|
TR INCISION AND DRAINAGE
|
Facility
OP
|
$477.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.90 |
| Max. Negotiated Rate |
$477.00 |
| Rate for Payer: AETNA Commercial |
$453.15
|
| Rate for Payer: AETNA Medicare |
$429.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$453.15
|
| Rate for Payer: BCBS Healthlink |
$429.30
|
| Rate for Payer: BCBS HMK CHIP |
$429.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$429.30
|
| Rate for Payer: BCBS POS |
$453.15
|
| Rate for Payer: BCBS Traditional |
$477.00
|
| Rate for Payer: CASH_PRICE |
$381.60
|
| Rate for Payer: CIGNA Commercial |
$453.15
|
| Rate for Payer: CIGNA Medicare |
$429.30
|
| Rate for Payer: HUMANA Commercial |
$429.30
|
| Rate for Payer: MEDICAID Medicaid |
$438.84
|
| Rate for Payer: MEDICARE Medicare |
$333.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$453.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$462.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$453.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$453.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$405.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$381.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$381.60
|
|
|
TR INCISION AND DRAINAGE ABCESS SIMPLE
|
Facility
OP
|
$416.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: AETNA Commercial |
$395.20
|
| Rate for Payer: AETNA Medicare |
$374.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$395.20
|
| Rate for Payer: BCBS Healthlink |
$374.40
|
| Rate for Payer: BCBS HMK CHIP |
$374.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$374.40
|
| Rate for Payer: BCBS POS |
$395.20
|
| Rate for Payer: BCBS Traditional |
$416.00
|
| Rate for Payer: CASH_PRICE |
$332.80
|
| Rate for Payer: CIGNA Commercial |
$395.20
|
| Rate for Payer: CIGNA Medicare |
$374.40
|
| Rate for Payer: HUMANA Commercial |
$374.40
|
| Rate for Payer: MEDICAID Medicaid |
$382.72
|
| Rate for Payer: MEDICARE Medicare |
$291.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$395.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$403.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$395.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$395.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$332.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$332.80
|
|
|
TR INCISION AND DRAINAGE ABCESS SIMPLE
|
Facility
IP
|
$416.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: AETNA Commercial |
$395.20
|
| Rate for Payer: AETNA Medicare |
$374.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$395.20
|
| Rate for Payer: BCBS Healthlink |
$374.40
|
| Rate for Payer: BCBS HMK CHIP |
$374.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$374.40
|
| Rate for Payer: BCBS POS |
$395.20
|
| Rate for Payer: BCBS Traditional |
$416.00
|
| Rate for Payer: CASH_PRICE |
$332.80
|
| Rate for Payer: CIGNA Commercial |
$395.20
|
| Rate for Payer: CIGNA Medicare |
$374.40
|
| Rate for Payer: HUMANA Commercial |
$374.40
|
| Rate for Payer: MEDICAID Medicaid |
$382.72
|
| Rate for Payer: MEDICARE Medicare |
$291.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$395.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$403.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$395.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$395.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$332.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$332.80
|
|
|
TR INJ TENDON SHEATH/LIGAMENT
|
Facility
IP
|
$312.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: AETNA Commercial |
$296.40
|
| Rate for Payer: AETNA Medicare |
$280.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$296.40
|
| Rate for Payer: BCBS Healthlink |
$280.80
|
| Rate for Payer: BCBS HMK CHIP |
$280.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$280.80
|
| Rate for Payer: BCBS POS |
$296.40
|
| Rate for Payer: BCBS Traditional |
$312.00
|
| Rate for Payer: CASH_PRICE |
$249.60
|
| Rate for Payer: CIGNA Commercial |
$296.40
|
| Rate for Payer: CIGNA Medicare |
$280.80
|
| Rate for Payer: HUMANA Commercial |
$280.80
|
| Rate for Payer: MEDICAID Medicaid |
$287.04
|
| Rate for Payer: MEDICARE Medicare |
$218.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$296.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$302.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$296.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$296.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$265.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$249.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$249.60
|
|
|
TR INJ TENDON SHEATH/LIGAMENT
|
Facility
OP
|
$312.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: AETNA Commercial |
$296.40
|
| Rate for Payer: AETNA Medicare |
$280.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$296.40
|
| Rate for Payer: BCBS Healthlink |
$280.80
|
| Rate for Payer: BCBS HMK CHIP |
$280.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$280.80
|
| Rate for Payer: BCBS POS |
$296.40
|
| Rate for Payer: BCBS Traditional |
$312.00
|
| Rate for Payer: CASH_PRICE |
$249.60
|
| Rate for Payer: CIGNA Commercial |
$296.40
|
| Rate for Payer: CIGNA Medicare |
$280.80
|
| Rate for Payer: HUMANA Commercial |
$280.80
|
| Rate for Payer: MEDICAID Medicaid |
$287.04
|
| Rate for Payer: MEDICARE Medicare |
$218.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$296.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$302.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$296.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$296.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$265.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$249.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$249.60
|
|
|
TR: IRRIGATION OF BLADDER
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: AETNA Commercial |
$137.75
|
| Rate for Payer: AETNA Medicare |
$130.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$137.75
|
| Rate for Payer: BCBS Healthlink |
$130.50
|
| Rate for Payer: BCBS HMK CHIP |
$130.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$130.50
|
| Rate for Payer: BCBS POS |
$137.75
|
| Rate for Payer: BCBS Traditional |
$145.00
|
| Rate for Payer: CASH_PRICE |
$116.00
|
| Rate for Payer: CIGNA Commercial |
$137.75
|
| Rate for Payer: CIGNA Medicare |
$130.50
|
| Rate for Payer: HUMANA Commercial |
$130.50
|
| Rate for Payer: MEDICAID Medicaid |
$133.40
|
| Rate for Payer: MEDICARE Medicare |
$101.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$137.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$140.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$137.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$137.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$123.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$116.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$116.00
|
|
|
TR: IRRIGATION OF BLADDER
|
Facility
IP
|
$145.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: AETNA Commercial |
$137.75
|
| Rate for Payer: AETNA Medicare |
$130.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$137.75
|
| Rate for Payer: BCBS Healthlink |
$130.50
|
| Rate for Payer: BCBS HMK CHIP |
$130.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$130.50
|
| Rate for Payer: BCBS POS |
$137.75
|
| Rate for Payer: BCBS Traditional |
$145.00
|
| Rate for Payer: CASH_PRICE |
$116.00
|
| Rate for Payer: CIGNA Commercial |
$137.75
|
| Rate for Payer: CIGNA Medicare |
$130.50
|
| Rate for Payer: HUMANA Commercial |
$130.50
|
| Rate for Payer: MEDICAID Medicaid |
$133.40
|
| Rate for Payer: MEDICARE Medicare |
$101.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$137.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$140.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$137.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$137.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$123.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$116.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$116.00
|
|
|
TR LUMBAR PUNCTURE
|
Facility
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,339.10 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: AETNA Commercial |
$1,817.35
|
| Rate for Payer: AETNA Medicare |
$1,721.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,817.35
|
| Rate for Payer: BCBS Healthlink |
$1,721.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,721.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,721.70
|
| Rate for Payer: BCBS POS |
$1,817.35
|
| Rate for Payer: BCBS Traditional |
$1,913.00
|
| Rate for Payer: CASH_PRICE |
$1,530.40
|
| Rate for Payer: CIGNA Commercial |
$1,817.35
|
| Rate for Payer: CIGNA Medicare |
$1,721.70
|
| Rate for Payer: HUMANA Commercial |
$1,721.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,759.96
|
| Rate for Payer: MEDICARE Medicare |
$1,339.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,817.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,855.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,817.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,817.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,626.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,530.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,530.40
|
|
|
TR LUMBAR PUNCTURE
|
Facility
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,339.10 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: AETNA Commercial |
$1,817.35
|
| Rate for Payer: AETNA Medicare |
$1,721.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,817.35
|
| Rate for Payer: BCBS Healthlink |
$1,721.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,721.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,721.70
|
| Rate for Payer: BCBS POS |
$1,817.35
|
| Rate for Payer: BCBS Traditional |
$1,913.00
|
| Rate for Payer: CASH_PRICE |
$1,530.40
|
| Rate for Payer: CIGNA Commercial |
$1,817.35
|
| Rate for Payer: CIGNA Medicare |
$1,721.70
|
| Rate for Payer: HUMANA Commercial |
$1,721.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,759.96
|
| Rate for Payer: MEDICARE Medicare |
$1,339.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,817.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,855.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,817.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,817.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,626.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,530.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,530.40
|
|
|
TR NEG PRESS WOUND TX </=50CM
|
Facility
IP
|
$417.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: AETNA Commercial |
$396.15
|
| Rate for Payer: AETNA Medicare |
$375.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$396.15
|
| Rate for Payer: BCBS Healthlink |
$375.30
|
| Rate for Payer: BCBS HMK CHIP |
$375.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$375.30
|
| Rate for Payer: BCBS POS |
$396.15
|
| Rate for Payer: BCBS Traditional |
$417.00
|
| Rate for Payer: CASH_PRICE |
$333.60
|
| Rate for Payer: CIGNA Commercial |
$396.15
|
| Rate for Payer: CIGNA Medicare |
$375.30
|
| Rate for Payer: HUMANA Commercial |
$375.30
|
| Rate for Payer: MEDICAID Medicaid |
$383.64
|
| Rate for Payer: MEDICARE Medicare |
$291.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$396.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$404.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$396.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$396.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$354.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$333.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$333.60
|
|
|
TR NEG PRESS WOUND TX </=50CM
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: AETNA Commercial |
$396.15
|
| Rate for Payer: AETNA Medicare |
$375.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$396.15
|
| Rate for Payer: BCBS Healthlink |
$375.30
|
| Rate for Payer: BCBS HMK CHIP |
$375.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$375.30
|
| Rate for Payer: BCBS POS |
$396.15
|
| Rate for Payer: BCBS Traditional |
$417.00
|
| Rate for Payer: CASH_PRICE |
$333.60
|
| Rate for Payer: CIGNA Commercial |
$396.15
|
| Rate for Payer: CIGNA Medicare |
$375.30
|
| Rate for Payer: HUMANA Commercial |
$375.30
|
| Rate for Payer: MEDICAID Medicaid |
$383.64
|
| Rate for Payer: MEDICARE Medicare |
$291.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$396.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$404.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$396.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$396.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$354.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$333.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$333.60
|
|
|
TR OF ANKLE FRACTURE
|
Facility
IP
|
$475.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: AETNA Commercial |
$451.25
|
| Rate for Payer: AETNA Medicare |
$427.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$451.25
|
| Rate for Payer: BCBS Healthlink |
$427.50
|
| Rate for Payer: BCBS HMK CHIP |
$427.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$427.50
|
| Rate for Payer: BCBS POS |
$451.25
|
| Rate for Payer: BCBS Traditional |
$475.00
|
| Rate for Payer: CASH_PRICE |
$380.00
|
| Rate for Payer: CIGNA Commercial |
$451.25
|
| Rate for Payer: CIGNA Medicare |
$427.50
|
| Rate for Payer: HUMANA Commercial |
$427.50
|
| Rate for Payer: MEDICAID Medicaid |
$437.00
|
| Rate for Payer: MEDICARE Medicare |
$332.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$451.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$460.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$451.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$451.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$380.00
|
|
|
TR OF ANKLE FRACTURE
|
Facility
OP
|
$475.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: AETNA Commercial |
$451.25
|
| Rate for Payer: AETNA Medicare |
$427.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$451.25
|
| Rate for Payer: BCBS Healthlink |
$427.50
|
| Rate for Payer: BCBS HMK CHIP |
$427.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$427.50
|
| Rate for Payer: BCBS POS |
$451.25
|
| Rate for Payer: BCBS Traditional |
$475.00
|
| Rate for Payer: CASH_PRICE |
$380.00
|
| Rate for Payer: CIGNA Commercial |
$451.25
|
| Rate for Payer: CIGNA Medicare |
$427.50
|
| Rate for Payer: HUMANA Commercial |
$427.50
|
| Rate for Payer: MEDICAID Medicaid |
$437.00
|
| Rate for Payer: MEDICARE Medicare |
$332.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$451.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$460.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$451.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$451.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$380.00
|
|
|
TROPONIN I, HIGH SENSITIVITY
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
TROPONIN I, HIGH SENSITIVITY
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
TR REMOVE FOREIGN BODY FROM EAR
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: AETNA Commercial |
$114.00
|
| Rate for Payer: AETNA Medicare |
$108.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.00
|
| Rate for Payer: BCBS Healthlink |
$108.00
|
| Rate for Payer: BCBS HMK CHIP |
$108.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.00
|
| Rate for Payer: BCBS POS |
$114.00
|
| Rate for Payer: BCBS Traditional |
$120.00
|
| Rate for Payer: CASH_PRICE |
$96.00
|
| Rate for Payer: CIGNA Commercial |
$114.00
|
| Rate for Payer: CIGNA Medicare |
$108.00
|
| Rate for Payer: HUMANA Commercial |
$108.00
|
| Rate for Payer: MEDICAID Medicaid |
$110.40
|
| Rate for Payer: MEDICARE Medicare |
$84.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$116.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.00
|
|
|
TR REMOVE FOREIGN BODY FROM EAR
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: AETNA Commercial |
$114.00
|
| Rate for Payer: AETNA Medicare |
$108.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.00
|
| Rate for Payer: BCBS Healthlink |
$108.00
|
| Rate for Payer: BCBS HMK CHIP |
$108.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.00
|
| Rate for Payer: BCBS POS |
$114.00
|
| Rate for Payer: BCBS Traditional |
$120.00
|
| Rate for Payer: CASH_PRICE |
$96.00
|
| Rate for Payer: CIGNA Commercial |
$114.00
|
| Rate for Payer: CIGNA Medicare |
$108.00
|
| Rate for Payer: HUMANA Commercial |
$108.00
|
| Rate for Payer: MEDICAID Medicaid |
$110.40
|
| Rate for Payer: MEDICARE Medicare |
$84.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$116.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.00
|
|
|
TR REMOVE IMPACTED CERUMEN
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
TR REMOVE IMPACTED CERUMEN
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
TR REMOVE IMPACTED EAR WAX/INST
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: AETNA Commercial |
$114.00
|
| Rate for Payer: AETNA Medicare |
$108.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.00
|
| Rate for Payer: BCBS Healthlink |
$108.00
|
| Rate for Payer: BCBS HMK CHIP |
$108.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.00
|
| Rate for Payer: BCBS POS |
$114.00
|
| Rate for Payer: BCBS Traditional |
$120.00
|
| Rate for Payer: CASH_PRICE |
$96.00
|
| Rate for Payer: CIGNA Commercial |
$114.00
|
| Rate for Payer: CIGNA Medicare |
$108.00
|
| Rate for Payer: HUMANA Commercial |
$108.00
|
| Rate for Payer: MEDICAID Medicaid |
$110.40
|
| Rate for Payer: MEDICARE Medicare |
$84.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$116.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.00
|
|
|
TR REMOVE IMPACTED EAR WAX/INST
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: AETNA Commercial |
$114.00
|
| Rate for Payer: AETNA Medicare |
$108.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.00
|
| Rate for Payer: BCBS Healthlink |
$108.00
|
| Rate for Payer: BCBS HMK CHIP |
$108.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.00
|
| Rate for Payer: BCBS POS |
$114.00
|
| Rate for Payer: BCBS Traditional |
$120.00
|
| Rate for Payer: CASH_PRICE |
$96.00
|
| Rate for Payer: CIGNA Commercial |
$114.00
|
| Rate for Payer: CIGNA Medicare |
$108.00
|
| Rate for Payer: HUMANA Commercial |
$108.00
|
| Rate for Payer: MEDICAID Medicaid |
$110.40
|
| Rate for Payer: MEDICARE Medicare |
$84.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$116.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.00
|
|
|
TRUMENBA MEN B
|
Facility
OP
|
$569.00
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: AETNA Commercial |
$540.55
|
| Rate for Payer: AETNA Medicare |
$512.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$540.55
|
| Rate for Payer: BCBS Healthlink |
$512.10
|
| Rate for Payer: BCBS HMK CHIP |
$512.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$512.10
|
| Rate for Payer: BCBS POS |
$540.55
|
| Rate for Payer: BCBS Traditional |
$569.00
|
| Rate for Payer: CASH_PRICE |
$455.20
|
| Rate for Payer: CIGNA Commercial |
$540.55
|
| Rate for Payer: CIGNA Medicare |
$512.10
|
| Rate for Payer: HUMANA Commercial |
$512.10
|
| Rate for Payer: MEDICAID Medicaid |
$523.48
|
| Rate for Payer: MEDICARE Medicare |
$398.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$540.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$551.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$540.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$540.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$483.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$455.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$455.20
|
|
|
TRUMENBA MEN B
|
Facility
IP
|
$569.00
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: AETNA Commercial |
$540.55
|
| Rate for Payer: AETNA Medicare |
$512.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$540.55
|
| Rate for Payer: BCBS Healthlink |
$512.10
|
| Rate for Payer: BCBS HMK CHIP |
$512.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$512.10
|
| Rate for Payer: BCBS POS |
$540.55
|
| Rate for Payer: BCBS Traditional |
$569.00
|
| Rate for Payer: CASH_PRICE |
$455.20
|
| Rate for Payer: CIGNA Commercial |
$540.55
|
| Rate for Payer: CIGNA Medicare |
$512.10
|
| Rate for Payer: HUMANA Commercial |
$512.10
|
| Rate for Payer: MEDICAID Medicaid |
$523.48
|
| Rate for Payer: MEDICARE Medicare |
$398.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$540.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$551.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$540.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$540.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$483.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$455.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$455.20
|
|
|
TRYPTASE (004280)
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
TRYPTASE (004280)
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
