|
COMPLEMENT, TOTAL (001941)
|
Facility
IP
|
$16.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
COMPLEMENT, TOTAL (001941)
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
.COMPLETE BLOOD COUNT, WITH AUTO DIFF
|
Facility
IP
|
$107.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: AETNA Commercial |
$101.65
|
| Rate for Payer: AETNA Medicare |
$96.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$101.65
|
| Rate for Payer: BCBS Healthlink |
$96.30
|
| Rate for Payer: BCBS HMK CHIP |
$96.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$96.30
|
| Rate for Payer: BCBS POS |
$101.65
|
| Rate for Payer: BCBS Traditional |
$107.00
|
| Rate for Payer: CASH_PRICE |
$85.60
|
| Rate for Payer: CIGNA Commercial |
$101.65
|
| Rate for Payer: CIGNA Medicare |
$96.30
|
| Rate for Payer: HUMANA Commercial |
$96.30
|
| Rate for Payer: MEDICAID Medicaid |
$98.44
|
| Rate for Payer: MEDICARE Medicare |
$74.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$101.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$103.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$101.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$101.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$85.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$85.60
|
|
|
.COMPLETE BLOOD COUNT, WITH AUTO DIFF
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$107.00 |
| Rate for Payer: AETNA Commercial |
$101.65
|
| Rate for Payer: AETNA Medicare |
$96.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$101.65
|
| Rate for Payer: BCBS Healthlink |
$96.30
|
| Rate for Payer: BCBS HMK CHIP |
$96.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$96.30
|
| Rate for Payer: BCBS POS |
$101.65
|
| Rate for Payer: BCBS Traditional |
$107.00
|
| Rate for Payer: CASH_PRICE |
$85.60
|
| Rate for Payer: CIGNA Commercial |
$101.65
|
| Rate for Payer: CIGNA Medicare |
$96.30
|
| Rate for Payer: HUMANA Commercial |
$96.30
|
| Rate for Payer: MEDICAID Medicaid |
$98.44
|
| Rate for Payer: MEDICARE Medicare |
$74.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$101.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$103.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$101.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$101.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$85.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$85.60
|
|
|
.COMPLETE BLOOD COUNT, WITHOUT DIFF
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: BCBS HMK CHIP |
$79.20
|
| Rate for Payer: AETNA Commercial |
$83.60
|
| Rate for Payer: AETNA Medicare |
$79.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$83.60
|
| Rate for Payer: BCBS Healthlink |
$79.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$79.20
|
| Rate for Payer: BCBS POS |
$83.60
|
| Rate for Payer: BCBS Traditional |
$88.00
|
| Rate for Payer: CASH_PRICE |
$70.40
|
| Rate for Payer: CIGNA Commercial |
$83.60
|
| Rate for Payer: CIGNA Medicare |
$79.20
|
| Rate for Payer: HUMANA Commercial |
$79.20
|
| Rate for Payer: MEDICAID Medicaid |
$80.96
|
| Rate for Payer: MEDICARE Medicare |
$61.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$83.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$85.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$83.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$83.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$74.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$70.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$70.40
|
|
|
.COMPLETE BLOOD COUNT, WITHOUT DIFF
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: AETNA Commercial |
$83.60
|
| Rate for Payer: AETNA Medicare |
$79.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$83.60
|
| Rate for Payer: BCBS Healthlink |
$79.20
|
| Rate for Payer: BCBS HMK CHIP |
$79.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$79.20
|
| Rate for Payer: BCBS POS |
$83.60
|
| Rate for Payer: BCBS Traditional |
$88.00
|
| Rate for Payer: CASH_PRICE |
$70.40
|
| Rate for Payer: CIGNA Commercial |
$83.60
|
| Rate for Payer: CIGNA Medicare |
$79.20
|
| Rate for Payer: HUMANA Commercial |
$79.20
|
| Rate for Payer: MEDICAID Medicaid |
$80.96
|
| Rate for Payer: MEDICARE Medicare |
$61.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$83.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$85.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$83.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$83.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$74.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$70.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$70.40
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: AETNA Commercial |
$204.25
|
| Rate for Payer: AETNA Medicare |
$193.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$204.25
|
| Rate for Payer: BCBS Healthlink |
$193.50
|
| Rate for Payer: BCBS HMK CHIP |
$193.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$193.50
|
| Rate for Payer: BCBS POS |
$204.25
|
| Rate for Payer: BCBS Traditional |
$215.00
|
| Rate for Payer: CASH_PRICE |
$172.00
|
| Rate for Payer: CIGNA Commercial |
$204.25
|
| Rate for Payer: CIGNA Medicare |
$193.50
|
| Rate for Payer: HUMANA Commercial |
$193.50
|
| Rate for Payer: MEDICAID Medicaid |
$197.80
|
| Rate for Payer: MEDICARE Medicare |
$150.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$204.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$208.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$204.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$204.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$182.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$172.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$172.00
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: AETNA Commercial |
$204.25
|
| Rate for Payer: AETNA Medicare |
$193.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$204.25
|
| Rate for Payer: BCBS Healthlink |
$193.50
|
| Rate for Payer: BCBS HMK CHIP |
$193.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$193.50
|
| Rate for Payer: BCBS POS |
$204.25
|
| Rate for Payer: BCBS Traditional |
$215.00
|
| Rate for Payer: CASH_PRICE |
$172.00
|
| Rate for Payer: CIGNA Commercial |
$204.25
|
| Rate for Payer: CIGNA Medicare |
$193.50
|
| Rate for Payer: HUMANA Commercial |
$193.50
|
| Rate for Payer: MEDICAID Medicaid |
$197.80
|
| Rate for Payer: MEDICARE Medicare |
$150.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$204.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$208.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$204.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$204.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$182.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$172.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$172.00
|
|
|
.CONCENTRATION INFECTIOUS AGENT
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
.CONCENTRATION INFECTIOUS AGENT
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
CONSULTATION L1/NEW-ESTABLISHED PT
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
CONSULTATION L1/NEW-ESTABLISHED PT
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
CONSULTATION L2/NEW-ESTABLISHED PATIENT
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
CONSULTATION L2/NEW-ESTABLISHED PATIENT
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
CONSULTATION L3/NEW-ESTABLISHED PATIENT
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
CONSULTATION L3/NEW-ESTABLISHED PATIENT
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
CONSULTATION L4 NEW/ESTAB.PATIENT
|
Facility
IP
|
$393.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$275.10 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: AETNA Commercial |
$373.35
|
| Rate for Payer: AETNA Medicare |
$353.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$373.35
|
| Rate for Payer: BCBS Healthlink |
$353.70
|
| Rate for Payer: BCBS HMK CHIP |
$353.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$353.70
|
| Rate for Payer: BCBS POS |
$373.35
|
| Rate for Payer: BCBS Traditional |
$393.00
|
| Rate for Payer: CASH_PRICE |
$314.40
|
| Rate for Payer: CIGNA Commercial |
$373.35
|
| Rate for Payer: CIGNA Medicare |
$353.70
|
| Rate for Payer: HUMANA Commercial |
$353.70
|
| Rate for Payer: MEDICAID Medicaid |
$361.56
|
| Rate for Payer: MEDICARE Medicare |
$275.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$373.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$381.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$373.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$373.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$334.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$314.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$314.40
|
|
|
CONSULTATION L4 NEW/ESTAB.PATIENT
|
Facility
OP
|
$393.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$275.10 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: AETNA Commercial |
$373.35
|
| Rate for Payer: AETNA Medicare |
$353.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$373.35
|
| Rate for Payer: BCBS Healthlink |
$353.70
|
| Rate for Payer: BCBS HMK CHIP |
$353.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$353.70
|
| Rate for Payer: BCBS POS |
$373.35
|
| Rate for Payer: BCBS Traditional |
$393.00
|
| Rate for Payer: CASH_PRICE |
$314.40
|
| Rate for Payer: CIGNA Commercial |
$373.35
|
| Rate for Payer: CIGNA Medicare |
$353.70
|
| Rate for Payer: HUMANA Commercial |
$353.70
|
| Rate for Payer: MEDICAID Medicaid |
$361.56
|
| Rate for Payer: MEDICARE Medicare |
$275.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$373.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$381.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$373.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$373.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$334.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$314.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$314.40
|
|
|
CONSULTATION L5 COMPREH/NEW-ESTABLISH PT
|
Facility
IP
|
$481.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: BCBS HMK CHIP |
$432.90
|
| Rate for Payer: AETNA Commercial |
$456.95
|
| Rate for Payer: AETNA Medicare |
$432.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$456.95
|
| Rate for Payer: BCBS Healthlink |
$432.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$432.90
|
| Rate for Payer: BCBS POS |
$456.95
|
| Rate for Payer: BCBS Traditional |
$481.00
|
| Rate for Payer: CASH_PRICE |
$384.80
|
| Rate for Payer: CIGNA Commercial |
$456.95
|
| Rate for Payer: CIGNA Medicare |
$432.90
|
| Rate for Payer: HUMANA Commercial |
$432.90
|
| Rate for Payer: MEDICAID Medicaid |
$442.52
|
| Rate for Payer: MEDICARE Medicare |
$336.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$456.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$466.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$456.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$456.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$408.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$384.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$384.80
|
|
|
CONSULTATION L5 COMPREH/NEW-ESTABLISH PT
|
Facility
OP
|
$481.00
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: AETNA Commercial |
$456.95
|
| Rate for Payer: AETNA Medicare |
$432.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$456.95
|
| Rate for Payer: BCBS Healthlink |
$432.90
|
| Rate for Payer: BCBS HMK CHIP |
$432.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$432.90
|
| Rate for Payer: BCBS POS |
$456.95
|
| Rate for Payer: BCBS Traditional |
$481.00
|
| Rate for Payer: CASH_PRICE |
$384.80
|
| Rate for Payer: CIGNA Commercial |
$456.95
|
| Rate for Payer: CIGNA Medicare |
$432.90
|
| Rate for Payer: HUMANA Commercial |
$432.90
|
| Rate for Payer: MEDICAID Medicaid |
$442.52
|
| Rate for Payer: MEDICARE Medicare |
$336.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$456.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$466.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$456.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$456.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$408.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$384.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$384.80
|
|
|
CONTROL NASAL HEMORRHAGE SIMPLE
|
Facility
OP
|
$309.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: AETNA Commercial |
$293.55
|
| Rate for Payer: AETNA Medicare |
$278.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$293.55
|
| Rate for Payer: BCBS Healthlink |
$278.10
|
| Rate for Payer: BCBS HMK CHIP |
$278.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$278.10
|
| Rate for Payer: BCBS POS |
$293.55
|
| Rate for Payer: BCBS Traditional |
$309.00
|
| Rate for Payer: CASH_PRICE |
$247.20
|
| Rate for Payer: CIGNA Commercial |
$293.55
|
| Rate for Payer: CIGNA Medicare |
$278.10
|
| Rate for Payer: HUMANA Commercial |
$278.10
|
| Rate for Payer: MEDICAID Medicaid |
$284.28
|
| Rate for Payer: MEDICARE Medicare |
$216.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$293.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$299.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$293.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$293.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$262.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$247.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$247.20
|
|
|
CONTROL NASAL HEMORRHAGE SIMPLE
|
Facility
IP
|
$309.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: AETNA Commercial |
$293.55
|
| Rate for Payer: AETNA Medicare |
$278.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$293.55
|
| Rate for Payer: BCBS Healthlink |
$278.10
|
| Rate for Payer: BCBS HMK CHIP |
$278.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$278.10
|
| Rate for Payer: BCBS POS |
$293.55
|
| Rate for Payer: BCBS Traditional |
$309.00
|
| Rate for Payer: CASH_PRICE |
$247.20
|
| Rate for Payer: CIGNA Commercial |
$293.55
|
| Rate for Payer: CIGNA Medicare |
$278.10
|
| Rate for Payer: HUMANA Commercial |
$278.10
|
| Rate for Payer: MEDICAID Medicaid |
$284.28
|
| Rate for Payer: MEDICARE Medicare |
$216.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$293.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$299.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$293.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$293.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$262.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$247.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$247.20
|
|
|
COPPER (001586)
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 82525
|
| 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
|
|
|
COPPER (001586)
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| 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 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
|
|
|
.COPPER, URINE
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
