294.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$277.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$277.60
|
|
|
PRO FEE OPO HIGH
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 99223 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: AETNA Commercial |
$329.65
|
| Rate for Payer: AETNA Medicare |
$312.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$329.65
|
| Rate for Payer: BCBS Healthlink |
$312.30
|
| Rate for Payer: BCBS HMK CHIP |
$312.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$312.30
|
| Rate for Payer: BCBS POS |
$329.65
|
| Rate for Payer: BCBS Traditional |
$347.00
|
| Rate for Payer: CASH_PRICE |
$277.60
|
| Rate for Payer: CIGNA Commercial |
$329.65
|
| Rate for Payer: CIGNA Medicare |
$312.30
|
| Rate for Payer: HUMANA Commercial |
$312.30
|
| Rate for Payer: MEDICAID Medicaid |
$319.24
|
| Rate for Payer: MEDICARE Medicare |
$242.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$329.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$336.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$329.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$329.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$294.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$277.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$277.60
|
|
|
PRO FEE OPO LOW (99221)
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 99221 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
PRO FEE OPO LOW (99221)
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 99221 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
PRO FEE OPO MODERATE
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 99222 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
PRO FEE OPO MODERATE
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 99222 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
PRO FEE OPO SAME DAY ADMIT/D/CLOW
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 99234 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
PRO FEE OPO SAME DAY ADMIT/D/CLOW
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 99234 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
PRO FEE OPO SAME DAY ADMIT HIGH
|
Facility
IP
|
$457.00
|
|
|
Service Code
|
CPT 99236 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$319.90 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$434.15
|
| 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 - 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 OPO SAME DAY ADMIT HIGH
|
Facility
OP
|
$457.00
|
|
|
Service Code
|
CPT 99236 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| 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 OPO SAME DAY ADMIT MOD
|
Facility
IP
|
$352.00
|
|
|
Service Code
|
CPT 99235 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| 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 OPO SAME DAY ADMIT MOD
|
Facility
OP
|
$352.00
|
|
|
Service Code
|
CPT 99235 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| 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 OPO SEPARATE DAY DISCHARGE 30MI
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 99238 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
PRO FEE OPO SEPARATE DAY DISCHARGE 30MI
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 99238 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
PRO FEE OPO SEPARATE DAY DISCHARGE>30MI
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
CPT 99239 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: AETNA Commercial |
$214.70
|
| Rate for Payer: AETNA Medicare |
$203.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$214.70
|
| Rate for Payer: BCBS Healthlink |
$203.40
|
| Rate for Payer: BCBS HMK CHIP |
$203.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$203.40
|
| Rate for Payer: BCBS POS |
$214.70
|
| Rate for Payer: BCBS Traditional |
$226.00
|
| Rate for Payer: CASH_PRICE |
$180.80
|
| Rate for Payer: CIGNA Commercial |
$214.70
|
| Rate for Payer: CIGNA Medicare |
$203.40
|
| Rate for Payer: HUMANA Commercial |
$203.40
|
| Rate for Payer: MEDICAID Medicaid |
$207.92
|
| Rate for Payer: MEDICARE Medicare |
$158.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$214.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$219.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$214.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$214.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.80
|
|
|
PRO FEE OPO SEPARATE DAY DISCHARGE>30MI
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
CPT 99239 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: AETNA Commercial |
$214.70
|
| Rate for Payer: AETNA Medicare |
$203.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$214.70
|
| Rate for Payer: BCBS Healthlink |
$203.40
|
| Rate for Payer: BCBS HMK CHIP |
$203.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$203.40
|
| Rate for Payer: BCBS POS |
$214.70
|
| Rate for Payer: BCBS Traditional |
$226.00
|
| Rate for Payer: CASH_PRICE |
$180.80
|
| Rate for Payer: CIGNA Commercial |
$214.70
|
| Rate for Payer: CIGNA Medicare |
$203.40
|
| Rate for Payer: HUMANA Commercial |
$203.40
|
| Rate for Payer: MEDICAID Medicaid |
$207.92
|
| Rate for Payer: MEDICARE Medicare |
$158.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$214.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$219.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$214.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$214.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.80
|
|
|
PRO FEE OPO SEPARATE DAY DISCHARGE 99217
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT 99217 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| 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 OPO SEPARATE DAY DISCHARGE 99217
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 99217 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| 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 - 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 PARAVERT SYMP BLOCK T/L 64520
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
|
PRO FEE PARAVERT SYMP BLOCK T/L 64520
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
|
PRO FEE PVB THORACIC 1ST LEVEL
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT 64461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
|
PRO FEE PVB THORACIC 1ST LEVEL
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT 64461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
