|
EPISTAXIS SIMPLE- ER
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: BCBS HMK CHIP |
$277.20
|
| Rate for Payer: AETNA Commercial |
$292.60
|
| Rate for Payer: AETNA Medicare |
$277.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$292.60
|
| Rate for Payer: BCBS Healthlink |
$277.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$277.20
|
| Rate for Payer: BCBS POS |
$292.60
|
| Rate for Payer: BCBS Traditional |
$308.00
|
| Rate for Payer: CASH_PRICE |
$246.40
|
| Rate for Payer: CIGNA Commercial |
$292.60
|
| Rate for Payer: CIGNA Medicare |
$277.20
|
| Rate for Payer: HUMANA Commercial |
$277.20
|
| Rate for Payer: MEDICAID Medicaid |
$283.36
|
| Rate for Payer: MEDICARE Medicare |
$215.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$292.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$298.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$292.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$292.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$261.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$246.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$246.40
|
|
|
EPISTAXIS SIMPLE- ER
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: AETNA Commercial |
$292.60
|
| Rate for Payer: AETNA Medicare |
$277.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$292.60
|
| Rate for Payer: BCBS Healthlink |
$277.20
|
| Rate for Payer: BCBS HMK CHIP |
$277.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$277.20
|
| Rate for Payer: BCBS POS |
$292.60
|
| Rate for Payer: BCBS Traditional |
$308.00
|
| Rate for Payer: CASH_PRICE |
$246.40
|
| Rate for Payer: CIGNA Commercial |
$292.60
|
| Rate for Payer: CIGNA Medicare |
$277.20
|
| Rate for Payer: HUMANA Commercial |
$277.20
|
| Rate for Payer: MEDICAID Medicaid |
$283.36
|
| Rate for Payer: MEDICARE Medicare |
$215.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$292.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$298.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$292.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$292.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$261.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$246.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$246.40
|
|
|
EPLEY MANEUVER / CANALITH REPOSITIONING
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: AETNA Commercial |
$122.55
|
| Rate for Payer: AETNA Medicare |
$116.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$122.55
|
| Rate for Payer: BCBS Healthlink |
$116.10
|
| Rate for Payer: BCBS HMK CHIP |
$116.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$116.10
|
| Rate for Payer: BCBS POS |
$122.55
|
| Rate for Payer: BCBS Traditional |
$129.00
|
| Rate for Payer: CASH_PRICE |
$103.20
|
| Rate for Payer: CIGNA Commercial |
$122.55
|
| Rate for Payer: CIGNA Medicare |
$116.10
|
| Rate for Payer: HUMANA Commercial |
$116.10
|
| Rate for Payer: MEDICAID Medicaid |
$118.68
|
| Rate for Payer: MEDICARE Medicare |
$90.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$122.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$125.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$122.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$122.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$109.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$103.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$103.20
|
|
|
EPLEY MANEUVER / CANALITH REPOSITIONING
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: AETNA Commercial |
$122.55
|
| Rate for Payer: AETNA Medicare |
$116.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$122.55
|
| Rate for Payer: BCBS Healthlink |
$116.10
|
| Rate for Payer: BCBS HMK CHIP |
$116.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$116.10
|
| Rate for Payer: BCBS POS |
$122.55
|
| Rate for Payer: BCBS Traditional |
$129.00
|
| Rate for Payer: CASH_PRICE |
$103.20
|
| Rate for Payer: CIGNA Commercial |
$122.55
|
| Rate for Payer: CIGNA Medicare |
$116.10
|
| Rate for Payer: HUMANA Commercial |
$116.10
|
| Rate for Payer: MEDICAID Medicaid |
$118.68
|
| Rate for Payer: MEDICARE Medicare |
$90.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$122.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$125.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$122.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$122.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$109.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$103.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$103.20
|
|
|
EPOETIN ALFA INJ [10,000 U/ML] SPEC ORD
|
Facility
IP
|
$640.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$448.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: BCBS HMK CHIP |
$576.00
|
| Rate for Payer: AETNA Commercial |
$608.00
|
| Rate for Payer: AETNA Medicare |
$576.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$608.00
|
| Rate for Payer: BCBS Healthlink |
$576.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$576.00
|
| Rate for Payer: BCBS POS |
$608.00
|
| Rate for Payer: BCBS Traditional |
$640.00
|
| Rate for Payer: CASH_PRICE |
$512.00
|
| Rate for Payer: CIGNA Commercial |
$608.00
|
| Rate for Payer: CIGNA Medicare |
$576.00
|
| Rate for Payer: HUMANA Commercial |
$576.00
|
| Rate for Payer: MEDICAID Medicaid |
$588.80
|
| Rate for Payer: MEDICARE Medicare |
$448.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$608.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$620.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$608.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$608.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$544.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$512.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$512.00
|
|
|
EPOETIN ALFA INJ [10,000 U/ML] SPEC ORD
|
Facility
OP
|
$640.00
|
|
|
Service Code
|
CPT J0885
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$448.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: AETNA Commercial |
$608.00
|
| Rate for Payer: AETNA Medicare |
$576.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$608.00
|
| Rate for Payer: BCBS Healthlink |
$576.00
|
| Rate for Payer: BCBS HMK CHIP |
$576.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$576.00
|
| Rate for Payer: BCBS POS |
$608.00
|
| Rate for Payer: BCBS Traditional |
$640.00
|
| Rate for Payer: CASH_PRICE |
$512.00
|
| Rate for Payer: CIGNA Commercial |
$608.00
|
| Rate for Payer: CIGNA Medicare |
$576.00
|
| Rate for Payer: HUMANA Commercial |
$576.00
|
| Rate for Payer: MEDICAID Medicaid |
$588.80
|
| Rate for Payer: MEDICARE Medicare |
$448.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$608.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$620.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$608.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$608.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$544.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$512.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$512.00
|
|
|
ER APPLICATION OF FINGER SPLINT; DYNAMIC
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
ER APPLICATION OF FINGER SPLINT; DYNAMIC
|
Facility
IP
|
$173.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
ER APPLICATION OF FOREARM CAST
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
ER APPLICATION OF FOREARM CAST
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
ER APPLICATION OF SPLINT PROFEE
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
ER APPLICATION OF SPLINT PROFEE
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
ER APPLICATION SPLING TO ANKLE/AND OR FO
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: BCBS HMK CHIP |
$152.10
|
| Rate for Payer: AETNA Commercial |
$160.55
|
| Rate for Payer: AETNA Medicare |
$152.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$160.55
|
| Rate for Payer: BCBS Healthlink |
$152.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$152.10
|
| Rate for Payer: BCBS POS |
$160.55
|
| Rate for Payer: BCBS Traditional |
$169.00
|
| Rate for Payer: CASH_PRICE |
$135.20
|
| Rate for Payer: CIGNA Commercial |
$160.55
|
| Rate for Payer: CIGNA Medicare |
$152.10
|
| Rate for Payer: HUMANA Commercial |
$152.10
|
| Rate for Payer: MEDICAID Medicaid |
$155.48
|
| Rate for Payer: MEDICARE Medicare |
$118.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$160.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$163.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$160.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$160.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$143.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$135.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$135.20
|
|
|
ER APPLICATION SPLING TO ANKLE/AND OR FO
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: AETNA Commercial |
$160.55
|
| Rate for Payer: AETNA Medicare |
$152.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$160.55
|
| Rate for Payer: BCBS Healthlink |
$152.10
|
| Rate for Payer: BCBS HMK CHIP |
$152.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$152.10
|
| Rate for Payer: BCBS POS |
$160.55
|
| Rate for Payer: BCBS Traditional |
$169.00
|
| Rate for Payer: CASH_PRICE |
$135.20
|
| Rate for Payer: CIGNA Commercial |
$160.55
|
| Rate for Payer: CIGNA Medicare |
$152.10
|
| Rate for Payer: HUMANA Commercial |
$152.10
|
| Rate for Payer: MEDICAID Medicaid |
$155.48
|
| Rate for Payer: MEDICARE Medicare |
$118.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$160.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$163.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$160.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$160.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$143.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$135.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$135.20
|
|
|
ER APPLICATION SPLINT ARM SHORT
|
Facility
IP
|
$311.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
ER APPLICATION SPLINT ARM SHORT
|
Facility
OP
|
$311.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
ER APPLICATION SPLINT FINGER STATIC
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
ER APPLICATION SPLINT FINGER STATIC
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
ER APPLICATION SPLINT HAND OR FINGER
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: AETNA Commercial |
$171.95
|
| Rate for Payer: AETNA Medicare |
$162.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$171.95
|
| Rate for Payer: BCBS Healthlink |
$162.90
|
| Rate for Payer: BCBS HMK CHIP |
$162.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$162.90
|
| Rate for Payer: BCBS POS |
$171.95
|
| Rate for Payer: BCBS Traditional |
$181.00
|
| Rate for Payer: CASH_PRICE |
$144.80
|
| Rate for Payer: CIGNA Commercial |
$171.95
|
| Rate for Payer: CIGNA Medicare |
$162.90
|
| Rate for Payer: HUMANA Commercial |
$162.90
|
| Rate for Payer: MEDICAID Medicaid |
$166.52
|
| Rate for Payer: MEDICARE Medicare |
$126.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$171.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$175.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$171.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$171.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$153.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$144.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$144.80
|
|
|
ER APPLICATION SPLINT HAND OR FINGER
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: AETNA Commercial |
$171.95
|
| Rate for Payer: AETNA Medicare |
$162.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$171.95
|
| Rate for Payer: BCBS Healthlink |
$162.90
|
| Rate for Payer: BCBS HMK CHIP |
$162.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$162.90
|
| Rate for Payer: BCBS POS |
$171.95
|
| Rate for Payer: BCBS Traditional |
$181.00
|
| Rate for Payer: CASH_PRICE |
$144.80
|
| Rate for Payer: CIGNA Commercial |
$171.95
|
| Rate for Payer: CIGNA Medicare |
$162.90
|
| Rate for Payer: HUMANA Commercial |
$162.90
|
| Rate for Payer: MEDICAID Medicaid |
$166.52
|
| Rate for Payer: MEDICARE Medicare |
$126.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$171.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$175.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$171.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$171.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$153.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$144.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$144.80
|
|
|
ER APPLICATION SPLINT LEG LONG
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
ER APPLICATION SPLINT LEG LONG
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
ER APPLICATION SPLINT LONG
|
Facility
OP
|
$345.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: AETNA Commercial |
$327.75
|
| Rate for Payer: AETNA Medicare |
$310.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$327.75
|
| Rate for Payer: BCBS Healthlink |
$310.50
|
| Rate for Payer: BCBS HMK CHIP |
$310.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$310.50
|
| Rate for Payer: BCBS POS |
$327.75
|
| Rate for Payer: BCBS Traditional |
$345.00
|
| Rate for Payer: CASH_PRICE |
$276.00
|
| Rate for Payer: CIGNA Commercial |
$327.75
|
| Rate for Payer: CIGNA Medicare |
$310.50
|
| Rate for Payer: HUMANA Commercial |
$310.50
|
| Rate for Payer: MEDICAID Medicaid |
$317.40
|
| Rate for Payer: MEDICARE Medicare |
$241.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$327.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$334.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$327.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$327.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$293.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$276.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$276.00
|
|
|
ER APPLICATION SPLINT LONG
|
Facility
IP
|
$345.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: AETNA Commercial |
$327.75
|
| Rate for Payer: AETNA Medicare |
$310.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$327.75
|
| Rate for Payer: BCBS Healthlink |
$310.50
|
| Rate for Payer: BCBS HMK CHIP |
$310.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$310.50
|
| Rate for Payer: BCBS POS |
$327.75
|
| Rate for Payer: BCBS Traditional |
$345.00
|
| Rate for Payer: CASH_PRICE |
$276.00
|
| Rate for Payer: CIGNA Commercial |
$327.75
|
| Rate for Payer: CIGNA Medicare |
$310.50
|
| Rate for Payer: HUMANA Commercial |
$310.50
|
| Rate for Payer: MEDICAID Medicaid |
$317.40
|
| Rate for Payer: MEDICARE Medicare |
$241.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$327.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$334.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$327.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$327.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$293.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$276.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$276.00
|
|
|
ER APPLICATION STRAPPING ELBOW OR WRIST
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
