|
ER ROOM/OP ROOM LIMITED
|
Facility
OP
|
$437.00
|
|
|
Service Code
|
CPT 99282 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
ER ROOM/OP ROOM LIMITED
|
Facility
IP
|
$437.00
|
|
|
Service Code
|
CPT 99282 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
ERTAPENEM 1GM VIAL
|
Facility
IP
|
$323.00
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.10 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: BCBS HMK CHIP |
$290.70
|
| Rate for Payer: AETNA Commercial |
$306.85
|
| Rate for Payer: AETNA Medicare |
$290.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$306.85
|
| Rate for Payer: BCBS Healthlink |
$290.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$290.70
|
| Rate for Payer: BCBS POS |
$306.85
|
| Rate for Payer: BCBS Traditional |
$323.00
|
| Rate for Payer: CASH_PRICE |
$258.40
|
| Rate for Payer: CIGNA Commercial |
$306.85
|
| Rate for Payer: CIGNA Medicare |
$290.70
|
| Rate for Payer: HUMANA Commercial |
$290.70
|
| Rate for Payer: MEDICAID Medicaid |
$297.16
|
| Rate for Payer: MEDICARE Medicare |
$226.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$306.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$313.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$306.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$306.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$274.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$258.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$258.40
|
|
|
ERTAPENEM 1GM VIAL
|
Facility
OP
|
$323.00
|
|
|
Service Code
|
CPT J1335
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.10 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: AETNA Commercial |
$306.85
|
| Rate for Payer: AETNA Medicare |
$290.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$306.85
|
| Rate for Payer: BCBS Healthlink |
$290.70
|
| Rate for Payer: BCBS HMK CHIP |
$290.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$290.70
|
| Rate for Payer: BCBS POS |
$306.85
|
| Rate for Payer: BCBS Traditional |
$323.00
|
| Rate for Payer: CASH_PRICE |
$258.40
|
| Rate for Payer: CIGNA Commercial |
$306.85
|
| Rate for Payer: CIGNA Medicare |
$290.70
|
| Rate for Payer: HUMANA Commercial |
$290.70
|
| Rate for Payer: MEDICAID Medicaid |
$297.16
|
| Rate for Payer: MEDICARE Medicare |
$226.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$306.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$313.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$306.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$306.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$274.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$258.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$258.40
|
|
|
ER TREAT ELBOW DISLOCATION
|
Facility
IP
|
$415.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: AETNA Commercial |
$394.25
|
| Rate for Payer: AETNA Medicare |
$373.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$394.25
|
| Rate for Payer: BCBS Healthlink |
$373.50
|
| Rate for Payer: BCBS HMK CHIP |
$373.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$373.50
|
| Rate for Payer: BCBS POS |
$394.25
|
| Rate for Payer: BCBS Traditional |
$415.00
|
| Rate for Payer: CASH_PRICE |
$332.00
|
| Rate for Payer: CIGNA Commercial |
$394.25
|
| Rate for Payer: CIGNA Medicare |
$373.50
|
| Rate for Payer: HUMANA Commercial |
$373.50
|
| Rate for Payer: MEDICAID Medicaid |
$381.80
|
| Rate for Payer: MEDICARE Medicare |
$290.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$394.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$402.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$394.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$394.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$352.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$332.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$332.00
|
|
|
ER TREAT ELBOW DISLOCATION
|
Facility
OP
|
$415.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: AETNA Commercial |
$394.25
|
| Rate for Payer: AETNA Medicare |
$373.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$394.25
|
| Rate for Payer: BCBS Healthlink |
$373.50
|
| Rate for Payer: BCBS HMK CHIP |
$373.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$373.50
|
| Rate for Payer: BCBS POS |
$394.25
|
| Rate for Payer: BCBS Traditional |
$415.00
|
| Rate for Payer: CASH_PRICE |
$332.00
|
| Rate for Payer: CIGNA Commercial |
$394.25
|
| Rate for Payer: CIGNA Medicare |
$373.50
|
| Rate for Payer: HUMANA Commercial |
$373.50
|
| Rate for Payer: MEDICAID Medicaid |
$381.80
|
| Rate for Payer: MEDICARE Medicare |
$290.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$394.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$402.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$394.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$394.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$352.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$332.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$332.00
|
|
|
ER TREAT SHOULDER DISLOCATION
|
Facility
IP
|
$1,127.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$788.90 |
| Max. Negotiated Rate |
$1,127.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,014.30
|
| Rate for Payer: AETNA Commercial |
$1,070.65
|
| Rate for Payer: AETNA Medicare |
$1,014.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,070.65
|
| Rate for Payer: BCBS Healthlink |
$1,014.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,014.30
|
| Rate for Payer: BCBS POS |
$1,070.65
|
| Rate for Payer: BCBS Traditional |
$1,127.00
|
| Rate for Payer: CASH_PRICE |
$901.60
|
| Rate for Payer: CIGNA Commercial |
$1,070.65
|
| Rate for Payer: CIGNA Medicare |
$1,014.30
|
| Rate for Payer: HUMANA Commercial |
$1,014.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,036.84
|
| Rate for Payer: MEDICARE Medicare |
$788.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,070.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,093.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,070.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,070.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$957.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$901.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$901.60
|
|
|
ER TREAT SHOULDER DISLOCATION
|
Facility
OP
|
$1,127.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$788.90 |
| Max. Negotiated Rate |
$1,127.00 |
| Rate for Payer: AETNA Commercial |
$1,070.65
|
| Rate for Payer: AETNA Medicare |
$1,014.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,070.65
|
| Rate for Payer: BCBS Healthlink |
$1,014.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,014.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,014.30
|
| Rate for Payer: BCBS POS |
$1,070.65
|
| Rate for Payer: BCBS Traditional |
$1,127.00
|
| Rate for Payer: CASH_PRICE |
$901.60
|
| Rate for Payer: CIGNA Commercial |
$1,070.65
|
| Rate for Payer: CIGNA Medicare |
$1,014.30
|
| Rate for Payer: HUMANA Commercial |
$1,014.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,036.84
|
| Rate for Payer: MEDICARE Medicare |
$788.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,070.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,093.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,070.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,070.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$957.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$901.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$901.60
|
|
|
ER TX BURN INITIAL 1ST DEGREE
|
Facility
IP
|
$274.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: AETNA Commercial |
$260.30
|
| Rate for Payer: AETNA Medicare |
$246.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$260.30
|
| Rate for Payer: BCBS Healthlink |
$246.60
|
| Rate for Payer: BCBS HMK CHIP |
$246.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$246.60
|
| Rate for Payer: BCBS POS |
$260.30
|
| Rate for Payer: BCBS Traditional |
$274.00
|
| Rate for Payer: CASH_PRICE |
$219.20
|
| Rate for Payer: CIGNA Commercial |
$260.30
|
| Rate for Payer: CIGNA Medicare |
$246.60
|
| Rate for Payer: HUMANA Commercial |
$246.60
|
| Rate for Payer: MEDICAID Medicaid |
$252.08
|
| Rate for Payer: MEDICARE Medicare |
$191.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$260.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$265.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$260.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$260.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$219.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$219.20
|
|
|
ER TX BURN INITIAL 1ST DEGREE
|
Facility
OP
|
$274.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: AETNA Commercial |
$260.30
|
| Rate for Payer: AETNA Medicare |
$246.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$260.30
|
| Rate for Payer: BCBS Healthlink |
$246.60
|
| Rate for Payer: BCBS HMK CHIP |
$246.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$246.60
|
| Rate for Payer: BCBS POS |
$260.30
|
| Rate for Payer: BCBS Traditional |
$274.00
|
| Rate for Payer: CASH_PRICE |
$219.20
|
| Rate for Payer: CIGNA Commercial |
$260.30
|
| Rate for Payer: CIGNA Medicare |
$246.60
|
| Rate for Payer: HUMANA Commercial |
$246.60
|
| Rate for Payer: MEDICAID Medicaid |
$252.08
|
| Rate for Payer: MEDICARE Medicare |
$191.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$260.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$265.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$260.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$260.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$219.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$219.20
|
|
|
ER TX DISLOC(I-P)JT W/O ANES W/MANIP CLO
|
Facility
OP
|
$387.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: AETNA Commercial |
$367.65
|
| Rate for Payer: AETNA Medicare |
$348.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$367.65
|
| Rate for Payer: BCBS Healthlink |
$348.30
|
| Rate for Payer: BCBS HMK CHIP |
$348.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$348.30
|
| Rate for Payer: BCBS POS |
$367.65
|
| Rate for Payer: BCBS Traditional |
$387.00
|
| Rate for Payer: CASH_PRICE |
$309.60
|
| Rate for Payer: CIGNA Commercial |
$367.65
|
| Rate for Payer: CIGNA Medicare |
$348.30
|
| Rate for Payer: HUMANA Commercial |
$348.30
|
| Rate for Payer: MEDICAID Medicaid |
$356.04
|
| Rate for Payer: MEDICARE Medicare |
$270.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$367.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$375.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$367.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$367.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$309.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$309.60
|
|
|
ER TX DISLOC(I-P)JT W/O ANES W/MANIP CLO
|
Facility
IP
|
$387.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: BCBS HMK CHIP |
$348.30
|
| Rate for Payer: AETNA Commercial |
$367.65
|
| Rate for Payer: AETNA Medicare |
$348.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$367.65
|
| Rate for Payer: BCBS Healthlink |
$348.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$348.30
|
| Rate for Payer: BCBS POS |
$367.65
|
| Rate for Payer: BCBS Traditional |
$387.00
|
| Rate for Payer: CASH_PRICE |
$309.60
|
| Rate for Payer: CIGNA Commercial |
$367.65
|
| Rate for Payer: CIGNA Medicare |
$348.30
|
| Rate for Payer: HUMANA Commercial |
$348.30
|
| Rate for Payer: MEDICAID Medicaid |
$356.04
|
| Rate for Payer: MEDICARE Medicare |
$270.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$367.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$375.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$367.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$367.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$309.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$309.60
|
|
|
ER TX DISLOC(M-P)W/ANES W/MANIP CLOSED
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: AETNA Commercial |
$513.00
|
| Rate for Payer: AETNA Medicare |
$486.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$513.00
|
| Rate for Payer: BCBS Healthlink |
$486.00
|
| Rate for Payer: BCBS HMK CHIP |
$486.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$486.00
|
| Rate for Payer: BCBS POS |
$513.00
|
| Rate for Payer: BCBS Traditional |
$540.00
|
| Rate for Payer: CASH_PRICE |
$432.00
|
| Rate for Payer: CIGNA Commercial |
$513.00
|
| Rate for Payer: CIGNA Medicare |
$486.00
|
| Rate for Payer: HUMANA Commercial |
$486.00
|
| Rate for Payer: MEDICAID Medicaid |
$496.80
|
| Rate for Payer: MEDICARE Medicare |
$378.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$513.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$523.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$513.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$513.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$459.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$432.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$432.00
|
|
|
ER TX DISLOC(M-P)W/ANES W/MANIP CLOSED
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: AETNA Commercial |
$513.00
|
| Rate for Payer: AETNA Medicare |
$486.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$513.00
|
| Rate for Payer: BCBS Healthlink |
$486.00
|
| Rate for Payer: BCBS HMK CHIP |
$486.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$486.00
|
| Rate for Payer: BCBS POS |
$513.00
|
| Rate for Payer: BCBS Traditional |
$540.00
|
| Rate for Payer: CASH_PRICE |
$432.00
|
| Rate for Payer: CIGNA Commercial |
$513.00
|
| Rate for Payer: CIGNA Medicare |
$486.00
|
| Rate for Payer: HUMANA Commercial |
$486.00
|
| Rate for Payer: MEDICAID Medicaid |
$496.80
|
| Rate for Payer: MEDICARE Medicare |
$378.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$513.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$523.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$513.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$513.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$459.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$432.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$432.00
|
|
|
ER TX OF TOE FRACTURE
|
Facility
IP
|
$410.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: BCBS HMK CHIP |
$369.00
|
| Rate for Payer: AETNA Commercial |
$389.50
|
| Rate for Payer: AETNA Medicare |
$369.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$389.50
|
| Rate for Payer: BCBS Healthlink |
$369.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$369.00
|
| Rate for Payer: BCBS POS |
$389.50
|
| Rate for Payer: BCBS Traditional |
$410.00
|
| Rate for Payer: CASH_PRICE |
$328.00
|
| Rate for Payer: CIGNA Commercial |
$389.50
|
| Rate for Payer: CIGNA Medicare |
$369.00
|
| Rate for Payer: HUMANA Commercial |
$369.00
|
| Rate for Payer: MEDICAID Medicaid |
$377.20
|
| Rate for Payer: MEDICARE Medicare |
$287.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$389.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$397.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$389.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$389.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$348.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$328.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$328.00
|
|
|
ER TX OF TOE FRACTURE
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: AETNA Commercial |
$389.50
|
| Rate for Payer: AETNA Medicare |
$369.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$389.50
|
| Rate for Payer: BCBS Healthlink |
$369.00
|
| Rate for Payer: BCBS HMK CHIP |
$369.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$369.00
|
| Rate for Payer: BCBS POS |
$389.50
|
| Rate for Payer: BCBS Traditional |
$410.00
|
| Rate for Payer: CASH_PRICE |
$328.00
|
| Rate for Payer: CIGNA Commercial |
$389.50
|
| Rate for Payer: CIGNA Medicare |
$369.00
|
| Rate for Payer: HUMANA Commercial |
$369.00
|
| Rate for Payer: MEDICAID Medicaid |
$377.20
|
| Rate for Payer: MEDICARE Medicare |
$287.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$389.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$397.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$389.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$389.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$348.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$328.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$328.00
|
|
|
ER TX SHOULDER DISLOC W/O ANEST CLOSED
|
Facility
IP
|
$563.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$394.10 |
| Max. Negotiated Rate |
$563.00 |
| Rate for Payer: AETNA Commercial |
$534.85
|
| Rate for Payer: AETNA Medicare |
$506.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$534.85
|
| Rate for Payer: BCBS Healthlink |
$506.70
|
| Rate for Payer: BCBS HMK CHIP |
$506.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$506.70
|
| Rate for Payer: BCBS POS |
$534.85
|
| Rate for Payer: BCBS Traditional |
$563.00
|
| Rate for Payer: CASH_PRICE |
$450.40
|
| Rate for Payer: CIGNA Commercial |
$534.85
|
| Rate for Payer: CIGNA Medicare |
$506.70
|
| Rate for Payer: HUMANA Commercial |
$506.70
|
| Rate for Payer: MEDICAID Medicaid |
$517.96
|
| Rate for Payer: MEDICARE Medicare |
$394.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$534.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$546.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$534.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$534.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$478.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$450.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$450.40
|
|
|
ER TX SHOULDER DISLOC W/O ANEST CLOSED
|
Facility
OP
|
$563.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$394.10 |
| Max. Negotiated Rate |
$563.00 |
| Rate for Payer: AETNA Commercial |
$534.85
|
| Rate for Payer: AETNA Medicare |
$506.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$534.85
|
| Rate for Payer: BCBS Healthlink |
$506.70
|
| Rate for Payer: BCBS HMK CHIP |
$506.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$506.70
|
| Rate for Payer: BCBS POS |
$534.85
|
| Rate for Payer: BCBS Traditional |
$563.00
|
| Rate for Payer: CASH_PRICE |
$450.40
|
| Rate for Payer: CIGNA Commercial |
$534.85
|
| Rate for Payer: CIGNA Medicare |
$506.70
|
| Rate for Payer: HUMANA Commercial |
$506.70
|
| Rate for Payer: MEDICAID Medicaid |
$517.96
|
| Rate for Payer: MEDICARE Medicare |
$394.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$534.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$546.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$534.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$534.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$478.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$450.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$450.40
|
|
|
ERYTHROCYTE SEDIMENTATION RATE, BLOOD
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
ERYTHROCYTE SEDIMENTATION RATE, BLOOD
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
ERYTHROMYCIN OPTH OINT [3.5 GM]
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
ERYTHROMYCIN OPTH OINT [3.5 GM]
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
ERYTHROPOIETIN (140277)
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ERYTHROPOIETIN (140277)
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ESCITALOPRAM TAB [10 MG]
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: AETNA Commercial |
$14.25
|
| Rate for Payer: AETNA Medicare |
$13.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14.25
|
| Rate for Payer: BCBS Healthlink |
$13.50
|
| Rate for Payer: BCBS HMK CHIP |
$13.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.50
|
| Rate for Payer: BCBS POS |
$14.25
|
| Rate for Payer: BCBS Traditional |
$15.00
|
| Rate for Payer: CASH_PRICE |
$12.00
|
| Rate for Payer: CIGNA Commercial |
$14.25
|
| Rate for Payer: CIGNA Medicare |
$13.50
|
| Rate for Payer: HUMANA Commercial |
$13.50
|
| Rate for Payer: MEDICAID Medicaid |
$13.80
|
| Rate for Payer: MEDICARE Medicare |
$10.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.00
|
|
