|
PSYCHOTHERAPY W/ PT 60 W/ E/M
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
PSYCHOTHERAPY W/ PT 60 W/ E/M
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
PSYCOTHERAPY CRISIS +30 MIN
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
PSYCOTHERAPY CRISIS +30 MIN
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
PSYCOTHERAPY W/ PT 30 MIN
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
PSYCOTHERAPY W/ PT 30 MIN
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
PSYCOTHERAPY W/ PT 30 MIN W E/M
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: AETNA Commercial |
$145.35
|
| Rate for Payer: AETNA Medicare |
$137.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$145.35
|
| Rate for Payer: BCBS Healthlink |
$137.70
|
| Rate for Payer: BCBS HMK CHIP |
$137.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$137.70
|
| Rate for Payer: BCBS POS |
$145.35
|
| Rate for Payer: BCBS Traditional |
$153.00
|
| Rate for Payer: CASH_PRICE |
$122.40
|
| Rate for Payer: CIGNA Commercial |
$145.35
|
| Rate for Payer: CIGNA Medicare |
$137.70
|
| Rate for Payer: HUMANA Commercial |
$137.70
|
| Rate for Payer: MEDICAID Medicaid |
$140.76
|
| Rate for Payer: MEDICARE Medicare |
$107.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$145.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$148.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$145.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$130.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$122.40
|
|
|
PSYCOTHERAPY W/ PT 30 MIN W E/M
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 90833
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: AETNA Commercial |
$145.35
|
| Rate for Payer: AETNA Medicare |
$137.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$145.35
|
| Rate for Payer: BCBS Healthlink |
$137.70
|
| Rate for Payer: BCBS HMK CHIP |
$137.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$137.70
|
| Rate for Payer: BCBS POS |
$145.35
|
| Rate for Payer: BCBS Traditional |
$153.00
|
| Rate for Payer: CASH_PRICE |
$122.40
|
| Rate for Payer: CIGNA Commercial |
$145.35
|
| Rate for Payer: CIGNA Medicare |
$137.70
|
| Rate for Payer: HUMANA Commercial |
$137.70
|
| Rate for Payer: MEDICAID Medicaid |
$140.76
|
| Rate for Payer: MEDICARE Medicare |
$107.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$145.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$148.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$145.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$130.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$122.40
|
|
|
PSYCOTHERAPY W/ PT 45 MIN
|
Facility
OP
|
$196.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
PSYCOTHERAPY W/ PT 45 MIN
|
Facility
IP
|
$196.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
PSYCOTHERAPY W/ PT 60 MIN
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
PSYCOTHERAPY W/ PT 60 MIN
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
PSYCOTHERAPY W/ PT 60 MIN W E/M
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
PSYCOTHERAPY W/ PT 60 MIN W E/M
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 90838
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
PSYLLIUM PACKET [28 %]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
PSYLLIUM PACKET [28 %]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
PSYTX CRISIS INITIAL 60 MIN
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
PSYTX CRISIS INITIAL 60 MIN
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
PT ASSISTED BATH
|
Facility
OP
|
$33.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
PT ASSISTED BATH
|
Facility
IP
|
$33.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
PT CANALITH REPOSITIONING PROC
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: AETNA Commercial |
$122.55
|
| Rate for Payer: AETNA Medicare |
$116.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$122.55
|
| Rate for Payer: BCBS Healthlink |
$116.10
|
| Rate for Payer: BCBS HMK CHIP |
$116.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$116.10
|
| Rate for Payer: BCBS POS |
$122.55
|
| Rate for Payer: BCBS Traditional |
$129.00
|
| Rate for Payer: CASH_PRICE |
$103.20
|
| Rate for Payer: CIGNA Commercial |
$122.55
|
| Rate for Payer: CIGNA Medicare |
$116.10
|
| Rate for Payer: HUMANA Commercial |
$116.10
|
| Rate for Payer: MEDICAID Medicaid |
$118.68
|
| Rate for Payer: MEDICARE Medicare |
$90.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$122.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$125.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$122.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$122.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$109.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$103.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$103.20
|
|
|
PT CANALITH REPOSITIONING PROC
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 95992 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: AETNA Commercial |
$122.55
|
| Rate for Payer: AETNA Medicare |
$116.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$122.55
|
| Rate for Payer: BCBS Healthlink |
$116.10
|
| Rate for Payer: BCBS HMK CHIP |
$116.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$116.10
|
| Rate for Payer: BCBS POS |
$122.55
|
| Rate for Payer: BCBS Traditional |
$129.00
|
| Rate for Payer: CASH_PRICE |
$103.20
|
| Rate for Payer: CIGNA Commercial |
$122.55
|
| Rate for Payer: CIGNA Medicare |
$116.10
|
| Rate for Payer: HUMANA Commercial |
$116.10
|
| Rate for Payer: MEDICAID Medicaid |
$118.68
|
| Rate for Payer: MEDICARE Medicare |
$90.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$122.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$125.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$122.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$122.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$109.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$103.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$103.20
|
|
|
PT COMMUNITY/WORK REINTEGRATION
|
Facility
IP
|
$87.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: AETNA Commercial |
$82.65
|
| Rate for Payer: AETNA Medicare |
$78.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$82.65
|
| Rate for Payer: BCBS Healthlink |
$78.30
|
| Rate for Payer: BCBS HMK CHIP |
$78.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$78.30
|
| Rate for Payer: BCBS POS |
$82.65
|
| Rate for Payer: BCBS Traditional |
$87.00
|
| Rate for Payer: CASH_PRICE |
$69.60
|
| Rate for Payer: CIGNA Commercial |
$82.65
|
| Rate for Payer: CIGNA Medicare |
$78.30
|
| Rate for Payer: HUMANA Commercial |
$78.30
|
| Rate for Payer: MEDICAID Medicaid |
$80.04
|
| Rate for Payer: MEDICARE Medicare |
$60.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$82.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$84.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$82.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$82.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$73.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$69.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$69.60
|
|
|
PT COMMUNITY/WORK REINTEGRATION
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: AETNA Commercial |
$82.65
|
| Rate for Payer: AETNA Medicare |
$78.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$82.65
|
| Rate for Payer: BCBS Healthlink |
$78.30
|
| Rate for Payer: BCBS HMK CHIP |
$78.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$78.30
|
| Rate for Payer: BCBS POS |
$82.65
|
| Rate for Payer: BCBS Traditional |
$87.00
|
| Rate for Payer: CASH_PRICE |
$69.60
|
| Rate for Payer: CIGNA Commercial |
$82.65
|
| Rate for Payer: CIGNA Medicare |
$78.30
|
| Rate for Payer: HUMANA Commercial |
$78.30
|
| Rate for Payer: MEDICAID Medicaid |
$80.04
|
| Rate for Payer: MEDICARE Medicare |
$60.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$82.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$84.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$82.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$82.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$73.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$69.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$69.60
|
|
|
PT CONSULTATION (15 MINUTE UNIT)
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
