|
SARS-COV-2/FLU A/FLU B, RT-PCR
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: AETNA Commercial |
$237.50
|
| Rate for Payer: AETNA Medicare |
$225.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$237.50
|
| Rate for Payer: BCBS Healthlink |
$225.00
|
| Rate for Payer: BCBS HMK CHIP |
$225.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.00
|
| Rate for Payer: BCBS POS |
$237.50
|
| Rate for Payer: BCBS Traditional |
$250.00
|
| Rate for Payer: CASH_PRICE |
$200.00
|
| Rate for Payer: CIGNA Commercial |
$237.50
|
| Rate for Payer: CIGNA Medicare |
$225.00
|
| Rate for Payer: HUMANA Commercial |
$225.00
|
| Rate for Payer: MEDICAID Medicaid |
$230.00
|
| Rate for Payer: MEDICARE Medicare |
$175.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$237.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$242.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$237.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$237.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$212.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.00
|
|
|
SARS-COV-2/FLU A/FLU B, RT-PCR
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: AETNA Commercial |
$237.50
|
| Rate for Payer: AETNA Medicare |
$225.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$237.50
|
| Rate for Payer: BCBS Healthlink |
$225.00
|
| Rate for Payer: BCBS HMK CHIP |
$225.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.00
|
| Rate for Payer: BCBS POS |
$237.50
|
| Rate for Payer: BCBS Traditional |
$250.00
|
| Rate for Payer: CASH_PRICE |
$200.00
|
| Rate for Payer: CIGNA Commercial |
$237.50
|
| Rate for Payer: CIGNA Medicare |
$225.00
|
| Rate for Payer: HUMANA Commercial |
$225.00
|
| Rate for Payer: MEDICAID Medicaid |
$230.00
|
| Rate for Payer: MEDICARE Medicare |
$175.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$237.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$242.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$237.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$237.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$212.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.00
|
|
|
SARS-COV-2, ID NOW
|
Facility
IP
|
$203.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: AETNA Commercial |
$192.85
|
| Rate for Payer: AETNA Medicare |
$182.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$192.85
|
| Rate for Payer: BCBS Healthlink |
$182.70
|
| Rate for Payer: BCBS HMK CHIP |
$182.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$182.70
|
| Rate for Payer: BCBS POS |
$192.85
|
| Rate for Payer: BCBS Traditional |
$203.00
|
| Rate for Payer: CASH_PRICE |
$162.40
|
| Rate for Payer: CIGNA Commercial |
$192.85
|
| Rate for Payer: CIGNA Medicare |
$182.70
|
| Rate for Payer: HUMANA Commercial |
$182.70
|
| Rate for Payer: MEDICAID Medicaid |
$186.76
|
| Rate for Payer: MEDICARE Medicare |
$142.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$192.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$196.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$192.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$192.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$172.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$162.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$162.40
|
|
|
SARS-COV-2, ID NOW
|
Facility
OP
|
$203.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: AETNA Commercial |
$192.85
|
| Rate for Payer: AETNA Medicare |
$182.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$192.85
|
| Rate for Payer: BCBS Healthlink |
$182.70
|
| Rate for Payer: BCBS HMK CHIP |
$182.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$182.70
|
| Rate for Payer: BCBS POS |
$192.85
|
| Rate for Payer: BCBS Traditional |
$203.00
|
| Rate for Payer: CASH_PRICE |
$162.40
|
| Rate for Payer: CIGNA Commercial |
$192.85
|
| Rate for Payer: CIGNA Medicare |
$182.70
|
| Rate for Payer: HUMANA Commercial |
$182.70
|
| Rate for Payer: MEDICAID Medicaid |
$186.76
|
| Rate for Payer: MEDICARE Medicare |
$142.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$192.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$196.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$192.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$192.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$172.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$162.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$162.40
|
|
|
SARS-COV-2, ID NOW - TRAVEL
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
SARS-COV-2, ID NOW - TRAVEL
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
SARS-COV-2, RT-PCR
|
Facility
OP
|
$203.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: BCBS HMK CHIP |
$182.70
|
| Rate for Payer: AETNA Commercial |
$192.85
|
| Rate for Payer: AETNA Medicare |
$182.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$192.85
|
| Rate for Payer: BCBS Healthlink |
$182.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$182.70
|
| Rate for Payer: BCBS POS |
$192.85
|
| Rate for Payer: BCBS Traditional |
$203.00
|
| Rate for Payer: CASH_PRICE |
$162.40
|
| Rate for Payer: CIGNA Commercial |
$192.85
|
| Rate for Payer: CIGNA Medicare |
$182.70
|
| Rate for Payer: HUMANA Commercial |
$182.70
|
| Rate for Payer: MEDICAID Medicaid |
$186.76
|
| Rate for Payer: MEDICARE Medicare |
$142.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$192.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$196.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$192.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$192.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$172.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$162.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$162.40
|
|
|
SARS-COV-2, RT-PCR
|
Facility
IP
|
$203.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: AETNA Commercial |
$192.85
|
| Rate for Payer: AETNA Medicare |
$182.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$192.85
|
| Rate for Payer: BCBS Healthlink |
$182.70
|
| Rate for Payer: BCBS HMK CHIP |
$182.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$182.70
|
| Rate for Payer: BCBS POS |
$192.85
|
| Rate for Payer: BCBS Traditional |
$203.00
|
| Rate for Payer: CASH_PRICE |
$162.40
|
| Rate for Payer: CIGNA Commercial |
$192.85
|
| Rate for Payer: CIGNA Medicare |
$182.70
|
| Rate for Payer: HUMANA Commercial |
$182.70
|
| Rate for Payer: MEDICAID Medicaid |
$186.76
|
| Rate for Payer: MEDICARE Medicare |
$142.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$192.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$196.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$192.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$192.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$172.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$162.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$162.40
|
|
|
SARS-COV-2 SEMI-QUANT IGG AB (164055)
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
SARS-COV-2 SEMI-QUANT IGG AB (164055)
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
SB/NH ADMISSION HIGH COMPLEX (99306)
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: AETNA Commercial |
$329.65
|
| Rate for Payer: AETNA Medicare |
$312.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$329.65
|
| Rate for Payer: BCBS Healthlink |
$312.30
|
| Rate for Payer: BCBS HMK CHIP |
$312.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$312.30
|
| Rate for Payer: BCBS POS |
$329.65
|
| Rate for Payer: BCBS Traditional |
$347.00
|
| Rate for Payer: CASH_PRICE |
$277.60
|
| Rate for Payer: CIGNA Commercial |
$329.65
|
| Rate for Payer: CIGNA Medicare |
$312.30
|
| Rate for Payer: HUMANA Commercial |
$312.30
|
| Rate for Payer: MEDICAID Medicaid |
$319.24
|
| Rate for Payer: MEDICARE Medicare |
$242.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$329.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$336.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$329.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$329.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$294.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$277.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$277.60
|
|
|
SB/NH ADMISSION HIGH COMPLEX (99306)
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT 99306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$347.00 |
| Rate for Payer: AETNA Commercial |
$329.65
|
| Rate for Payer: AETNA Medicare |
$312.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$329.65
|
| Rate for Payer: BCBS Healthlink |
$312.30
|
| Rate for Payer: BCBS HMK CHIP |
$312.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$312.30
|
| Rate for Payer: BCBS POS |
$329.65
|
| Rate for Payer: BCBS Traditional |
$347.00
|
| Rate for Payer: CASH_PRICE |
$277.60
|
| Rate for Payer: CIGNA Commercial |
$329.65
|
| Rate for Payer: CIGNA Medicare |
$312.30
|
| Rate for Payer: HUMANA Commercial |
$312.30
|
| Rate for Payer: MEDICAID Medicaid |
$319.24
|
| Rate for Payer: MEDICARE Medicare |
$242.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$329.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$336.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$329.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$329.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$294.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$277.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$277.60
|
|
|
SB/NH ADMISSION LOW COMPLEX (99304)
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
CPT 99304
|
| 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
|
|
|
SB/NH ADMISSION LOW COMPLEX (99304)
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 99304
|
| 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
|
|
|
SB/NH ADMISSION MOD COMPLEX (99305)
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
SB/NH ADMISSION MOD COMPLEX (99305)
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 99305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
SB/NH ANNUAL ASSESSMENT (99318)
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 99318
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: AETNA Commercial |
$190.00
|
| Rate for Payer: AETNA Medicare |
$180.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.00
|
| Rate for Payer: BCBS Healthlink |
$180.00
|
| Rate for Payer: BCBS HMK CHIP |
$180.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.00
|
| Rate for Payer: BCBS POS |
$190.00
|
| Rate for Payer: BCBS Traditional |
$200.00
|
| Rate for Payer: CASH_PRICE |
$160.00
|
| Rate for Payer: CIGNA Commercial |
$190.00
|
| Rate for Payer: CIGNA Medicare |
$180.00
|
| Rate for Payer: HUMANA Commercial |
$180.00
|
| Rate for Payer: MEDICAID Medicaid |
$184.00
|
| Rate for Payer: MEDICARE Medicare |
$140.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.00
|
|
|
SB/NH ANNUAL ASSESSMENT (99318)
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 99318
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: AETNA Commercial |
$190.00
|
| Rate for Payer: AETNA Medicare |
$180.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.00
|
| Rate for Payer: BCBS Healthlink |
$180.00
|
| Rate for Payer: BCBS HMK CHIP |
$180.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.00
|
| Rate for Payer: BCBS POS |
$190.00
|
| Rate for Payer: BCBS Traditional |
$200.00
|
| Rate for Payer: CASH_PRICE |
$160.00
|
| Rate for Payer: CIGNA Commercial |
$190.00
|
| Rate for Payer: CIGNA Medicare |
$180.00
|
| Rate for Payer: HUMANA Commercial |
$180.00
|
| Rate for Payer: MEDICAID Medicaid |
$184.00
|
| Rate for Payer: MEDICARE Medicare |
$140.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.00
|
|
|
SB/NH DISCHARGE 30 MIN (99315)
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
SB/NH DISCHARGE 30 MIN (99315)
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
SB/NH DISCHARGE >30 MIN (99316)
|
Facility
IP
|
$221.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AETNA Commercial |
$209.95
|
| Rate for Payer: AETNA Medicare |
$198.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$209.95
|
| Rate for Payer: BCBS Healthlink |
$198.90
|
| Rate for Payer: BCBS HMK CHIP |
$198.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$198.90
|
| Rate for Payer: BCBS POS |
$209.95
|
| Rate for Payer: BCBS Traditional |
$221.00
|
| Rate for Payer: CASH_PRICE |
$176.80
|
| Rate for Payer: CIGNA Commercial |
$209.95
|
| Rate for Payer: CIGNA Medicare |
$198.90
|
| Rate for Payer: HUMANA Commercial |
$198.90
|
| Rate for Payer: MEDICAID Medicaid |
$203.32
|
| Rate for Payer: MEDICARE Medicare |
$154.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$209.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$214.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$209.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$209.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$187.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$176.80
|
|
|
SB/NH DISCHARGE >30 MIN (99316)
|
Facility
OP
|
$221.00
|
|
|
Service Code
|
CPT 99316
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AETNA Commercial |
$209.95
|
| Rate for Payer: AETNA Medicare |
$198.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$209.95
|
| Rate for Payer: BCBS Healthlink |
$198.90
|
| Rate for Payer: BCBS HMK CHIP |
$198.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$198.90
|
| Rate for Payer: BCBS POS |
$209.95
|
| Rate for Payer: BCBS Traditional |
$221.00
|
| Rate for Payer: CASH_PRICE |
$176.80
|
| Rate for Payer: CIGNA Commercial |
$209.95
|
| Rate for Payer: CIGNA Medicare |
$198.90
|
| Rate for Payer: HUMANA Commercial |
$198.90
|
| Rate for Payer: MEDICAID Medicaid |
$203.32
|
| Rate for Payer: MEDICARE Medicare |
$154.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$209.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$214.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$209.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$209.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$187.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$176.80
|
|
|
SB/NH SUBSEQUENT CARE 10 MIN (99307)
|
Facility
OP
|
$95.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
SB/NH SUBSEQUENT CARE 10 MIN (99307)
|
Facility
IP
|
$95.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
SB/NH SUBSEQUENT CARE 15 MIN (99308)
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
