|
ALTEPLASE INJ [2 MG/2 ML]
|
Facility
OP
|
$733.00
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$513.10 |
| Max. Negotiated Rate |
$733.00 |
| Rate for Payer: AETNA Commercial |
$696.35
|
| Rate for Payer: AETNA Medicare |
$659.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$696.35
|
| Rate for Payer: BCBS Healthlink |
$659.70
|
| Rate for Payer: BCBS HMK CHIP |
$659.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$659.70
|
| Rate for Payer: BCBS POS |
$696.35
|
| Rate for Payer: BCBS Traditional |
$733.00
|
| Rate for Payer: CASH_PRICE |
$586.40
|
| Rate for Payer: CIGNA Commercial |
$696.35
|
| Rate for Payer: CIGNA Medicare |
$659.70
|
| Rate for Payer: HUMANA Commercial |
$659.70
|
| Rate for Payer: MEDICAID Medicaid |
$674.36
|
| Rate for Payer: MEDICARE Medicare |
$513.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$696.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$711.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$696.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$696.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$623.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$586.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$586.40
|
|
|
AMBULANCE ALS 2 EMERGENT
|
Facility
IP
|
$2,625.00
|
|
|
Service Code
|
CPT A0433 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: AETNA Commercial |
$2,493.75
|
| Rate for Payer: AETNA Medicare |
$2,362.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,493.75
|
| Rate for Payer: BCBS Healthlink |
$2,362.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,362.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,362.50
|
| Rate for Payer: BCBS POS |
$2,493.75
|
| Rate for Payer: BCBS Traditional |
$2,625.00
|
| Rate for Payer: CASH_PRICE |
$2,100.00
|
| Rate for Payer: CIGNA Commercial |
$2,493.75
|
| Rate for Payer: CIGNA Medicare |
$2,362.50
|
| Rate for Payer: HUMANA Commercial |
$2,362.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,415.00
|
| Rate for Payer: MEDICARE Medicare |
$1,837.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,493.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,546.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,493.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,493.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,231.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,100.00
|
|
|
AMBULANCE ALS 2 EMERGENT
|
Facility
OP
|
$2,625.00
|
|
|
Service Code
|
CPT A0433 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,837.50 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: AETNA Commercial |
$2,493.75
|
| Rate for Payer: AETNA Medicare |
$2,362.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,493.75
|
| Rate for Payer: BCBS Healthlink |
$2,362.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,362.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,362.50
|
| Rate for Payer: BCBS POS |
$2,493.75
|
| Rate for Payer: BCBS Traditional |
$2,625.00
|
| Rate for Payer: CASH_PRICE |
$2,100.00
|
| Rate for Payer: CIGNA Commercial |
$2,493.75
|
| Rate for Payer: CIGNA Medicare |
$2,362.50
|
| Rate for Payer: HUMANA Commercial |
$2,362.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,415.00
|
| Rate for Payer: MEDICARE Medicare |
$1,837.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,493.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,546.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,493.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,493.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,231.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,100.00
|
|
|
AMBULANCE ALS EMERGENT
|
Facility
IP
|
$2,132.00
|
|
|
Service Code
|
CPT A0427 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,492.40 |
| Max. Negotiated Rate |
$2,132.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,918.80
|
| Rate for Payer: AETNA Commercial |
$2,025.40
|
| Rate for Payer: AETNA Medicare |
$1,918.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,025.40
|
| Rate for Payer: BCBS Healthlink |
$1,918.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,918.80
|
| Rate for Payer: BCBS POS |
$2,025.40
|
| Rate for Payer: BCBS Traditional |
$2,132.00
|
| Rate for Payer: CASH_PRICE |
$1,705.60
|
| Rate for Payer: CIGNA Commercial |
$2,025.40
|
| Rate for Payer: CIGNA Medicare |
$1,918.80
|
| Rate for Payer: HUMANA Commercial |
$1,918.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,961.44
|
| Rate for Payer: MEDICARE Medicare |
$1,492.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,025.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,068.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,025.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,025.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,812.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,705.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,705.60
|
|
|
AMBULANCE ALS EMERGENT
|
Facility
OP
|
$2,132.00
|
|
|
Service Code
|
CPT A0427 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,492.40 |
| Max. Negotiated Rate |
$2,132.00 |
| Rate for Payer: AETNA Commercial |
$2,025.40
|
| Rate for Payer: AETNA Medicare |
$1,918.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,025.40
|
| Rate for Payer: BCBS Healthlink |
$1,918.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,918.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,918.80
|
| Rate for Payer: BCBS POS |
$2,025.40
|
| Rate for Payer: BCBS Traditional |
$2,132.00
|
| Rate for Payer: CASH_PRICE |
$1,705.60
|
| Rate for Payer: CIGNA Commercial |
$2,025.40
|
| Rate for Payer: CIGNA Medicare |
$1,918.80
|
| Rate for Payer: HUMANA Commercial |
$1,918.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,961.44
|
| Rate for Payer: MEDICARE Medicare |
$1,492.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,025.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,068.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,025.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,025.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,812.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,705.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,705.60
|
|
|
AMBULANCE ALS INTUBATION SUPPLIES
|
Facility
OP
|
$368.00
|
|
|
Service Code
|
CPT A0396 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: AETNA Commercial |
$349.60
|
| Rate for Payer: AETNA Medicare |
$331.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$349.60
|
| Rate for Payer: BCBS Healthlink |
$331.20
|
| Rate for Payer: BCBS HMK CHIP |
$331.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$331.20
|
| Rate for Payer: BCBS POS |
$349.60
|
| Rate for Payer: BCBS Traditional |
$368.00
|
| Rate for Payer: CASH_PRICE |
$294.40
|
| Rate for Payer: CIGNA Commercial |
$349.60
|
| Rate for Payer: CIGNA Medicare |
$331.20
|
| Rate for Payer: HUMANA Commercial |
$331.20
|
| Rate for Payer: MEDICAID Medicaid |
$338.56
|
| Rate for Payer: MEDICARE Medicare |
$257.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$349.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$356.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$349.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$294.40
|
|
|
AMBULANCE ALS INTUBATION SUPPLIES
|
Facility
IP
|
$368.00
|
|
|
Service Code
|
CPT A0396 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: AETNA Commercial |
$349.60
|
| Rate for Payer: AETNA Medicare |
$331.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$349.60
|
| Rate for Payer: BCBS Healthlink |
$331.20
|
| Rate for Payer: BCBS HMK CHIP |
$331.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$331.20
|
| Rate for Payer: BCBS POS |
$349.60
|
| Rate for Payer: BCBS Traditional |
$368.00
|
| Rate for Payer: CASH_PRICE |
$294.40
|
| Rate for Payer: CIGNA Commercial |
$349.60
|
| Rate for Payer: CIGNA Medicare |
$331.20
|
| Rate for Payer: HUMANA Commercial |
$331.20
|
| Rate for Payer: MEDICAID Medicaid |
$338.56
|
| Rate for Payer: MEDICARE Medicare |
$257.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$349.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$356.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$349.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$294.40
|
|
|
AMBULANCE ALS NON EMERGENT
|
Facility
OP
|
$1,607.00
|
|
|
Service Code
|
CPT A0426 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,124.90 |
| Max. Negotiated Rate |
$1,607.00 |
| Rate for Payer: AETNA Commercial |
$1,526.65
|
| Rate for Payer: AETNA Medicare |
$1,446.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,526.65
|
| Rate for Payer: BCBS Healthlink |
$1,446.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,446.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,446.30
|
| Rate for Payer: BCBS POS |
$1,526.65
|
| Rate for Payer: BCBS Traditional |
$1,607.00
|
| Rate for Payer: CASH_PRICE |
$1,285.60
|
| Rate for Payer: CIGNA Commercial |
$1,526.65
|
| Rate for Payer: CIGNA Medicare |
$1,446.30
|
| Rate for Payer: HUMANA Commercial |
$1,446.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,478.44
|
| Rate for Payer: MEDICARE Medicare |
$1,124.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,526.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,558.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,526.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,526.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,365.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,285.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,285.60
|
|
|
AMBULANCE ALS NON EMERGENT
|
Facility
IP
|
$1,607.00
|
|
|
Service Code
|
CPT A0426 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$1,124.90 |
| Max. Negotiated Rate |
$1,607.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,446.30
|
| Rate for Payer: AETNA Commercial |
$1,526.65
|
| Rate for Payer: AETNA Medicare |
$1,446.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,526.65
|
| Rate for Payer: BCBS Healthlink |
$1,446.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,446.30
|
| Rate for Payer: BCBS POS |
$1,526.65
|
| Rate for Payer: BCBS Traditional |
$1,607.00
|
| Rate for Payer: CASH_PRICE |
$1,285.60
|
| Rate for Payer: CIGNA Commercial |
$1,526.65
|
| Rate for Payer: CIGNA Medicare |
$1,446.30
|
| Rate for Payer: HUMANA Commercial |
$1,446.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,478.44
|
| Rate for Payer: MEDICARE Medicare |
$1,124.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,526.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,558.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,526.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,526.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,365.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,285.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,285.60
|
|
|
AMBULANCE ALS ROUTINE SUPPLIES
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT A0398 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
AMBULANCE ALS ROUTINE SUPPLIES
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT A0398 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
AMBULANCE BLS EMERGENT
|
Facility
IP
|
$1,397.00
|
|
|
Service Code
|
CPT A0429 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$977.90 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,257.30
|
| Rate for Payer: AETNA Commercial |
$1,327.15
|
| Rate for Payer: AETNA Medicare |
$1,257.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,327.15
|
| Rate for Payer: BCBS Healthlink |
$1,257.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,257.30
|
| Rate for Payer: BCBS POS |
$1,327.15
|
| Rate for Payer: BCBS Traditional |
$1,397.00
|
| Rate for Payer: CASH_PRICE |
$1,117.60
|
| Rate for Payer: CIGNA Commercial |
$1,327.15
|
| Rate for Payer: CIGNA Medicare |
$1,257.30
|
| Rate for Payer: HUMANA Commercial |
$1,257.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,285.24
|
| Rate for Payer: MEDICARE Medicare |
$977.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,327.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,355.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,327.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,327.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,187.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,117.60
|
|
|
AMBULANCE BLS EMERGENT
|
Facility
OP
|
$1,397.00
|
|
|
Service Code
|
CPT A0429 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$977.90 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: AETNA Commercial |
$1,327.15
|
| Rate for Payer: AETNA Medicare |
$1,257.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,327.15
|
| Rate for Payer: BCBS Healthlink |
$1,257.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,257.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,257.30
|
| Rate for Payer: BCBS POS |
$1,327.15
|
| Rate for Payer: BCBS Traditional |
$1,397.00
|
| Rate for Payer: CASH_PRICE |
$1,117.60
|
| Rate for Payer: CIGNA Commercial |
$1,327.15
|
| Rate for Payer: CIGNA Medicare |
$1,257.30
|
| Rate for Payer: HUMANA Commercial |
$1,257.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,285.24
|
| Rate for Payer: MEDICARE Medicare |
$977.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,327.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,355.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,327.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,327.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,187.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,117.60
|
|
|
AMBULANCE BLS NON EMERGENT
|
Facility
OP
|
$998.00
|
|
|
Service Code
|
CPT A0428 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$698.60 |
| Max. Negotiated Rate |
$998.00 |
| Rate for Payer: AETNA Commercial |
$948.10
|
| Rate for Payer: AETNA Medicare |
$898.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$948.10
|
| Rate for Payer: BCBS Healthlink |
$898.20
|
| Rate for Payer: BCBS HMK CHIP |
$898.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$898.20
|
| Rate for Payer: BCBS POS |
$948.10
|
| Rate for Payer: BCBS Traditional |
$998.00
|
| Rate for Payer: CASH_PRICE |
$798.40
|
| Rate for Payer: CIGNA Commercial |
$948.10
|
| Rate for Payer: CIGNA Medicare |
$898.20
|
| Rate for Payer: HUMANA Commercial |
$898.20
|
| Rate for Payer: MEDICAID Medicaid |
$918.16
|
| Rate for Payer: MEDICARE Medicare |
$698.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$948.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$968.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$948.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$948.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$848.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$798.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$798.40
|
|
|
AMBULANCE BLS NON EMERGENT
|
Facility
IP
|
$998.00
|
|
|
Service Code
|
CPT A0428 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$698.60 |
| Max. Negotiated Rate |
$998.00 |
| Rate for Payer: AETNA Commercial |
$948.10
|
| Rate for Payer: AETNA Medicare |
$898.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$948.10
|
| Rate for Payer: BCBS Healthlink |
$898.20
|
| Rate for Payer: BCBS HMK CHIP |
$898.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$898.20
|
| Rate for Payer: BCBS POS |
$948.10
|
| Rate for Payer: BCBS Traditional |
$998.00
|
| Rate for Payer: CASH_PRICE |
$798.40
|
| Rate for Payer: CIGNA Commercial |
$948.10
|
| Rate for Payer: CIGNA Medicare |
$898.20
|
| Rate for Payer: HUMANA Commercial |
$898.20
|
| Rate for Payer: MEDICAID Medicaid |
$918.16
|
| Rate for Payer: MEDICARE Medicare |
$698.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$948.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$968.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$948.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$948.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$848.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$798.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$798.40
|
|
|
AMBULANCE BLS ROUTINE SUPPLIES
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT A0382 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
AMBULANCE BLS ROUTINE SUPPLIES
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT A0382 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
AMBULANCE CPAP
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT A0999 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
AMBULANCE CPAP
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT A0999 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
AMBULANCE DEFIBRILLATION SUPPLIES
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT A0384 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
AMBULANCE DEFIBRILLATION SUPPLIES
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT A0384 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
AMBULANCE FINGER STICK BLOOD COUNT(GLUCO
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 82948 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
AMBULANCE FINGER STICK BLOOD COUNT(GLUCO
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 82948 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
AMBULANCE GROUND MILEAGE
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT A0390 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
AMBULANCE GROUND MILEAGE
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT A0425 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
