|
EXCISION BENIGN LESION 1.1-2.0CM
|
Facility
IP
|
$442.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AETNA Commercial |
$419.90
|
| Rate for Payer: AETNA Medicare |
$397.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$419.90
|
| Rate for Payer: BCBS Healthlink |
$397.80
|
| Rate for Payer: BCBS HMK CHIP |
$397.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$397.80
|
| Rate for Payer: BCBS POS |
$419.90
|
| Rate for Payer: BCBS Traditional |
$442.00
|
| Rate for Payer: CASH_PRICE |
$353.60
|
| Rate for Payer: CIGNA Commercial |
$419.90
|
| Rate for Payer: CIGNA Medicare |
$397.80
|
| Rate for Payer: HUMANA Commercial |
$397.80
|
| Rate for Payer: MEDICAID Medicaid |
$406.64
|
| Rate for Payer: MEDICARE Medicare |
$309.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$419.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$428.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$419.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$419.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$375.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$353.60
|
|
|
EXCISION BENIGN LESION 1.1-2.0CM
|
Facility
OP
|
$442.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AETNA Commercial |
$419.90
|
| Rate for Payer: AETNA Medicare |
$397.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$419.90
|
| Rate for Payer: BCBS Healthlink |
$397.80
|
| Rate for Payer: BCBS HMK CHIP |
$397.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$397.80
|
| Rate for Payer: BCBS POS |
$419.90
|
| Rate for Payer: BCBS Traditional |
$442.00
|
| Rate for Payer: CASH_PRICE |
$353.60
|
| Rate for Payer: CIGNA Commercial |
$419.90
|
| Rate for Payer: CIGNA Medicare |
$397.80
|
| Rate for Payer: HUMANA Commercial |
$397.80
|
| Rate for Payer: MEDICAID Medicaid |
$406.64
|
| Rate for Payer: MEDICARE Medicare |
$309.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$419.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$428.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$419.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$419.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$375.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$353.60
|
|
|
EXCISION BENIGN LESION 2.1-3.0CM
|
Facility
IP
|
$469.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: BCBS HMK CHIP |
$422.10
|
| Rate for Payer: AETNA Commercial |
$445.55
|
| Rate for Payer: AETNA Medicare |
$422.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$445.55
|
| Rate for Payer: BCBS Healthlink |
$422.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$422.10
|
| Rate for Payer: BCBS POS |
$445.55
|
| Rate for Payer: BCBS Traditional |
$469.00
|
| Rate for Payer: CASH_PRICE |
$375.20
|
| Rate for Payer: CIGNA Commercial |
$445.55
|
| Rate for Payer: CIGNA Medicare |
$422.10
|
| Rate for Payer: HUMANA Commercial |
$422.10
|
| Rate for Payer: MEDICAID Medicaid |
$431.48
|
| Rate for Payer: MEDICARE Medicare |
$328.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$445.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$454.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$445.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$445.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$398.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$375.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$375.20
|
|
|
EXCISION BENIGN LESION 2.1-3.0CM
|
Facility
OP
|
$469.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: AETNA Commercial |
$445.55
|
| Rate for Payer: AETNA Medicare |
$422.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$445.55
|
| Rate for Payer: BCBS Healthlink |
$422.10
|
| Rate for Payer: BCBS HMK CHIP |
$422.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$422.10
|
| Rate for Payer: BCBS POS |
$445.55
|
| Rate for Payer: BCBS Traditional |
$469.00
|
| Rate for Payer: CASH_PRICE |
$375.20
|
| Rate for Payer: CIGNA Commercial |
$445.55
|
| Rate for Payer: CIGNA Medicare |
$422.10
|
| Rate for Payer: HUMANA Commercial |
$422.10
|
| Rate for Payer: MEDICAID Medicaid |
$431.48
|
| Rate for Payer: MEDICARE Medicare |
$328.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$445.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$454.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$445.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$445.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$398.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$375.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$375.20
|
|
|
EXCISION BENIGN LESION 3.1-4.0 CM
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$362.60 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: AETNA Commercial |
$492.10
|
| Rate for Payer: AETNA Medicare |
$466.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$492.10
|
| Rate for Payer: BCBS Healthlink |
$466.20
|
| Rate for Payer: BCBS HMK CHIP |
$466.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$466.20
|
| Rate for Payer: BCBS POS |
$492.10
|
| Rate for Payer: BCBS Traditional |
$518.00
|
| Rate for Payer: CASH_PRICE |
$414.40
|
| Rate for Payer: CIGNA Commercial |
$492.10
|
| Rate for Payer: CIGNA Medicare |
$466.20
|
| Rate for Payer: HUMANA Commercial |
$466.20
|
| Rate for Payer: MEDICAID Medicaid |
$476.56
|
| Rate for Payer: MEDICARE Medicare |
$362.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$492.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$502.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$492.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$492.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$440.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$414.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$414.40
|
|
|
EXCISION BENIGN LESION 3.1-4.0 CM
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$362.60 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: AETNA Commercial |
$492.10
|
| Rate for Payer: AETNA Medicare |
$466.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$492.10
|
| Rate for Payer: BCBS Healthlink |
$466.20
|
| Rate for Payer: BCBS HMK CHIP |
$466.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$466.20
|
| Rate for Payer: BCBS POS |
$492.10
|
| Rate for Payer: BCBS Traditional |
$518.00
|
| Rate for Payer: CASH_PRICE |
$414.40
|
| Rate for Payer: CIGNA Commercial |
$492.10
|
| Rate for Payer: CIGNA Medicare |
$466.20
|
| Rate for Payer: HUMANA Commercial |
$466.20
|
| Rate for Payer: MEDICAID Medicaid |
$476.56
|
| Rate for Payer: MEDICARE Medicare |
$362.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$492.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$502.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$492.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$492.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$440.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$414.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$414.40
|
|
|
EXCISION BENIGN LESION + MARGINS >0.5CM
|
Facility
IP
|
$553.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: BCBS HMK CHIP |
$497.70
|
| Rate for Payer: AETNA Commercial |
$525.35
|
| Rate for Payer: AETNA Medicare |
$497.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$525.35
|
| Rate for Payer: BCBS Healthlink |
$497.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$497.70
|
| Rate for Payer: BCBS POS |
$525.35
|
| Rate for Payer: BCBS Traditional |
$553.00
|
| Rate for Payer: CASH_PRICE |
$442.40
|
| Rate for Payer: CIGNA Commercial |
$525.35
|
| Rate for Payer: CIGNA Medicare |
$497.70
|
| Rate for Payer: HUMANA Commercial |
$497.70
|
| Rate for Payer: MEDICAID Medicaid |
$508.76
|
| Rate for Payer: MEDICARE Medicare |
$387.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$525.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$536.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$525.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$525.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$470.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$442.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$442.40
|
|
|
EXCISION BENIGN LESION + MARGINS >0.5CM
|
Facility
OP
|
$553.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: AETNA Commercial |
$525.35
|
| Rate for Payer: AETNA Medicare |
$497.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$525.35
|
| Rate for Payer: BCBS Healthlink |
$497.70
|
| Rate for Payer: BCBS HMK CHIP |
$497.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$497.70
|
| Rate for Payer: BCBS POS |
$525.35
|
| Rate for Payer: BCBS Traditional |
$553.00
|
| Rate for Payer: CASH_PRICE |
$442.40
|
| Rate for Payer: CIGNA Commercial |
$525.35
|
| Rate for Payer: CIGNA Medicare |
$497.70
|
| Rate for Payer: HUMANA Commercial |
$497.70
|
| Rate for Payer: MEDICAID Medicaid |
$508.76
|
| Rate for Payer: MEDICARE Medicare |
$387.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$525.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$536.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$525.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$525.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$470.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$442.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$442.40
|
|
|
EXCISION BENIGN LESION + MARGINS 0.6-1CM
|
Facility
OP
|
$553.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: AETNA Commercial |
$525.35
|
| Rate for Payer: AETNA Medicare |
$497.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$525.35
|
| Rate for Payer: BCBS Healthlink |
$497.70
|
| Rate for Payer: BCBS HMK CHIP |
$497.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$497.70
|
| Rate for Payer: BCBS POS |
$525.35
|
| Rate for Payer: BCBS Traditional |
$553.00
|
| Rate for Payer: CASH_PRICE |
$442.40
|
| Rate for Payer: CIGNA Commercial |
$525.35
|
| Rate for Payer: CIGNA Medicare |
$497.70
|
| Rate for Payer: HUMANA Commercial |
$497.70
|
| Rate for Payer: MEDICAID Medicaid |
$508.76
|
| Rate for Payer: MEDICARE Medicare |
$387.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$525.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$536.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$525.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$525.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$470.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$442.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$442.40
|
|
|
EXCISION BENIGN LESION + MARGINS 0.6-1CM
|
Facility
IP
|
$553.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$553.00 |
| Rate for Payer: AETNA Commercial |
$525.35
|
| Rate for Payer: AETNA Medicare |
$497.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$525.35
|
| Rate for Payer: BCBS Healthlink |
$497.70
|
| Rate for Payer: BCBS HMK CHIP |
$497.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$497.70
|
| Rate for Payer: BCBS POS |
$525.35
|
| Rate for Payer: BCBS Traditional |
$553.00
|
| Rate for Payer: CASH_PRICE |
$442.40
|
| Rate for Payer: CIGNA Commercial |
$525.35
|
| Rate for Payer: CIGNA Medicare |
$497.70
|
| Rate for Payer: HUMANA Commercial |
$497.70
|
| Rate for Payer: MEDICAID Medicaid |
$508.76
|
| Rate for Payer: MEDICARE Medicare |
$387.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$525.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$536.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$525.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$525.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$470.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$442.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$442.40
|
|
|
EXCISION BENIGN LESION-SCALP-1.1-2.0CM
|
Facility
IP
|
$442.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: BCBS HMK CHIP |
$397.80
|
| Rate for Payer: AETNA Commercial |
$419.90
|
| Rate for Payer: AETNA Medicare |
$397.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$419.90
|
| Rate for Payer: BCBS Healthlink |
$397.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$397.80
|
| Rate for Payer: BCBS POS |
$419.90
|
| Rate for Payer: BCBS Traditional |
$442.00
|
| Rate for Payer: CASH_PRICE |
$353.60
|
| Rate for Payer: CIGNA Commercial |
$419.90
|
| Rate for Payer: CIGNA Medicare |
$397.80
|
| Rate for Payer: HUMANA Commercial |
$397.80
|
| Rate for Payer: MEDICAID Medicaid |
$406.64
|
| Rate for Payer: MEDICARE Medicare |
$309.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$419.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$428.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$419.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$419.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$375.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$353.60
|
|
|
EXCISION BENIGN LESION-SCALP-1.1-2.0CM
|
Facility
OP
|
$442.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AETNA Commercial |
$419.90
|
| Rate for Payer: AETNA Medicare |
$397.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$419.90
|
| Rate for Payer: BCBS Healthlink |
$397.80
|
| Rate for Payer: BCBS HMK CHIP |
$397.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$397.80
|
| Rate for Payer: BCBS POS |
$419.90
|
| Rate for Payer: BCBS Traditional |
$442.00
|
| Rate for Payer: CASH_PRICE |
$353.60
|
| Rate for Payer: CIGNA Commercial |
$419.90
|
| Rate for Payer: CIGNA Medicare |
$397.80
|
| Rate for Payer: HUMANA Commercial |
$397.80
|
| Rate for Payer: MEDICAID Medicaid |
$406.64
|
| Rate for Payer: MEDICARE Medicare |
$309.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$419.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$428.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$419.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$419.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$375.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$353.60
|
|
|
EXCISION MALIG LESION 0.6-1.0CM
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: AETNA Commercial |
$386.65
|
| Rate for Payer: AETNA Medicare |
$366.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.65
|
| Rate for Payer: BCBS Healthlink |
$366.30
|
| Rate for Payer: BCBS HMK CHIP |
$366.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$366.30
|
| Rate for Payer: BCBS POS |
$386.65
|
| Rate for Payer: BCBS Traditional |
$407.00
|
| Rate for Payer: CASH_PRICE |
$325.60
|
| Rate for Payer: CIGNA Commercial |
$386.65
|
| Rate for Payer: CIGNA Medicare |
$366.30
|
| Rate for Payer: HUMANA Commercial |
$366.30
|
| Rate for Payer: MEDICAID Medicaid |
$374.44
|
| Rate for Payer: MEDICARE Medicare |
$284.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.60
|
|
|
EXCISION MALIG LESION 0.6-1.0CM
|
Facility
OP
|
$407.00
|
|
|
Service Code
|
CPT 11601
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: AETNA Commercial |
$386.65
|
| Rate for Payer: AETNA Medicare |
$366.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.65
|
| Rate for Payer: BCBS Healthlink |
$366.30
|
| Rate for Payer: BCBS HMK CHIP |
$366.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$366.30
|
| Rate for Payer: BCBS POS |
$386.65
|
| Rate for Payer: BCBS Traditional |
$407.00
|
| Rate for Payer: CASH_PRICE |
$325.60
|
| Rate for Payer: CIGNA Commercial |
$386.65
|
| Rate for Payer: CIGNA Medicare |
$366.30
|
| Rate for Payer: HUMANA Commercial |
$366.30
|
| Rate for Payer: MEDICAID Medicaid |
$374.44
|
| Rate for Payer: MEDICARE Medicare |
$284.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.60
|
|
|
EXCISION MALIG LESION 1.1-2.0CM
|
Facility
IP
|
$443.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$310.10 |
| Max. Negotiated Rate |
$443.00 |
| Rate for Payer: BCBS HMK CHIP |
$398.70
|
| Rate for Payer: AETNA Commercial |
$420.85
|
| Rate for Payer: AETNA Medicare |
$398.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$420.85
|
| Rate for Payer: BCBS Healthlink |
$398.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$398.70
|
| Rate for Payer: BCBS POS |
$420.85
|
| Rate for Payer: BCBS Traditional |
$443.00
|
| Rate for Payer: CASH_PRICE |
$354.40
|
| Rate for Payer: CIGNA Commercial |
$420.85
|
| Rate for Payer: CIGNA Medicare |
$398.70
|
| Rate for Payer: HUMANA Commercial |
$398.70
|
| Rate for Payer: MEDICAID Medicaid |
$407.56
|
| Rate for Payer: MEDICARE Medicare |
$310.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$420.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$429.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$420.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$420.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$376.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$354.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$354.40
|
|
|
EXCISION MALIG LESION 1.1-2.0CM
|
Facility
OP
|
$443.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$310.10 |
| Max. Negotiated Rate |
$443.00 |
| Rate for Payer: AETNA Commercial |
$420.85
|
| Rate for Payer: AETNA Medicare |
$398.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$420.85
|
| Rate for Payer: BCBS Healthlink |
$398.70
|
| Rate for Payer: BCBS HMK CHIP |
$398.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$398.70
|
| Rate for Payer: BCBS POS |
$420.85
|
| Rate for Payer: BCBS Traditional |
$443.00
|
| Rate for Payer: CASH_PRICE |
$354.40
|
| Rate for Payer: CIGNA Commercial |
$420.85
|
| Rate for Payer: CIGNA Medicare |
$398.70
|
| Rate for Payer: HUMANA Commercial |
$398.70
|
| Rate for Payer: MEDICAID Medicaid |
$407.56
|
| Rate for Payer: MEDICARE Medicare |
$310.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$420.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$429.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$420.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$420.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$376.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$354.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$354.40
|
|
|
EXCISION NAIL INGROWN PART/COMPLETE
|
Facility
OP
|
$491.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$343.70 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: AETNA Commercial |
$466.45
|
| Rate for Payer: AETNA Medicare |
$441.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$466.45
|
| Rate for Payer: BCBS Healthlink |
$441.90
|
| Rate for Payer: BCBS HMK CHIP |
$441.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$441.90
|
| Rate for Payer: BCBS POS |
$466.45
|
| Rate for Payer: BCBS Traditional |
$491.00
|
| Rate for Payer: CASH_PRICE |
$392.80
|
| Rate for Payer: CIGNA Commercial |
$466.45
|
| Rate for Payer: CIGNA Medicare |
$441.90
|
| Rate for Payer: HUMANA Commercial |
$441.90
|
| Rate for Payer: MEDICAID Medicaid |
$451.72
|
| Rate for Payer: MEDICARE Medicare |
$343.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$466.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$476.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$466.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$466.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$417.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$392.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$392.80
|
|
|
EXCISION NAIL INGROWN PART/COMPLETE
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$343.70 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: AETNA Commercial |
$466.45
|
| Rate for Payer: AETNA Medicare |
$441.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$466.45
|
| Rate for Payer: BCBS Healthlink |
$441.90
|
| Rate for Payer: BCBS HMK CHIP |
$441.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$441.90
|
| Rate for Payer: BCBS POS |
$466.45
|
| Rate for Payer: BCBS Traditional |
$491.00
|
| Rate for Payer: CASH_PRICE |
$392.80
|
| Rate for Payer: CIGNA Commercial |
$466.45
|
| Rate for Payer: CIGNA Medicare |
$441.90
|
| Rate for Payer: HUMANA Commercial |
$441.90
|
| Rate for Payer: MEDICAID Medicaid |
$451.72
|
| Rate for Payer: MEDICARE Medicare |
$343.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$466.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$476.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$466.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$466.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$417.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$392.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$392.80
|
|
|
EXCISION OF NAIL FOLD SKIN
|
Facility
OP
|
$286.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: AETNA Commercial |
$271.70
|
| Rate for Payer: AETNA Medicare |
$257.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$271.70
|
| Rate for Payer: BCBS Healthlink |
$257.40
|
| Rate for Payer: BCBS HMK CHIP |
$257.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$257.40
|
| Rate for Payer: BCBS POS |
$271.70
|
| Rate for Payer: BCBS Traditional |
$286.00
|
| Rate for Payer: CASH_PRICE |
$228.80
|
| Rate for Payer: CIGNA Commercial |
$271.70
|
| Rate for Payer: CIGNA Medicare |
$257.40
|
| Rate for Payer: HUMANA Commercial |
$257.40
|
| Rate for Payer: MEDICAID Medicaid |
$263.12
|
| Rate for Payer: MEDICARE Medicare |
$200.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$271.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$277.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$271.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$271.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$243.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$228.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$228.80
|
|
|
EXCISION OF NAIL FOLD SKIN
|
Facility
IP
|
$286.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: BCBS HMK CHIP |
$257.40
|
| Rate for Payer: AETNA Commercial |
$271.70
|
| Rate for Payer: AETNA Medicare |
$257.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$271.70
|
| Rate for Payer: BCBS Healthlink |
$257.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$257.40
|
| Rate for Payer: BCBS POS |
$271.70
|
| Rate for Payer: BCBS Traditional |
$286.00
|
| Rate for Payer: CASH_PRICE |
$228.80
|
| Rate for Payer: CIGNA Commercial |
$271.70
|
| Rate for Payer: CIGNA Medicare |
$257.40
|
| Rate for Payer: HUMANA Commercial |
$257.40
|
| Rate for Payer: MEDICAID Medicaid |
$263.12
|
| Rate for Payer: MEDICARE Medicare |
$200.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$271.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$277.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$271.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$271.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$243.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$228.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$228.80
|
|
|
.EXTRACTABLE NUCLEAR AG AB (160014)
|
Facility
IP
|
$187.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
.EXTRACTABLE NUCLEAR AG AB (160014)
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
EYE PADS
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
EYE PADS
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
EYE STREAM IRRIGATING RINSE [4 OZ]
|
Facility
OP
|
$117.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: AETNA Commercial |
$111.15
|
| Rate for Payer: AETNA Medicare |
$105.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$111.15
|
| Rate for Payer: BCBS Healthlink |
$105.30
|
| Rate for Payer: BCBS HMK CHIP |
$105.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$105.30
|
| Rate for Payer: BCBS POS |
$111.15
|
| Rate for Payer: BCBS Traditional |
$117.00
|
| Rate for Payer: CASH_PRICE |
$93.60
|
| Rate for Payer: CIGNA Commercial |
$111.15
|
| Rate for Payer: CIGNA Medicare |
$105.30
|
| Rate for Payer: HUMANA Commercial |
$105.30
|
| Rate for Payer: MEDICAID Medicaid |
$107.64
|
| Rate for Payer: MEDICARE Medicare |
$81.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$111.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$113.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$111.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$111.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$99.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$93.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$93.60
|
|
