|
REMOVAL FB EYE EXT CONJUNTIVAL SUPERFIC
|
Facility
OP
|
$222.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: AETNA Commercial |
$210.90
|
| Rate for Payer: AETNA Medicare |
$199.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$210.90
|
| Rate for Payer: BCBS Healthlink |
$199.80
|
| Rate for Payer: BCBS HMK CHIP |
$199.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$199.80
|
| Rate for Payer: BCBS POS |
$210.90
|
| Rate for Payer: BCBS Traditional |
$222.00
|
| Rate for Payer: CASH_PRICE |
$177.60
|
| Rate for Payer: CIGNA Commercial |
$210.90
|
| Rate for Payer: CIGNA Medicare |
$199.80
|
| Rate for Payer: HUMANA Commercial |
$199.80
|
| Rate for Payer: MEDICAID Medicaid |
$204.24
|
| Rate for Payer: MEDICARE Medicare |
$155.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$210.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$215.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$210.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$210.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$188.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$177.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$177.60
|
|
|
REMOVAL FB EYE EXT CONJUNTIVAL SUPERFIC
|
Facility
IP
|
$222.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: AETNA Commercial |
$210.90
|
| Rate for Payer: AETNA Medicare |
$199.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$210.90
|
| Rate for Payer: BCBS Healthlink |
$199.80
|
| Rate for Payer: BCBS HMK CHIP |
$199.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$199.80
|
| Rate for Payer: BCBS POS |
$210.90
|
| Rate for Payer: BCBS Traditional |
$222.00
|
| Rate for Payer: CASH_PRICE |
$177.60
|
| Rate for Payer: CIGNA Commercial |
$210.90
|
| Rate for Payer: CIGNA Medicare |
$199.80
|
| Rate for Payer: HUMANA Commercial |
$199.80
|
| Rate for Payer: MEDICAID Medicaid |
$204.24
|
| Rate for Payer: MEDICARE Medicare |
$155.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$210.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$215.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$210.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$210.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$188.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$177.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$177.60
|
|
|
REMOVAL FB FOOT SC SIMPLE
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$401.10 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: AETNA Commercial |
$544.35
|
| Rate for Payer: AETNA Medicare |
$515.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$544.35
|
| Rate for Payer: BCBS Healthlink |
$515.70
|
| Rate for Payer: BCBS HMK CHIP |
$515.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$515.70
|
| Rate for Payer: BCBS POS |
$544.35
|
| Rate for Payer: BCBS Traditional |
$573.00
|
| Rate for Payer: CASH_PRICE |
$458.40
|
| Rate for Payer: CIGNA Commercial |
$544.35
|
| Rate for Payer: CIGNA Medicare |
$515.70
|
| Rate for Payer: HUMANA Commercial |
$515.70
|
| Rate for Payer: MEDICAID Medicaid |
$527.16
|
| Rate for Payer: MEDICARE Medicare |
$401.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$544.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$555.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$544.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$544.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$487.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$458.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$458.40
|
|
|
REMOVAL FB FOOT SC SIMPLE
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$401.10 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: AETNA Commercial |
$544.35
|
| Rate for Payer: AETNA Medicare |
$515.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$544.35
|
| Rate for Payer: BCBS Healthlink |
$515.70
|
| Rate for Payer: BCBS HMK CHIP |
$515.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$515.70
|
| Rate for Payer: BCBS POS |
$544.35
|
| Rate for Payer: BCBS Traditional |
$573.00
|
| Rate for Payer: CASH_PRICE |
$458.40
|
| Rate for Payer: CIGNA Commercial |
$544.35
|
| Rate for Payer: CIGNA Medicare |
$515.70
|
| Rate for Payer: HUMANA Commercial |
$515.70
|
| Rate for Payer: MEDICAID Medicaid |
$527.16
|
| Rate for Payer: MEDICARE Medicare |
$401.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$544.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$555.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$544.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$544.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$487.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$458.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$458.40
|
|
|
REMOVAL FB INTRANASAL OFFICE TYPE TX
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AETNA Commercial |
$184.30
|
| Rate for Payer: AETNA Medicare |
$174.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$184.30
|
| Rate for Payer: BCBS Healthlink |
$174.60
|
| Rate for Payer: BCBS HMK CHIP |
$174.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$174.60
|
| Rate for Payer: BCBS POS |
$184.30
|
| Rate for Payer: BCBS Traditional |
$194.00
|
| Rate for Payer: CASH_PRICE |
$155.20
|
| Rate for Payer: CIGNA Commercial |
$184.30
|
| Rate for Payer: CIGNA Medicare |
$174.60
|
| Rate for Payer: HUMANA Commercial |
$174.60
|
| Rate for Payer: MEDICAID Medicaid |
$178.48
|
| Rate for Payer: MEDICARE Medicare |
$135.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$184.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$188.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$184.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$184.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$155.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$155.20
|
|
|
REMOVAL FB INTRANASAL OFFICE TYPE TX
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AETNA Commercial |
$184.30
|
| Rate for Payer: AETNA Medicare |
$174.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$184.30
|
| Rate for Payer: BCBS Healthlink |
$174.60
|
| Rate for Payer: BCBS HMK CHIP |
$174.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$174.60
|
| Rate for Payer: BCBS POS |
$184.30
|
| Rate for Payer: BCBS Traditional |
$194.00
|
| Rate for Payer: CASH_PRICE |
$155.20
|
| Rate for Payer: CIGNA Commercial |
$184.30
|
| Rate for Payer: CIGNA Medicare |
$174.60
|
| Rate for Payer: HUMANA Commercial |
$174.60
|
| Rate for Payer: MEDICAID Medicaid |
$178.48
|
| Rate for Payer: MEDICARE Medicare |
$135.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$184.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$188.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$184.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$184.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$155.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$155.20
|
|
|
REMOVAL FB MUSCLE/TENDON / DEEP OR COMPL
|
Facility
OP
|
$3,577.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$2,503.90 |
| Max. Negotiated Rate |
$3,577.00 |
| Rate for Payer: AETNA Commercial |
$3,398.15
|
| Rate for Payer: AETNA Medicare |
$3,219.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,398.15
|
| Rate for Payer: BCBS Healthlink |
$3,219.30
|
| Rate for Payer: BCBS HMK CHIP |
$3,219.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,219.30
|
| Rate for Payer: BCBS POS |
$3,398.15
|
| Rate for Payer: BCBS Traditional |
$3,577.00
|
| Rate for Payer: CASH_PRICE |
$2,861.60
|
| Rate for Payer: CIGNA Commercial |
$3,398.15
|
| Rate for Payer: CIGNA Medicare |
$3,219.30
|
| Rate for Payer: HUMANA Commercial |
$3,219.30
|
| Rate for Payer: MEDICAID Medicaid |
$3,290.84
|
| Rate for Payer: MEDICARE Medicare |
$2,503.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,469.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,398.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3,040.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,861.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,861.60
|
|
|
REMOVAL FB MUSCLE/TENDON / DEEP OR COMPL
|
Facility
IP
|
$3,577.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$2,503.90 |
| Max. Negotiated Rate |
$3,577.00 |
| Rate for Payer: AETNA Commercial |
$3,398.15
|
| Rate for Payer: AETNA Medicare |
$3,219.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,398.15
|
| Rate for Payer: BCBS Healthlink |
$3,219.30
|
| Rate for Payer: BCBS HMK CHIP |
$3,219.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,219.30
|
| Rate for Payer: BCBS POS |
$3,398.15
|
| Rate for Payer: BCBS Traditional |
$3,577.00
|
| Rate for Payer: CASH_PRICE |
$2,861.60
|
| Rate for Payer: CIGNA Commercial |
$3,398.15
|
| Rate for Payer: CIGNA Medicare |
$3,219.30
|
| Rate for Payer: HUMANA Commercial |
$3,219.30
|
| Rate for Payer: MEDICAID Medicaid |
$3,290.84
|
| Rate for Payer: MEDICARE Medicare |
$2,503.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,469.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,398.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3,040.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,861.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,861.60
|
|
|
REMOVAL FB SUBCUTAN TISSUE SIMPLE
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: AETNA Commercial |
$472.15
|
| Rate for Payer: AETNA Medicare |
$447.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$472.15
|
| Rate for Payer: BCBS Healthlink |
$447.30
|
| Rate for Payer: BCBS HMK CHIP |
$447.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$447.30
|
| Rate for Payer: BCBS POS |
$472.15
|
| Rate for Payer: BCBS Traditional |
$497.00
|
| Rate for Payer: CASH_PRICE |
$397.60
|
| Rate for Payer: CIGNA Commercial |
$472.15
|
| Rate for Payer: CIGNA Medicare |
$447.30
|
| Rate for Payer: HUMANA Commercial |
$447.30
|
| Rate for Payer: MEDICAID Medicaid |
$457.24
|
| Rate for Payer: MEDICARE Medicare |
$347.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$472.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$482.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$472.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$472.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$422.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$397.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$397.60
|
|
|
REMOVAL FB SUBCUTAN TISSUE SIMPLE
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: AETNA Commercial |
$472.15
|
| Rate for Payer: AETNA Medicare |
$447.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$472.15
|
| Rate for Payer: BCBS Healthlink |
$447.30
|
| Rate for Payer: BCBS HMK CHIP |
$447.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$447.30
|
| Rate for Payer: BCBS POS |
$472.15
|
| Rate for Payer: BCBS Traditional |
$497.00
|
| Rate for Payer: CASH_PRICE |
$397.60
|
| Rate for Payer: CIGNA Commercial |
$472.15
|
| Rate for Payer: CIGNA Medicare |
$447.30
|
| Rate for Payer: HUMANA Commercial |
$447.30
|
| Rate for Payer: MEDICAID Medicaid |
$457.24
|
| Rate for Payer: MEDICARE Medicare |
$347.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$472.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$482.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$472.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$472.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$422.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$397.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$397.60
|
|
|
REMOVAL IMPACTED CERUMEN
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: AETNA Commercial |
$155.80
|
| Rate for Payer: AETNA Medicare |
$147.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$155.80
|
| Rate for Payer: BCBS Healthlink |
$147.60
|
| Rate for Payer: BCBS HMK CHIP |
$147.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$147.60
|
| Rate for Payer: BCBS POS |
$155.80
|
| Rate for Payer: BCBS Traditional |
$164.00
|
| Rate for Payer: CASH_PRICE |
$131.20
|
| Rate for Payer: CIGNA Commercial |
$155.80
|
| Rate for Payer: CIGNA Medicare |
$147.60
|
| Rate for Payer: HUMANA Commercial |
$147.60
|
| Rate for Payer: MEDICAID Medicaid |
$150.88
|
| Rate for Payer: MEDICARE Medicare |
$114.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$155.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$159.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$155.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$155.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$139.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$131.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$131.20
|
|
|
REMOVAL IMPACTED CERUMEN
|
Facility
OP
|
$164.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: AETNA Commercial |
$155.80
|
| Rate for Payer: AETNA Medicare |
$147.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$155.80
|
| Rate for Payer: BCBS Healthlink |
$147.60
|
| Rate for Payer: BCBS HMK CHIP |
$147.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$147.60
|
| Rate for Payer: BCBS POS |
$155.80
|
| Rate for Payer: BCBS Traditional |
$164.00
|
| Rate for Payer: CASH_PRICE |
$131.20
|
| Rate for Payer: CIGNA Commercial |
$155.80
|
| Rate for Payer: CIGNA Medicare |
$147.60
|
| Rate for Payer: HUMANA Commercial |
$147.60
|
| Rate for Payer: MEDICAID Medicaid |
$150.88
|
| Rate for Payer: MEDICARE Medicare |
$114.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$155.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$159.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$155.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$155.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$139.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$131.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$131.20
|
|
|
REMOVAL IMPACTED CERUMEN - IRRIGATION
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
REMOVAL IMPACTED CERUMEN - IRRIGATION
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
REMOVAL OF IUD
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
REMOVAL OF IUD
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
REMOVAL SKIN TAG <15 LESIONS
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: AETNA Commercial |
$201.40
|
| Rate for Payer: AETNA Medicare |
$190.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$201.40
|
| Rate for Payer: BCBS Healthlink |
$190.80
|
| Rate for Payer: BCBS HMK CHIP |
$190.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$190.80
|
| Rate for Payer: BCBS POS |
$201.40
|
| Rate for Payer: BCBS Traditional |
$212.00
|
| Rate for Payer: CASH_PRICE |
$169.60
|
| Rate for Payer: CIGNA Commercial |
$201.40
|
| Rate for Payer: CIGNA Medicare |
$190.80
|
| Rate for Payer: HUMANA Commercial |
$190.80
|
| Rate for Payer: MEDICAID Medicaid |
$195.04
|
| Rate for Payer: MEDICARE Medicare |
$148.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$201.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$205.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$201.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$201.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$180.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$169.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$169.60
|
|
|
REMOVAL SKIN TAG <15 LESIONS
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: AETNA Commercial |
$201.40
|
| Rate for Payer: AETNA Medicare |
$190.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$201.40
|
| Rate for Payer: BCBS Healthlink |
$190.80
|
| Rate for Payer: BCBS HMK CHIP |
$190.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$190.80
|
| Rate for Payer: BCBS POS |
$201.40
|
| Rate for Payer: BCBS Traditional |
$212.00
|
| Rate for Payer: CASH_PRICE |
$169.60
|
| Rate for Payer: CIGNA Commercial |
$201.40
|
| Rate for Payer: CIGNA Medicare |
$190.80
|
| Rate for Payer: HUMANA Commercial |
$190.80
|
| Rate for Payer: MEDICAID Medicaid |
$195.04
|
| Rate for Payer: MEDICARE Medicare |
$148.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$201.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$205.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$201.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$201.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$180.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$169.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$169.60
|
|
|
REMOVAL WART BENIGN >15
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
REMOVAL WART BENIGN >15
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
RENAL FUNCTION PANEL
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
RENAL FUNCTION PANEL
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
RENIN ACTIVITY (002006)
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
RENIN ACTIVITY (002006)
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
RESPIRATORY PANEL, NAD
|
Facility
IP
|
$578.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: AETNA Commercial |
$549.10
|
| Rate for Payer: AETNA Medicare |
$520.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$549.10
|
| Rate for Payer: BCBS Healthlink |
$520.20
|
| Rate for Payer: BCBS HMK CHIP |
$520.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$520.20
|
| Rate for Payer: BCBS POS |
$549.10
|
| Rate for Payer: BCBS Traditional |
$578.00
|
| Rate for Payer: CASH_PRICE |
$462.40
|
| Rate for Payer: CIGNA Commercial |
$549.10
|
| Rate for Payer: CIGNA Medicare |
$520.20
|
| Rate for Payer: HUMANA Commercial |
$520.20
|
| Rate for Payer: MEDICAID Medicaid |
$531.76
|
| Rate for Payer: MEDICARE Medicare |
$404.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$549.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$560.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$549.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$549.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$491.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$462.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$462.40
|
|
