|
PT INFRARED-ANODYNE
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 97026 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AETNA Commercial |
$32.30
|
| Rate for Payer: AETNA Medicare |
$30.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$32.30
|
| Rate for Payer: BCBS Healthlink |
$30.60
|
| Rate for Payer: BCBS HMK CHIP |
$30.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$30.60
|
| Rate for Payer: BCBS POS |
$32.30
|
| Rate for Payer: BCBS Traditional |
$34.00
|
| Rate for Payer: CASH_PRICE |
$27.20
|
| Rate for Payer: CIGNA Commercial |
$32.30
|
| Rate for Payer: CIGNA Medicare |
$30.60
|
| Rate for Payer: HUMANA Commercial |
$30.60
|
| Rate for Payer: MEDICAID Medicaid |
$31.28
|
| Rate for Payer: MEDICARE Medicare |
$23.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$32.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$32.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$27.20
|
|
|
PT INFRARED-ANODYNE
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT 97026 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AETNA Commercial |
$32.30
|
| Rate for Payer: AETNA Medicare |
$30.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$32.30
|
| Rate for Payer: BCBS Healthlink |
$30.60
|
| Rate for Payer: BCBS HMK CHIP |
$30.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$30.60
|
| Rate for Payer: BCBS POS |
$32.30
|
| Rate for Payer: BCBS Traditional |
$34.00
|
| Rate for Payer: CASH_PRICE |
$27.20
|
| Rate for Payer: CIGNA Commercial |
$32.30
|
| Rate for Payer: CIGNA Medicare |
$30.60
|
| Rate for Payer: HUMANA Commercial |
$30.60
|
| Rate for Payer: MEDICAID Medicaid |
$31.28
|
| Rate for Payer: MEDICARE Medicare |
$23.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$32.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$32.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$27.20
|
|
|
PT IONTOPHORESIS
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: AETNA Commercial |
$105.45
|
| Rate for Payer: AETNA Medicare |
$99.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$105.45
|
| Rate for Payer: BCBS Healthlink |
$99.90
|
| Rate for Payer: BCBS HMK CHIP |
$99.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$99.90
|
| Rate for Payer: BCBS POS |
$105.45
|
| Rate for Payer: BCBS Traditional |
$111.00
|
| Rate for Payer: CASH_PRICE |
$88.80
|
| Rate for Payer: CIGNA Commercial |
$105.45
|
| Rate for Payer: CIGNA Medicare |
$99.90
|
| Rate for Payer: HUMANA Commercial |
$99.90
|
| Rate for Payer: MEDICAID Medicaid |
$102.12
|
| Rate for Payer: MEDICARE Medicare |
$77.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$105.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$107.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$105.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$105.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$94.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$88.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$88.80
|
|
|
PT IONTOPHORESIS
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: AETNA Commercial |
$105.45
|
| Rate for Payer: AETNA Medicare |
$99.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$105.45
|
| Rate for Payer: BCBS Healthlink |
$99.90
|
| Rate for Payer: BCBS HMK CHIP |
$99.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$99.90
|
| Rate for Payer: BCBS POS |
$105.45
|
| Rate for Payer: BCBS Traditional |
$111.00
|
| Rate for Payer: CASH_PRICE |
$88.80
|
| Rate for Payer: CIGNA Commercial |
$105.45
|
| Rate for Payer: CIGNA Medicare |
$99.90
|
| Rate for Payer: HUMANA Commercial |
$99.90
|
| Rate for Payer: MEDICAID Medicaid |
$102.12
|
| Rate for Payer: MEDICARE Medicare |
$77.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$105.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$107.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$105.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$105.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$94.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$88.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$88.80
|
|
|
PT MANUAL THERAPY 15 MIN
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
PT MANUAL THERAPY 15 MIN
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
PT MUSCULOSKELETAL TEST/FCE
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: AETNA Commercial |
$113.05
|
| Rate for Payer: AETNA Medicare |
$107.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$113.05
|
| Rate for Payer: BCBS Healthlink |
$107.10
|
| Rate for Payer: BCBS HMK CHIP |
$107.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$107.10
|
| Rate for Payer: BCBS POS |
$113.05
|
| Rate for Payer: BCBS Traditional |
$119.00
|
| Rate for Payer: CASH_PRICE |
$95.20
|
| Rate for Payer: CIGNA Commercial |
$113.05
|
| Rate for Payer: CIGNA Medicare |
$107.10
|
| Rate for Payer: HUMANA Commercial |
$107.10
|
| Rate for Payer: MEDICAID Medicaid |
$109.48
|
| Rate for Payer: MEDICARE Medicare |
$83.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$113.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$115.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$113.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$101.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$95.20
|
|
|
PT MUSCULOSKELETAL TEST/FCE
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 97750 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: AETNA Commercial |
$113.05
|
| Rate for Payer: AETNA Medicare |
$107.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$113.05
|
| Rate for Payer: BCBS Healthlink |
$107.10
|
| Rate for Payer: BCBS HMK CHIP |
$107.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$107.10
|
| Rate for Payer: BCBS POS |
$113.05
|
| Rate for Payer: BCBS Traditional |
$119.00
|
| Rate for Payer: CASH_PRICE |
$95.20
|
| Rate for Payer: CIGNA Commercial |
$113.05
|
| Rate for Payer: CIGNA Medicare |
$107.10
|
| Rate for Payer: HUMANA Commercial |
$107.10
|
| Rate for Payer: MEDICAID Medicaid |
$109.48
|
| Rate for Payer: MEDICARE Medicare |
$83.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$113.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$115.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$113.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$101.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$95.20
|
|
|
PT NEUROMUSCULAR RE-EDUCATION
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: AETNA Commercial |
$108.30
|
| Rate for Payer: AETNA Medicare |
$102.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$108.30
|
| Rate for Payer: BCBS Healthlink |
$102.60
|
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$102.60
|
| Rate for Payer: BCBS POS |
$108.30
|
| Rate for Payer: BCBS Traditional |
$114.00
|
| Rate for Payer: CASH_PRICE |
$91.20
|
| Rate for Payer: CIGNA Commercial |
$108.30
|
| Rate for Payer: CIGNA Medicare |
$102.60
|
| Rate for Payer: HUMANA Commercial |
$102.60
|
| Rate for Payer: MEDICAID Medicaid |
$104.88
|
| Rate for Payer: MEDICARE Medicare |
$79.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$108.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$110.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$108.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$108.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$91.20
|
|
|
PT NEUROMUSCULAR RE-EDUCATION
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: AETNA Commercial |
$108.30
|
| Rate for Payer: AETNA Medicare |
$102.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$108.30
|
| Rate for Payer: BCBS Healthlink |
$102.60
|
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$102.60
|
| Rate for Payer: BCBS POS |
$108.30
|
| Rate for Payer: BCBS Traditional |
$114.00
|
| Rate for Payer: CASH_PRICE |
$91.20
|
| Rate for Payer: CIGNA Commercial |
$108.30
|
| Rate for Payer: CIGNA Medicare |
$102.60
|
| Rate for Payer: HUMANA Commercial |
$102.60
|
| Rate for Payer: MEDICAID Medicaid |
$104.88
|
| Rate for Payer: MEDICARE Medicare |
$79.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$108.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$110.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$108.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$108.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$91.20
|
|
|
PT ORTHOTICS FITTING/TRAINING/15 MIN
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
PT ORTHOTICS FITTING/TRAINING/15 MIN
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
PT OTHER
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 97799
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
PT OTHER
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 97799
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
PT PARAFFIN BATH
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
PT PARAFFIN BATH
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
PT PROSTHETIC SOCKS
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
PT PROSTHETIC SOCKS
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
IP
|
$134.00
|
|
|
Service Code
|
CPT 97164 59
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$134.00 |
| Rate for Payer: AETNA Commercial |
$127.30
|
| Rate for Payer: AETNA Medicare |
$120.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$127.30
|
| Rate for Payer: BCBS Healthlink |
$120.60
|
| Rate for Payer: BCBS HMK CHIP |
$120.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$120.60
|
| Rate for Payer: BCBS POS |
$127.30
|
| Rate for Payer: BCBS Traditional |
$134.00
|
| Rate for Payer: CASH_PRICE |
$107.20
|
| Rate for Payer: CIGNA Commercial |
$127.30
|
| Rate for Payer: CIGNA Medicare |
$120.60
|
| Rate for Payer: HUMANA Commercial |
$120.60
|
| Rate for Payer: MEDICAID Medicaid |
$123.28
|
| Rate for Payer: MEDICARE Medicare |
$93.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$127.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$129.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$127.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$127.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$113.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$107.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$107.20
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
OP
|
$134.00
|
|
|
Service Code
|
CPT 97164 59
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$134.00 |
| Rate for Payer: AETNA Commercial |
$127.30
|
| Rate for Payer: AETNA Medicare |
$120.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$127.30
|
| Rate for Payer: BCBS Healthlink |
$120.60
|
| Rate for Payer: BCBS HMK CHIP |
$120.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$120.60
|
| Rate for Payer: BCBS POS |
$127.30
|
| Rate for Payer: BCBS Traditional |
$134.00
|
| Rate for Payer: CASH_PRICE |
$107.20
|
| Rate for Payer: CIGNA Commercial |
$127.30
|
| Rate for Payer: CIGNA Medicare |
$120.60
|
| Rate for Payer: HUMANA Commercial |
$120.60
|
| Rate for Payer: MEDICAID Medicaid |
$123.28
|
| Rate for Payer: MEDICARE Medicare |
$93.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$127.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$129.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$127.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$127.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$113.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$107.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$107.20
|
|
|
PT SELF CARE HOME MGMT ADL
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
PT SELF CARE HOME MGMT ADL
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
PT SHARP 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 SHARP 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 SHARP DEBRIDEMENT
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$297.50
|
| Rate for Payer: AETNA Commercial |
$332.50
|
| Rate for Payer: AETNA Medicare |
$315.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$332.50
|
| Rate for Payer: BCBS Healthlink |
$315.00
|
| Rate for Payer: BCBS HMK CHIP |
$315.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$315.00
|
| Rate for Payer: BCBS POS |
$332.50
|
| Rate for Payer: BCBS Traditional |
$350.00
|
| Rate for Payer: CASH_PRICE |
$280.00
|
| Rate for Payer: CIGNA Commercial |
$332.50
|
| Rate for Payer: CIGNA Medicare |
$315.00
|
| Rate for Payer: HUMANA Commercial |
$315.00
|
| Rate for Payer: MEDICAID Medicaid |
$322.00
|
| Rate for Payer: MEDICARE Medicare |
$245.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$332.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$339.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$332.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$332.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$280.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$280.00
|
|
