|
CREATININE
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
CREATININE
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
CREATININE, 24 HOUR URINE
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
CREATININE, 24 HOUR URINE
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
CREATININE CLEARANCE (003004)
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
CREATININE CLEARANCE (003004)
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
.CREATININE, URINE, RANDOM
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
.CREATININE, URINE, RANDOM
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
.CREATININE, URINE, RANDOM (LABCORP)
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: AETNA Commercial |
$11.40
|
| Rate for Payer: AETNA Medicare |
$10.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.40
|
| Rate for Payer: BCBS Healthlink |
$10.80
|
| Rate for Payer: BCBS HMK CHIP |
$10.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10.80
|
| Rate for Payer: BCBS POS |
$11.40
|
| Rate for Payer: BCBS Traditional |
$12.00
|
| Rate for Payer: CASH_PRICE |
$9.60
|
| Rate for Payer: CIGNA Commercial |
$11.40
|
| Rate for Payer: CIGNA Medicare |
$10.80
|
| Rate for Payer: HUMANA Commercial |
$10.80
|
| Rate for Payer: MEDICAID Medicaid |
$11.04
|
| Rate for Payer: MEDICARE Medicare |
$8.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.60
|
|
|
.CREATININE, URINE, RANDOM (LABCORP)
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: BCBS HMK CHIP |
$10.80
|
| Rate for Payer: AETNA Commercial |
$11.40
|
| Rate for Payer: AETNA Medicare |
$10.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.40
|
| Rate for Payer: BCBS Healthlink |
$10.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10.80
|
| Rate for Payer: BCBS POS |
$11.40
|
| Rate for Payer: BCBS Traditional |
$12.00
|
| Rate for Payer: CASH_PRICE |
$9.60
|
| Rate for Payer: CIGNA Commercial |
$11.40
|
| Rate for Payer: CIGNA Medicare |
$10.80
|
| Rate for Payer: HUMANA Commercial |
$10.80
|
| Rate for Payer: MEDICAID Medicaid |
$11.04
|
| Rate for Payer: MEDICARE Medicare |
$8.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.60
|
|
|
CRITICAL CARE 1ST HOUR
|
Facility
OP
|
$2,490.00
|
|
|
Service Code
|
CPT 99291 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,743.00 |
| Max. Negotiated Rate |
$2,490.00 |
| Rate for Payer: AETNA Commercial |
$2,365.50
|
| Rate for Payer: AETNA Medicare |
$2,241.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,365.50
|
| Rate for Payer: BCBS Healthlink |
$2,241.00
|
| Rate for Payer: BCBS HMK CHIP |
$2,241.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,241.00
|
| Rate for Payer: BCBS POS |
$2,365.50
|
| Rate for Payer: BCBS Traditional |
$2,490.00
|
| Rate for Payer: CASH_PRICE |
$1,992.00
|
| Rate for Payer: CIGNA Commercial |
$2,365.50
|
| Rate for Payer: CIGNA Medicare |
$2,241.00
|
| Rate for Payer: HUMANA Commercial |
$2,241.00
|
| Rate for Payer: MEDICAID Medicaid |
$2,290.80
|
| Rate for Payer: MEDICARE Medicare |
$1,743.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,365.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,415.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,365.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,365.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,116.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,992.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,992.00
|
|
|
CRITICAL CARE 1ST HOUR
|
Facility
IP
|
$2,490.00
|
|
|
Service Code
|
CPT 99291 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,743.00 |
| Max. Negotiated Rate |
$2,490.00 |
| Rate for Payer: AETNA Commercial |
$2,365.50
|
| Rate for Payer: AETNA Medicare |
$2,241.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,365.50
|
| Rate for Payer: BCBS Healthlink |
$2,241.00
|
| Rate for Payer: BCBS HMK CHIP |
$2,241.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,241.00
|
| Rate for Payer: BCBS POS |
$2,365.50
|
| Rate for Payer: BCBS Traditional |
$2,490.00
|
| Rate for Payer: CASH_PRICE |
$1,992.00
|
| Rate for Payer: CIGNA Commercial |
$2,365.50
|
| Rate for Payer: CIGNA Medicare |
$2,241.00
|
| Rate for Payer: HUMANA Commercial |
$2,241.00
|
| Rate for Payer: MEDICAID Medicaid |
$2,290.80
|
| Rate for Payer: MEDICARE Medicare |
$1,743.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,365.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,415.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,365.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,365.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,116.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,992.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,992.00
|
|
|
CRITICAL CARE (EA 1/2 HR)
|
Facility
OP
|
$628.00
|
|
|
Service Code
|
CPT 99292 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: AETNA Commercial |
$596.60
|
| Rate for Payer: AETNA Medicare |
$565.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$596.60
|
| Rate for Payer: BCBS Healthlink |
$565.20
|
| Rate for Payer: BCBS HMK CHIP |
$565.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$565.20
|
| Rate for Payer: BCBS POS |
$596.60
|
| Rate for Payer: BCBS Traditional |
$628.00
|
| Rate for Payer: CASH_PRICE |
$502.40
|
| Rate for Payer: CIGNA Commercial |
$596.60
|
| Rate for Payer: CIGNA Medicare |
$565.20
|
| Rate for Payer: HUMANA Commercial |
$565.20
|
| Rate for Payer: MEDICAID Medicaid |
$577.76
|
| Rate for Payer: MEDICARE Medicare |
$439.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$596.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$609.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$596.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$596.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$533.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$502.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$502.40
|
|
|
CRITICAL CARE (EA 1/2 HR)
|
Facility
IP
|
$628.00
|
|
|
Service Code
|
CPT 99292 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: BCBS HMK CHIP |
$565.20
|
| Rate for Payer: AETNA Commercial |
$596.60
|
| Rate for Payer: AETNA Medicare |
$565.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$596.60
|
| Rate for Payer: BCBS Healthlink |
$565.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$565.20
|
| Rate for Payer: BCBS POS |
$596.60
|
| Rate for Payer: BCBS Traditional |
$628.00
|
| Rate for Payer: CASH_PRICE |
$502.40
|
| Rate for Payer: CIGNA Commercial |
$596.60
|
| Rate for Payer: CIGNA Medicare |
$565.20
|
| Rate for Payer: HUMANA Commercial |
$565.20
|
| Rate for Payer: MEDICAID Medicaid |
$577.76
|
| Rate for Payer: MEDICARE Medicare |
$439.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$596.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$609.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$596.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$596.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$533.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$502.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$502.40
|
|
|
CRP HIGH SENSITIVITY (120766)
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
CRP HIGH SENSITIVITY (120766)
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
CRUTCH ADULT 5'1-5'9
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
CRUTCH ADULT 5'1-5'9
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
CRUTCH ADULT TALL 5'10"
|
Facility
OP
|
$95.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
CRUTCH ADULT TALL 5'10"
|
Facility
IP
|
$95.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
CRUTCH DRESSED CHILD
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
CRUTCH DRESSED CHILD
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
CRUTCH YOUTH 4'6 - 5'2
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: AETNA Commercial |
$62.70
|
| Rate for Payer: AETNA Medicare |
$59.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$62.70
|
| Rate for Payer: BCBS Healthlink |
$59.40
|
| Rate for Payer: BCBS HMK CHIP |
$59.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$59.40
|
| Rate for Payer: BCBS POS |
$62.70
|
| Rate for Payer: BCBS Traditional |
$66.00
|
| Rate for Payer: CASH_PRICE |
$52.80
|
| Rate for Payer: CIGNA Commercial |
$62.70
|
| Rate for Payer: CIGNA Medicare |
$59.40
|
| Rate for Payer: HUMANA Commercial |
$59.40
|
| Rate for Payer: MEDICAID Medicaid |
$60.72
|
| Rate for Payer: MEDICARE Medicare |
$46.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$62.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$62.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$62.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.80
|
|
|
CRUTCH YOUTH 4'6 - 5'2
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT E0116
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: BCBS HMK CHIP |
$59.40
|
| Rate for Payer: AETNA Commercial |
$62.70
|
| Rate for Payer: AETNA Medicare |
$59.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$62.70
|
| Rate for Payer: BCBS Healthlink |
$59.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$59.40
|
| Rate for Payer: BCBS POS |
$62.70
|
| Rate for Payer: BCBS Traditional |
$66.00
|
| Rate for Payer: CASH_PRICE |
$52.80
|
| Rate for Payer: CIGNA Commercial |
$62.70
|
| Rate for Payer: CIGNA Medicare |
$59.40
|
| Rate for Payer: HUMANA Commercial |
$59.40
|
| Rate for Payer: MEDICAID Medicaid |
$60.72
|
| Rate for Payer: MEDICARE Medicare |
$46.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$62.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$62.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$62.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.80
|
|
|
CRYOTHERAPY ACNE
|
Facility
IP
|
$185.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
