|
CYTP CERV/VAG AUTO THIN LAYER PREP MNL S
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: AETNA Commercial |
$164.35
|
| Rate for Payer: AETNA Medicare |
$155.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$164.35
|
| Rate for Payer: BCBS Healthlink |
$155.70
|
| Rate for Payer: BCBS HMK CHIP |
$155.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$155.70
|
| Rate for Payer: BCBS POS |
$164.35
|
| Rate for Payer: BCBS Traditional |
$173.00
|
| Rate for Payer: CASH_PRICE |
$138.40
|
| Rate for Payer: CIGNA Commercial |
$164.35
|
| Rate for Payer: CIGNA Medicare |
$155.70
|
| Rate for Payer: HUMANA Commercial |
$155.70
|
| Rate for Payer: MEDICAID Medicaid |
$159.16
|
| Rate for Payer: MEDICARE Medicare |
$121.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$164.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$167.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$164.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$164.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$147.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$138.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$138.40
|
|
|
D50W 50% INJ SYR [50 ML]
|
Facility
IP
|
$41.00
|
|
|
Service Code
|
CPT J7799
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
D50W 50% INJ SYR [50 ML]
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT J7799
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
DAKIN'S SOLUTION 0.25%
|
Facility
IP
|
$44.35
|
|
| Hospital Charge Code |
20230119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$44.35 |
| Rate for Payer: BCBS HMK CHIP |
$39.91
|
| Rate for Payer: AETNA Commercial |
$42.13
|
| Rate for Payer: AETNA Medicare |
$39.91
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.13
|
| Rate for Payer: BCBS Healthlink |
$39.91
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.91
|
| Rate for Payer: BCBS POS |
$42.13
|
| Rate for Payer: BCBS Traditional |
$44.35
|
| Rate for Payer: CASH_PRICE |
$35.48
|
| Rate for Payer: CIGNA Commercial |
$42.13
|
| Rate for Payer: CIGNA Medicare |
$39.91
|
| Rate for Payer: HUMANA Commercial |
$39.91
|
| Rate for Payer: MEDICAID Medicaid |
$40.80
|
| Rate for Payer: MEDICARE Medicare |
$31.04
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.13
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.13
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.13
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.48
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.48
|
|
|
DAKIN'S SOLUTION 0.25%
|
Facility
OP
|
$44.35
|
|
| Hospital Charge Code |
20230119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$44.35 |
| Rate for Payer: AETNA Commercial |
$42.13
|
| Rate for Payer: AETNA Medicare |
$39.91
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.13
|
| Rate for Payer: BCBS Healthlink |
$39.91
|
| Rate for Payer: BCBS HMK CHIP |
$39.91
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.91
|
| Rate for Payer: BCBS POS |
$42.13
|
| Rate for Payer: BCBS Traditional |
$44.35
|
| Rate for Payer: CASH_PRICE |
$35.48
|
| Rate for Payer: CIGNA Commercial |
$42.13
|
| Rate for Payer: CIGNA Medicare |
$39.91
|
| Rate for Payer: HUMANA Commercial |
$39.91
|
| Rate for Payer: MEDICAID Medicaid |
$40.80
|
| Rate for Payer: MEDICARE Medicare |
$31.04
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.13
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.13
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.13
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.48
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.48
|
|
|
DAPTOMYCIN 500MG INJ
|
Facility
OP
|
$230.40
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
20230315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.28 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: AETNA Commercial |
$218.88
|
| Rate for Payer: AETNA Medicare |
$207.36
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$218.88
|
| Rate for Payer: BCBS Healthlink |
$207.36
|
| Rate for Payer: BCBS HMK CHIP |
$207.36
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$207.36
|
| Rate for Payer: BCBS POS |
$218.88
|
| Rate for Payer: BCBS Traditional |
$230.40
|
| Rate for Payer: CASH_PRICE |
$184.32
|
| Rate for Payer: CIGNA Commercial |
$218.88
|
| Rate for Payer: CIGNA Medicare |
$207.36
|
| Rate for Payer: HUMANA Commercial |
$207.36
|
| Rate for Payer: MEDICAID Medicaid |
$211.97
|
| Rate for Payer: MEDICARE Medicare |
$161.28
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$218.88
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$223.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$218.88
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$218.88
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$195.84
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$184.32
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$184.32
|
|
|
DAPTOMYCIN 500MG INJ
|
Facility
IP
|
$230.40
|
|
|
Service Code
|
CPT J0878
|
| Hospital Charge Code |
20230315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.28 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: AETNA Commercial |
$218.88
|
| Rate for Payer: AETNA Medicare |
$207.36
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$218.88
|
| Rate for Payer: BCBS Healthlink |
$207.36
|
| Rate for Payer: BCBS HMK CHIP |
$207.36
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$207.36
|
| Rate for Payer: BCBS POS |
$218.88
|
| Rate for Payer: BCBS Traditional |
$230.40
|
| Rate for Payer: CASH_PRICE |
$184.32
|
| Rate for Payer: CIGNA Commercial |
$218.88
|
| Rate for Payer: CIGNA Medicare |
$207.36
|
| Rate for Payer: HUMANA Commercial |
$207.36
|
| Rate for Payer: MEDICAID Medicaid |
$211.97
|
| Rate for Payer: MEDICARE Medicare |
$161.28
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$218.88
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$223.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$218.88
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$218.88
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$195.84
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$184.32
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$184.32
|
|
|
D-DIMER
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: BCBS HMK CHIP |
$156.60
|
| Rate for Payer: AETNA Commercial |
$165.30
|
| Rate for Payer: AETNA Medicare |
$156.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$165.30
|
| Rate for Payer: BCBS Healthlink |
$156.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$156.60
|
| Rate for Payer: BCBS POS |
$165.30
|
| Rate for Payer: BCBS Traditional |
$174.00
|
| Rate for Payer: CASH_PRICE |
$139.20
|
| Rate for Payer: CIGNA Commercial |
$165.30
|
| Rate for Payer: CIGNA Medicare |
$156.60
|
| Rate for Payer: HUMANA Commercial |
$156.60
|
| Rate for Payer: MEDICAID Medicaid |
$160.08
|
| Rate for Payer: MEDICARE Medicare |
$121.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$165.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$168.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$165.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$165.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$147.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$139.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$139.20
|
|
|
D-DIMER
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: AETNA Commercial |
$165.30
|
| Rate for Payer: AETNA Medicare |
$156.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$165.30
|
| Rate for Payer: BCBS Healthlink |
$156.60
|
| Rate for Payer: BCBS HMK CHIP |
$156.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$156.60
|
| Rate for Payer: BCBS POS |
$165.30
|
| Rate for Payer: BCBS Traditional |
$174.00
|
| Rate for Payer: CASH_PRICE |
$139.20
|
| Rate for Payer: CIGNA Commercial |
$165.30
|
| Rate for Payer: CIGNA Medicare |
$156.60
|
| Rate for Payer: HUMANA Commercial |
$156.60
|
| Rate for Payer: MEDICAID Medicaid |
$160.08
|
| Rate for Payer: MEDICARE Medicare |
$121.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$165.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$168.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$165.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$165.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$147.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$139.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$139.20
|
|
|
DEBRIDE/DRESS BURN >5%
|
Facility
OP
|
$365.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: AETNA Commercial |
$346.75
|
| Rate for Payer: AETNA Medicare |
$328.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$346.75
|
| Rate for Payer: BCBS Healthlink |
$328.50
|
| Rate for Payer: BCBS HMK CHIP |
$328.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$328.50
|
| Rate for Payer: BCBS POS |
$346.75
|
| Rate for Payer: BCBS Traditional |
$365.00
|
| Rate for Payer: CASH_PRICE |
$292.00
|
| Rate for Payer: CIGNA Commercial |
$346.75
|
| Rate for Payer: CIGNA Medicare |
$328.50
|
| Rate for Payer: HUMANA Commercial |
$328.50
|
| Rate for Payer: MEDICAID Medicaid |
$335.80
|
| Rate for Payer: MEDICARE Medicare |
$255.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$346.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$354.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$346.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$346.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$310.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$292.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$292.00
|
|
|
DEBRIDE/DRESS BURN >5%
|
Facility
IP
|
$365.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: AETNA Commercial |
$346.75
|
| Rate for Payer: AETNA Medicare |
$328.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$346.75
|
| Rate for Payer: BCBS Healthlink |
$328.50
|
| Rate for Payer: BCBS HMK CHIP |
$328.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$328.50
|
| Rate for Payer: BCBS POS |
$346.75
|
| Rate for Payer: BCBS Traditional |
$365.00
|
| Rate for Payer: CASH_PRICE |
$292.00
|
| Rate for Payer: CIGNA Commercial |
$346.75
|
| Rate for Payer: CIGNA Medicare |
$328.50
|
| Rate for Payer: HUMANA Commercial |
$328.50
|
| Rate for Payer: MEDICAID Medicaid |
$335.80
|
| Rate for Payer: MEDICARE Medicare |
$255.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$346.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$354.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$346.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$346.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$310.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$292.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$292.00
|
|
|
DEBRIDEMENT 20CM OR LESS
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
DEBRIDEMENT 20CM OR LESS
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
DEBRIDEMENT, MUSCLE/FASCIA, FIRST 20CM
|
Facility
IP
|
$505.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$353.50 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: BCBS HMK CHIP |
$454.50
|
| Rate for Payer: AETNA Commercial |
$479.75
|
| Rate for Payer: AETNA Medicare |
$454.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$479.75
|
| Rate for Payer: BCBS Healthlink |
$454.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$454.50
|
| Rate for Payer: BCBS POS |
$479.75
|
| Rate for Payer: BCBS Traditional |
$505.00
|
| Rate for Payer: CASH_PRICE |
$404.00
|
| Rate for Payer: CIGNA Commercial |
$479.75
|
| Rate for Payer: CIGNA Medicare |
$454.50
|
| Rate for Payer: HUMANA Commercial |
$454.50
|
| Rate for Payer: MEDICAID Medicaid |
$464.60
|
| Rate for Payer: MEDICARE Medicare |
$353.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$479.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$489.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$479.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$479.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$429.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$404.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$404.00
|
|
|
DEBRIDEMENT, MUSCLE/FASCIA, FIRST 20CM
|
Facility
OP
|
$505.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$353.50 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: AETNA Commercial |
$479.75
|
| Rate for Payer: AETNA Medicare |
$454.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$479.75
|
| Rate for Payer: BCBS Healthlink |
$454.50
|
| Rate for Payer: BCBS HMK CHIP |
$454.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$454.50
|
| Rate for Payer: BCBS POS |
$479.75
|
| Rate for Payer: BCBS Traditional |
$505.00
|
| Rate for Payer: CASH_PRICE |
$404.00
|
| Rate for Payer: CIGNA Commercial |
$479.75
|
| Rate for Payer: CIGNA Medicare |
$454.50
|
| Rate for Payer: HUMANA Commercial |
$454.50
|
| Rate for Payer: MEDICAID Medicaid |
$464.60
|
| Rate for Payer: MEDICARE Medicare |
$353.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$479.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$489.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$479.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$479.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$429.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$404.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$404.00
|
|
|
DEBRIDEMENT NAIL(S) ONE TO FIVE
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
DEBRIDEMENT NAIL(S) ONE TO FIVE
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
DEBRIDEMENT NON-SELECTIVE W/O ANESTH
|
Facility
IP
|
$343.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
20230628
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: BCBS HMK CHIP |
$308.70
|
| Rate for Payer: AETNA Commercial |
$325.85
|
| Rate for Payer: AETNA Medicare |
$308.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$325.85
|
| Rate for Payer: BCBS Healthlink |
$308.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$308.70
|
| Rate for Payer: BCBS POS |
$325.85
|
| Rate for Payer: BCBS Traditional |
$343.00
|
| Rate for Payer: CASH_PRICE |
$274.40
|
| Rate for Payer: CIGNA Commercial |
$325.85
|
| Rate for Payer: CIGNA Medicare |
$308.70
|
| Rate for Payer: HUMANA Commercial |
$308.70
|
| Rate for Payer: MEDICAID Medicaid |
$315.56
|
| Rate for Payer: MEDICARE Medicare |
$240.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$325.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$332.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$325.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$325.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$291.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$274.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$274.40
|
|
|
DEBRIDEMENT NON-SELECTIVE W/O ANESTH
|
Facility
OP
|
$343.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
20230628
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: AETNA Commercial |
$325.85
|
| Rate for Payer: AETNA Medicare |
$308.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$325.85
|
| Rate for Payer: BCBS Healthlink |
$308.70
|
| Rate for Payer: BCBS HMK CHIP |
$308.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$308.70
|
| Rate for Payer: BCBS POS |
$325.85
|
| Rate for Payer: BCBS Traditional |
$343.00
|
| Rate for Payer: CASH_PRICE |
$274.40
|
| Rate for Payer: CIGNA Commercial |
$325.85
|
| Rate for Payer: CIGNA Medicare |
$308.70
|
| Rate for Payer: HUMANA Commercial |
$308.70
|
| Rate for Payer: MEDICAID Medicaid |
$315.56
|
| Rate for Payer: MEDICARE Medicare |
$240.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$325.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$332.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$325.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$325.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$291.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$274.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$274.40
|
|
|
DEBRIDEMENT SKIN INFECTED UP TO 10%
|
Facility
OP
|
$495.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: AETNA Commercial |
$470.25
|
| Rate for Payer: AETNA Medicare |
$445.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$470.25
|
| Rate for Payer: BCBS Healthlink |
$445.50
|
| Rate for Payer: BCBS HMK CHIP |
$445.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$445.50
|
| Rate for Payer: BCBS POS |
$470.25
|
| Rate for Payer: BCBS Traditional |
$495.00
|
| Rate for Payer: CASH_PRICE |
$396.00
|
| Rate for Payer: CIGNA Commercial |
$470.25
|
| Rate for Payer: CIGNA Medicare |
$445.50
|
| Rate for Payer: HUMANA Commercial |
$445.50
|
| Rate for Payer: MEDICAID Medicaid |
$455.40
|
| Rate for Payer: MEDICARE Medicare |
$346.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$470.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$480.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$470.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$470.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$420.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$396.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$396.00
|
|
|
DEBRIDEMENT SKIN INFECTED UP TO 10%
|
Facility
IP
|
$495.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: AETNA Commercial |
$470.25
|
| Rate for Payer: AETNA Medicare |
$445.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$470.25
|
| Rate for Payer: BCBS Healthlink |
$445.50
|
| Rate for Payer: BCBS HMK CHIP |
$445.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$445.50
|
| Rate for Payer: BCBS POS |
$470.25
|
| Rate for Payer: BCBS Traditional |
$495.00
|
| Rate for Payer: CASH_PRICE |
$396.00
|
| Rate for Payer: CIGNA Commercial |
$470.25
|
| Rate for Payer: CIGNA Medicare |
$445.50
|
| Rate for Payer: HUMANA Commercial |
$445.50
|
| Rate for Payer: MEDICAID Medicaid |
$455.40
|
| Rate for Payer: MEDICARE Medicare |
$346.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$470.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$480.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$470.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$470.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$420.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$396.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$396.00
|
|
|
DEBRIDEMENT, SUBCU, FIRST 20CM
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
DEBRIDEMENT, SUBCU, FIRST 20CM
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
DECLOTTING IMPLANTED DEVICE
|
Facility
OP
|
$437.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: AETNA Commercial |
$415.15
|
| Rate for Payer: AETNA Medicare |
$393.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$415.15
|
| Rate for Payer: BCBS Healthlink |
$393.30
|
| Rate for Payer: BCBS HMK CHIP |
$393.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$393.30
|
| Rate for Payer: BCBS POS |
$415.15
|
| Rate for Payer: BCBS Traditional |
$437.00
|
| Rate for Payer: CASH_PRICE |
$349.60
|
| Rate for Payer: CIGNA Commercial |
$415.15
|
| Rate for Payer: CIGNA Medicare |
$393.30
|
| Rate for Payer: HUMANA Commercial |
$393.30
|
| Rate for Payer: MEDICAID Medicaid |
$402.04
|
| Rate for Payer: MEDICARE Medicare |
$305.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$415.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$423.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$415.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$415.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$371.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$349.60
|
|
|
DECLOTTING IMPLANTED DEVICE
|
Facility
IP
|
$437.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: BCBS HMK CHIP |
$393.30
|
| Rate for Payer: AETNA Commercial |
$415.15
|
| Rate for Payer: AETNA Medicare |
$393.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$415.15
|
| Rate for Payer: BCBS Healthlink |
$393.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$393.30
|
| Rate for Payer: BCBS POS |
$415.15
|
| Rate for Payer: BCBS Traditional |
$437.00
|
| Rate for Payer: CASH_PRICE |
$349.60
|
| Rate for Payer: CIGNA Commercial |
$415.15
|
| Rate for Payer: CIGNA Medicare |
$393.30
|
| Rate for Payer: HUMANA Commercial |
$393.30
|
| Rate for Payer: MEDICAID Medicaid |
$402.04
|
| Rate for Payer: MEDICARE Medicare |
$305.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$415.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$423.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$415.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$415.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$371.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$349.60
|
|
