|
SKIN SUBS APPLIC H,FT,FC EA 25SQCM 15276
|
Facility
OP
|
$555.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: AETNA Commercial |
$527.25
|
| Rate for Payer: AETNA Medicare |
$499.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$527.25
|
| Rate for Payer: BCBS Healthlink |
$499.50
|
| Rate for Payer: BCBS HMK CHIP |
$499.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$499.50
|
| Rate for Payer: BCBS POS |
$527.25
|
| Rate for Payer: BCBS Traditional |
$555.00
|
| Rate for Payer: CASH_PRICE |
$444.00
|
| Rate for Payer: CIGNA Commercial |
$527.25
|
| Rate for Payer: CIGNA Medicare |
$499.50
|
| Rate for Payer: HUMANA Commercial |
$499.50
|
| Rate for Payer: MEDICAID Medicaid |
$510.60
|
| Rate for Payer: MEDICARE Medicare |
$388.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$527.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$538.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$527.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$527.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$471.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$444.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$444.00
|
|
|
SKIN SUBS APPLIC H,FT,FC EA 25SQCM 15276
|
Facility
IP
|
$555.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: AETNA Commercial |
$527.25
|
| Rate for Payer: AETNA Medicare |
$499.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$527.25
|
| Rate for Payer: BCBS Healthlink |
$499.50
|
| Rate for Payer: BCBS HMK CHIP |
$499.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$499.50
|
| Rate for Payer: BCBS POS |
$527.25
|
| Rate for Payer: BCBS Traditional |
$555.00
|
| Rate for Payer: CASH_PRICE |
$444.00
|
| Rate for Payer: CIGNA Commercial |
$527.25
|
| Rate for Payer: CIGNA Medicare |
$499.50
|
| Rate for Payer: HUMANA Commercial |
$499.50
|
| Rate for Payer: MEDICAID Medicaid |
$510.60
|
| Rate for Payer: MEDICARE Medicare |
$388.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$527.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$538.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$527.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$527.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$471.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$444.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$444.00
|
|
|
SKIN SUBS APPLIC T,A,L 1-25 SQCM 15271
|
Facility
IP
|
$1,653.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,157.10 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: AETNA Commercial |
$1,570.35
|
| Rate for Payer: AETNA Medicare |
$1,487.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,570.35
|
| Rate for Payer: BCBS Healthlink |
$1,487.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,487.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,487.70
|
| Rate for Payer: BCBS POS |
$1,570.35
|
| Rate for Payer: BCBS Traditional |
$1,653.00
|
| Rate for Payer: CASH_PRICE |
$1,322.40
|
| Rate for Payer: CIGNA Commercial |
$1,570.35
|
| Rate for Payer: CIGNA Medicare |
$1,487.70
|
| Rate for Payer: HUMANA Commercial |
$1,487.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,520.76
|
| Rate for Payer: MEDICARE Medicare |
$1,157.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,570.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,603.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,570.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,570.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,405.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,322.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,322.40
|
|
|
SKIN SUBS APPLIC T,A,L 1-25 SQCM 15271
|
Facility
OP
|
$1,653.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,157.10 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: AETNA Commercial |
$1,570.35
|
| Rate for Payer: AETNA Medicare |
$1,487.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,570.35
|
| Rate for Payer: BCBS Healthlink |
$1,487.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,487.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,487.70
|
| Rate for Payer: BCBS POS |
$1,570.35
|
| Rate for Payer: BCBS Traditional |
$1,653.00
|
| Rate for Payer: CASH_PRICE |
$1,322.40
|
| Rate for Payer: CIGNA Commercial |
$1,570.35
|
| Rate for Payer: CIGNA Medicare |
$1,487.70
|
| Rate for Payer: HUMANA Commercial |
$1,487.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,520.76
|
| Rate for Payer: MEDICARE Medicare |
$1,157.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,570.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,603.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,570.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,570.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,405.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,322.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,322.40
|
|
|
SKIN SUBS APPLIC T,A,L 1ST100 SQCM 15273
|
Facility
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,264.20 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: AETNA Commercial |
$1,715.70
|
| Rate for Payer: AETNA Medicare |
$1,625.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,715.70
|
| Rate for Payer: BCBS Healthlink |
$1,625.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,625.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,625.40
|
| Rate for Payer: BCBS POS |
$1,715.70
|
| Rate for Payer: BCBS Traditional |
$1,806.00
|
| Rate for Payer: CASH_PRICE |
$1,444.80
|
| Rate for Payer: CIGNA Commercial |
$1,715.70
|
| Rate for Payer: CIGNA Medicare |
$1,625.40
|
| Rate for Payer: HUMANA Commercial |
$1,625.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,661.52
|
| Rate for Payer: MEDICARE Medicare |
$1,264.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,715.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,751.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,715.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,715.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,535.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,444.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,444.80
|
|
|
SKIN SUBS APPLIC T,A,L 1ST100 SQCM 15273
|
Facility
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,264.20 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: AETNA Commercial |
$1,715.70
|
| Rate for Payer: AETNA Medicare |
$1,625.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,715.70
|
| Rate for Payer: BCBS Healthlink |
$1,625.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,625.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,625.40
|
| Rate for Payer: BCBS POS |
$1,715.70
|
| Rate for Payer: BCBS Traditional |
$1,806.00
|
| Rate for Payer: CASH_PRICE |
$1,444.80
|
| Rate for Payer: CIGNA Commercial |
$1,715.70
|
| Rate for Payer: CIGNA Medicare |
$1,625.40
|
| Rate for Payer: HUMANA Commercial |
$1,625.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,661.52
|
| Rate for Payer: MEDICARE Medicare |
$1,264.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,715.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,751.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,715.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,715.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,535.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,444.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,444.80
|
|
|
SKIN SUBS APPLIC T,A,L EA100+ SQCM 15274
|
Facility
IP
|
$769.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.30 |
| Max. Negotiated Rate |
$769.00 |
| Rate for Payer: AETNA Commercial |
$730.55
|
| Rate for Payer: AETNA Medicare |
$692.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$730.55
|
| Rate for Payer: BCBS Healthlink |
$692.10
|
| Rate for Payer: BCBS HMK CHIP |
$692.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$692.10
|
| Rate for Payer: BCBS POS |
$730.55
|
| Rate for Payer: BCBS Traditional |
$769.00
|
| Rate for Payer: CASH_PRICE |
$615.20
|
| Rate for Payer: CIGNA Commercial |
$730.55
|
| Rate for Payer: CIGNA Medicare |
$692.10
|
| Rate for Payer: HUMANA Commercial |
$692.10
|
| Rate for Payer: MEDICAID Medicaid |
$707.48
|
| Rate for Payer: MEDICARE Medicare |
$538.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$730.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$745.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$730.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$730.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$653.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$615.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$615.20
|
|
|
SKIN SUBS APPLIC T,A,L EA100+ SQCM 15274
|
Facility
OP
|
$769.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.30 |
| Max. Negotiated Rate |
$769.00 |
| Rate for Payer: AETNA Commercial |
$730.55
|
| Rate for Payer: AETNA Medicare |
$692.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$730.55
|
| Rate for Payer: BCBS Healthlink |
$692.10
|
| Rate for Payer: BCBS HMK CHIP |
$692.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$692.10
|
| Rate for Payer: BCBS POS |
$730.55
|
| Rate for Payer: BCBS Traditional |
$769.00
|
| Rate for Payer: CASH_PRICE |
$615.20
|
| Rate for Payer: CIGNA Commercial |
$730.55
|
| Rate for Payer: CIGNA Medicare |
$692.10
|
| Rate for Payer: HUMANA Commercial |
$692.10
|
| Rate for Payer: MEDICAID Medicaid |
$707.48
|
| Rate for Payer: MEDICARE Medicare |
$538.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$730.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$745.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$730.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$730.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$653.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$615.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$615.20
|
|
|
SKIN SUBS APPLIC T,A,L EA 25 SQCM 15272
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: AETNA Commercial |
$441.75
|
| Rate for Payer: AETNA Medicare |
$418.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$441.75
|
| Rate for Payer: BCBS Healthlink |
$418.50
|
| Rate for Payer: BCBS HMK CHIP |
$418.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$418.50
|
| Rate for Payer: BCBS POS |
$441.75
|
| Rate for Payer: BCBS Traditional |
$465.00
|
| Rate for Payer: CASH_PRICE |
$372.00
|
| Rate for Payer: CIGNA Commercial |
$441.75
|
| Rate for Payer: CIGNA Medicare |
$418.50
|
| Rate for Payer: HUMANA Commercial |
$418.50
|
| Rate for Payer: MEDICAID Medicaid |
$427.80
|
| Rate for Payer: MEDICARE Medicare |
$325.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$441.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$451.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$441.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$441.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$395.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$372.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$372.00
|
|
|
SKIN SUBS APPLIC T,A,L EA 25 SQCM 15272
|
Facility
IP
|
$465.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
20230401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: AETNA Commercial |
$441.75
|
| Rate for Payer: AETNA Medicare |
$418.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$441.75
|
| Rate for Payer: BCBS Healthlink |
$418.50
|
| Rate for Payer: BCBS HMK CHIP |
$418.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$418.50
|
| Rate for Payer: BCBS POS |
$441.75
|
| Rate for Payer: BCBS Traditional |
$465.00
|
| Rate for Payer: CASH_PRICE |
$372.00
|
| Rate for Payer: CIGNA Commercial |
$441.75
|
| Rate for Payer: CIGNA Medicare |
$418.50
|
| Rate for Payer: HUMANA Commercial |
$418.50
|
| Rate for Payer: MEDICAID Medicaid |
$427.80
|
| Rate for Payer: MEDICARE Medicare |
$325.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$441.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$451.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$441.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$441.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$395.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$372.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$372.00
|
|
|
SLING AND SWATHE LG
|
Facility
IP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
SLING AND SWATHE LG
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
SLING AND SWATHE MD
|
Facility
IP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
SLING AND SWATHE MD
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
SLING AND SWATHE SM
|
Facility
IP
|
$43.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
SLING AND SWATHE SM
|
Facility
OP
|
$43.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
SMALLBORE EXTENSION SET
|
Facility
IP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
SMALLBORE EXTENSION SET
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
SMITH ANTIBODIES (016360)
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
SMITH ANTIBODIES (016360)
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
SODIUM
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
SODIUM
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
SODIUM BICARB INJ 4.2% [5MEQ/10ML] PEDS
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
SODIUM BICARB INJ 4.2% [5MEQ/10ML] PEDS
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
SODIUM BICARB INJ 8.4% [50 MEQ/50 ML]
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: AETNA Commercial |
$61.75
|
| Rate for Payer: AETNA Medicare |
$58.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$61.75
|
| Rate for Payer: BCBS Healthlink |
$58.50
|
| Rate for Payer: BCBS HMK CHIP |
$58.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$58.50
|
| Rate for Payer: BCBS POS |
$61.75
|
| Rate for Payer: BCBS Traditional |
$65.00
|
| Rate for Payer: CASH_PRICE |
$52.00
|
| Rate for Payer: CIGNA Commercial |
$61.75
|
| Rate for Payer: CIGNA Medicare |
$58.50
|
| Rate for Payer: HUMANA Commercial |
$58.50
|
| Rate for Payer: MEDICAID Medicaid |
$59.80
|
| Rate for Payer: MEDICARE Medicare |
$45.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$61.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$63.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$61.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$61.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$55.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.00
|
|
