|
PT CONSULTATION (15 MINUTE UNIT)
|
Facility
IP
|
$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
|
|
|
PT CONTRAST BATHS
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: AETNA Commercial |
$71.25
|
| Rate for Payer: AETNA Medicare |
$67.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$71.25
|
| Rate for Payer: BCBS Healthlink |
$67.50
|
| Rate for Payer: BCBS HMK CHIP |
$67.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$67.50
|
| Rate for Payer: BCBS POS |
$71.25
|
| Rate for Payer: BCBS Traditional |
$75.00
|
| Rate for Payer: CASH_PRICE |
$60.00
|
| Rate for Payer: CIGNA Commercial |
$71.25
|
| Rate for Payer: CIGNA Medicare |
$67.50
|
| Rate for Payer: HUMANA Commercial |
$67.50
|
| Rate for Payer: MEDICAID Medicaid |
$69.00
|
| Rate for Payer: MEDICARE Medicare |
$52.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$71.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$72.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$71.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$71.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$63.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.00
|
|
|
PT CONTRAST BATHS
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: AETNA Commercial |
$71.25
|
| Rate for Payer: AETNA Medicare |
$67.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$71.25
|
| Rate for Payer: BCBS Healthlink |
$67.50
|
| Rate for Payer: BCBS HMK CHIP |
$67.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$67.50
|
| Rate for Payer: BCBS POS |
$71.25
|
| Rate for Payer: BCBS Traditional |
$75.00
|
| Rate for Payer: CASH_PRICE |
$60.00
|
| Rate for Payer: CIGNA Commercial |
$71.25
|
| Rate for Payer: CIGNA Medicare |
$67.50
|
| Rate for Payer: HUMANA Commercial |
$67.50
|
| Rate for Payer: MEDICAID Medicaid |
$69.00
|
| Rate for Payer: MEDICARE Medicare |
$52.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$71.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$72.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$71.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$71.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$63.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.00
|
|
|
PT DEBRIDEMENT
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
PT DEBRIDEMENT
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
PT DRESSING CHANGE
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
PT DRESSING CHANGE
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
PT E-STIM MAN INCLUDES TENS
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PT E-STIM MAN INCLUDES TENS
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
PT E-STIMULATION UNATTENDED
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT G0283 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: AETNA Commercial |
$81.70
|
| Rate for Payer: AETNA Medicare |
$77.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$81.70
|
| Rate for Payer: BCBS Healthlink |
$77.40
|
| Rate for Payer: BCBS HMK CHIP |
$77.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$77.40
|
| Rate for Payer: BCBS POS |
$81.70
|
| Rate for Payer: BCBS Traditional |
$86.00
|
| Rate for Payer: CASH_PRICE |
$68.80
|
| Rate for Payer: CIGNA Commercial |
$81.70
|
| Rate for Payer: CIGNA Medicare |
$77.40
|
| Rate for Payer: HUMANA Commercial |
$77.40
|
| Rate for Payer: MEDICAID Medicaid |
$79.12
|
| Rate for Payer: MEDICARE Medicare |
$60.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$81.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$83.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$81.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$81.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$73.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.80
|
|
|
PT E-STIMULATION UNATTENDED
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT G0283 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: AETNA Commercial |
$81.70
|
| Rate for Payer: AETNA Medicare |
$77.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$81.70
|
| Rate for Payer: BCBS Healthlink |
$77.40
|
| Rate for Payer: BCBS HMK CHIP |
$77.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$77.40
|
| Rate for Payer: BCBS POS |
$81.70
|
| Rate for Payer: BCBS Traditional |
$86.00
|
| Rate for Payer: CASH_PRICE |
$68.80
|
| Rate for Payer: CIGNA Commercial |
$81.70
|
| Rate for Payer: CIGNA Medicare |
$77.40
|
| Rate for Payer: HUMANA Commercial |
$77.40
|
| Rate for Payer: MEDICAID Medicaid |
$79.12
|
| Rate for Payer: MEDICARE Medicare |
$60.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$81.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$83.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$81.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$81.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$73.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.80
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
OP
|
$254.00
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$254.00 |
| Rate for Payer: AETNA Commercial |
$241.30
|
| Rate for Payer: AETNA Medicare |
$228.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$241.30
|
| Rate for Payer: BCBS Healthlink |
$228.60
|
| Rate for Payer: BCBS HMK CHIP |
$228.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$228.60
|
| Rate for Payer: BCBS POS |
$241.30
|
| Rate for Payer: BCBS Traditional |
$254.00
|
| Rate for Payer: CASH_PRICE |
$203.20
|
| Rate for Payer: CIGNA Commercial |
$241.30
|
| Rate for Payer: CIGNA Medicare |
$228.60
|
| Rate for Payer: HUMANA Commercial |
$228.60
|
| Rate for Payer: MEDICAID Medicaid |
$233.68
|
| Rate for Payer: MEDICARE Medicare |
$177.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$241.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$246.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$241.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$241.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$215.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$203.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$203.20
|
|
|
PT EVAL HIGH COMPLEX 45 MIN
|
Facility
IP
|
$254.00
|
|
|
Service Code
|
CPT 97163 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$254.00 |
| Rate for Payer: AETNA Commercial |
$241.30
|
| Rate for Payer: AETNA Medicare |
$228.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$241.30
|
| Rate for Payer: BCBS Healthlink |
$228.60
|
| Rate for Payer: BCBS HMK CHIP |
$228.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$228.60
|
| Rate for Payer: BCBS POS |
$241.30
|
| Rate for Payer: BCBS Traditional |
$254.00
|
| Rate for Payer: CASH_PRICE |
$203.20
|
| Rate for Payer: CIGNA Commercial |
$241.30
|
| Rate for Payer: CIGNA Medicare |
$228.60
|
| Rate for Payer: HUMANA Commercial |
$228.60
|
| Rate for Payer: MEDICAID Medicaid |
$233.68
|
| Rate for Payer: MEDICARE Medicare |
$177.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$241.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$246.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$241.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$241.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$215.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$203.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$203.20
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
OP
|
$197.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: AETNA Commercial |
$187.15
|
| Rate for Payer: AETNA Medicare |
$177.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$187.15
|
| Rate for Payer: BCBS Healthlink |
$177.30
|
| Rate for Payer: BCBS HMK CHIP |
$177.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$177.30
|
| Rate for Payer: BCBS POS |
$187.15
|
| Rate for Payer: BCBS Traditional |
$197.00
|
| Rate for Payer: CASH_PRICE |
$157.60
|
| Rate for Payer: CIGNA Commercial |
$187.15
|
| Rate for Payer: CIGNA Medicare |
$177.30
|
| Rate for Payer: HUMANA Commercial |
$177.30
|
| Rate for Payer: MEDICAID Medicaid |
$181.24
|
| Rate for Payer: MEDICARE Medicare |
$137.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$187.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$191.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$187.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$187.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$167.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$157.60
|
|
|
PT EVAL LOW COMPLEX 20 MIN
|
Facility
IP
|
$197.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: AETNA Commercial |
$187.15
|
| Rate for Payer: AETNA Medicare |
$177.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$187.15
|
| Rate for Payer: BCBS Healthlink |
$177.30
|
| Rate for Payer: BCBS HMK CHIP |
$177.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$177.30
|
| Rate for Payer: BCBS POS |
$187.15
|
| Rate for Payer: BCBS Traditional |
$197.00
|
| Rate for Payer: CASH_PRICE |
$157.60
|
| Rate for Payer: CIGNA Commercial |
$187.15
|
| Rate for Payer: CIGNA Medicare |
$177.30
|
| Rate for Payer: HUMANA Commercial |
$177.30
|
| Rate for Payer: MEDICAID Medicaid |
$181.24
|
| Rate for Payer: MEDICARE Medicare |
$137.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$187.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$191.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$187.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$187.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$167.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$157.60
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
OP
|
$223.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$156.10 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: BCBS HMK CHIP |
$200.70
|
| Rate for Payer: AETNA Commercial |
$211.85
|
| Rate for Payer: AETNA Medicare |
$200.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$211.85
|
| Rate for Payer: BCBS Healthlink |
$200.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$200.70
|
| Rate for Payer: BCBS POS |
$211.85
|
| Rate for Payer: BCBS Traditional |
$223.00
|
| Rate for Payer: CASH_PRICE |
$178.40
|
| Rate for Payer: CIGNA Commercial |
$211.85
|
| Rate for Payer: CIGNA Medicare |
$200.70
|
| Rate for Payer: HUMANA Commercial |
$200.70
|
| Rate for Payer: MEDICAID Medicaid |
$205.16
|
| Rate for Payer: MEDICARE Medicare |
$156.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$211.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$216.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$211.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$211.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$189.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$178.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$178.40
|
|
|
PT EVAL MOD COMPLEX 30 MIN
|
Facility
IP
|
$223.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$156.10 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: AETNA Commercial |
$211.85
|
| Rate for Payer: AETNA Medicare |
$200.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$211.85
|
| Rate for Payer: BCBS Healthlink |
$200.70
|
| Rate for Payer: BCBS HMK CHIP |
$200.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$200.70
|
| Rate for Payer: BCBS POS |
$211.85
|
| Rate for Payer: BCBS Traditional |
$223.00
|
| Rate for Payer: CASH_PRICE |
$178.40
|
| Rate for Payer: CIGNA Commercial |
$211.85
|
| Rate for Payer: CIGNA Medicare |
$200.70
|
| Rate for Payer: HUMANA Commercial |
$200.70
|
| Rate for Payer: MEDICAID Medicaid |
$205.16
|
| Rate for Payer: MEDICARE Medicare |
$156.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$211.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$216.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$211.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$211.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$189.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$178.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$178.40
|
|
|
PT GAIT TRAINING (15 MINUTES)
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
PT GAIT TRAINING (15 MINUTES)
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
PT IEP GOAL SETTING (15 MINUTE UNIT)
|
Facility
IP
|
$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
|
|
|
PT IEP GOAL SETTING (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
|
|
|
PT IEP GOAL SETTING (15 MINUTE UNIT)
|
Facility
IP
|
$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
|
|
|
PT IEP GOAL SETTING (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
|
|
|
PT IEP MEETING (15 MINUTE UNIT)
|
Facility
IP
|
$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
|
|
|
PT IEP MEETING (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
|
|
