|
PT SHARP DEBRIDEMENT
|
Facility
OP
|
$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: 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 Commercial |
$297.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$280.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$280.00
|
|
|
PT SPECIAL REPORTS
|
Facility
IP
|
$127.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.95
|
| Rate for Payer: AETNA Commercial |
$120.65
|
| Rate for Payer: AETNA Medicare |
$114.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$120.65
|
| Rate for Payer: BCBS Healthlink |
$114.30
|
| Rate for Payer: BCBS HMK CHIP |
$114.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$114.30
|
| Rate for Payer: BCBS POS |
$120.65
|
| Rate for Payer: BCBS Traditional |
$127.00
|
| Rate for Payer: CASH_PRICE |
$101.60
|
| Rate for Payer: CIGNA Commercial |
$120.65
|
| Rate for Payer: CIGNA Medicare |
$114.30
|
| Rate for Payer: HUMANA Commercial |
$114.30
|
| Rate for Payer: MEDICAID Medicaid |
$116.84
|
| Rate for Payer: MEDICARE Medicare |
$88.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$120.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$123.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$120.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$120.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$101.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$101.60
|
|
|
PT SPECIAL REPORTS
|
Facility
OP
|
$127.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: AETNA Commercial |
$120.65
|
| Rate for Payer: AETNA Medicare |
$114.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$120.65
|
| Rate for Payer: BCBS Healthlink |
$114.30
|
| Rate for Payer: BCBS HMK CHIP |
$114.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$114.30
|
| Rate for Payer: BCBS POS |
$120.65
|
| Rate for Payer: BCBS Traditional |
$127.00
|
| Rate for Payer: CASH_PRICE |
$101.60
|
| Rate for Payer: CIGNA Commercial |
$120.65
|
| Rate for Payer: CIGNA Medicare |
$114.30
|
| Rate for Payer: HUMANA Commercial |
$114.30
|
| Rate for Payer: MEDICAID Medicaid |
$116.84
|
| Rate for Payer: MEDICARE Medicare |
$88.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$120.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$123.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$120.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$120.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$101.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$101.60
|
|
|
PT STANDARDIZED DEVELOP TESTING
|
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 STANDARDIZED DEVELOP TESTING
|
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 THERA CANE
|
Facility
IP
|
$102.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| 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 THERA CANE
|
Facility
OP
|
$102.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| 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 THERAPEUTIC ACTIVITIES
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
PT THERAPEUTIC ACTIVITIES
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
PT THERAPEUTIC EXERCISES
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 97110 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 THERAPEUTIC EXERCISES
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 97110 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 THERAPEUTIC MASSAGE
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: AETNA Commercial |
$88.35
|
| Rate for Payer: AETNA Medicare |
$83.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$88.35
|
| Rate for Payer: BCBS Healthlink |
$83.70
|
| Rate for Payer: BCBS HMK CHIP |
$83.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$83.70
|
| Rate for Payer: BCBS POS |
$88.35
|
| Rate for Payer: BCBS Traditional |
$93.00
|
| Rate for Payer: CASH_PRICE |
$74.40
|
| Rate for Payer: CIGNA Commercial |
$88.35
|
| Rate for Payer: CIGNA Medicare |
$83.70
|
| Rate for Payer: HUMANA Commercial |
$83.70
|
| Rate for Payer: MEDICAID Medicaid |
$85.56
|
| Rate for Payer: MEDICARE Medicare |
$65.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$88.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$90.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$88.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$88.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$74.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$74.40
|
|
|
PT THERAPEUTIC MASSAGE
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: AETNA Commercial |
$88.35
|
| Rate for Payer: AETNA Medicare |
$83.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$88.35
|
| Rate for Payer: BCBS Healthlink |
$83.70
|
| Rate for Payer: BCBS HMK CHIP |
$83.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$83.70
|
| Rate for Payer: BCBS POS |
$88.35
|
| Rate for Payer: BCBS Traditional |
$93.00
|
| Rate for Payer: CASH_PRICE |
$74.40
|
| Rate for Payer: CIGNA Commercial |
$88.35
|
| Rate for Payer: CIGNA Medicare |
$83.70
|
| Rate for Payer: HUMANA Commercial |
$83.70
|
| Rate for Payer: MEDICAID Medicaid |
$85.56
|
| Rate for Payer: MEDICARE Medicare |
$65.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$88.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$90.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$88.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$88.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$74.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$74.40
|
|
|
PT THERAPEUTIC PROC GROUP
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
PT THERAPEUTIC PROC GROUP
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
PT TRACTION MECHANICAL
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 97012 59
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
PT TRACTION MECHANICAL
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 97012 59
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
PT ULISTED PROCEDURE SPECIFY
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 97139 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
PT ULISTED PROCEDURE SPECIFY
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 97139 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
PT ULTRASOUND
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
PT ULTRASOUND
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
PT UNLISTED PHYSICAL THERAPY SERVICE
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 97799 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
PT UNLISTED PHYSICAL THERAPY SERVICE
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 97799 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
PT VASOPNEUMATIC DEVICE
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 97016 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 VASOPNEUMATIC DEVICE
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 97016 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
|
|
