|
FX CLOSED CARPAL BONE EA BONE W/O MANIP
|
Facility
OP
|
$643.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$450.10 |
| Max. Negotiated Rate |
$643.00 |
| Rate for Payer: AETNA Commercial |
$610.85
|
| Rate for Payer: AETNA Medicare |
$578.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$610.85
|
| Rate for Payer: BCBS Healthlink |
$578.70
|
| Rate for Payer: BCBS HMK CHIP |
$578.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$578.70
|
| Rate for Payer: BCBS POS |
$610.85
|
| Rate for Payer: BCBS Traditional |
$643.00
|
| Rate for Payer: CASH_PRICE |
$514.40
|
| Rate for Payer: CIGNA Commercial |
$610.85
|
| Rate for Payer: CIGNA Medicare |
$578.70
|
| Rate for Payer: HUMANA Commercial |
$578.70
|
| Rate for Payer: MEDICAID Medicaid |
$591.56
|
| Rate for Payer: MEDICARE Medicare |
$450.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$610.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$623.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$610.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$610.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$546.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$514.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$514.40
|
|
|
FX CLOSED CARPAL BONE EA BONE W/O MANIP
|
Facility
IP
|
$643.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$450.10 |
| Max. Negotiated Rate |
$643.00 |
| Rate for Payer: BCBS HMK CHIP |
$578.70
|
| Rate for Payer: AETNA Commercial |
$610.85
|
| Rate for Payer: AETNA Medicare |
$578.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$610.85
|
| Rate for Payer: BCBS Healthlink |
$578.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$578.70
|
| Rate for Payer: BCBS POS |
$610.85
|
| Rate for Payer: BCBS Traditional |
$643.00
|
| Rate for Payer: CASH_PRICE |
$514.40
|
| Rate for Payer: CIGNA Commercial |
$610.85
|
| Rate for Payer: CIGNA Medicare |
$578.70
|
| Rate for Payer: HUMANA Commercial |
$578.70
|
| Rate for Payer: MEDICAID Medicaid |
$591.56
|
| Rate for Payer: MEDICARE Medicare |
$450.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$610.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$623.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$610.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$610.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$546.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$514.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$514.40
|
|
|
FX CLOSED DISTAL FIBULA W/O MAN
|
Facility
OP
|
$685.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$479.50 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: AETNA Commercial |
$650.75
|
| Rate for Payer: AETNA Medicare |
$616.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$650.75
|
| Rate for Payer: BCBS Healthlink |
$616.50
|
| Rate for Payer: BCBS HMK CHIP |
$616.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$616.50
|
| Rate for Payer: BCBS POS |
$650.75
|
| Rate for Payer: BCBS Traditional |
$685.00
|
| Rate for Payer: CASH_PRICE |
$548.00
|
| Rate for Payer: CIGNA Commercial |
$650.75
|
| Rate for Payer: CIGNA Medicare |
$616.50
|
| Rate for Payer: HUMANA Commercial |
$616.50
|
| Rate for Payer: MEDICAID Medicaid |
$630.20
|
| Rate for Payer: MEDICARE Medicare |
$479.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$650.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$664.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$650.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$650.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$582.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$548.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$548.00
|
|
|
FX CLOSED DISTAL FIBULA W/O MAN
|
Facility
IP
|
$685.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$479.50 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: AETNA Commercial |
$650.75
|
| Rate for Payer: AETNA Medicare |
$616.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$650.75
|
| Rate for Payer: BCBS Healthlink |
$616.50
|
| Rate for Payer: BCBS HMK CHIP |
$616.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$616.50
|
| Rate for Payer: BCBS POS |
$650.75
|
| Rate for Payer: BCBS Traditional |
$685.00
|
| Rate for Payer: CASH_PRICE |
$548.00
|
| Rate for Payer: CIGNA Commercial |
$650.75
|
| Rate for Payer: CIGNA Medicare |
$616.50
|
| Rate for Payer: HUMANA Commercial |
$616.50
|
| Rate for Payer: MEDICAID Medicaid |
$630.20
|
| Rate for Payer: MEDICARE Medicare |
$479.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$650.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$664.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$650.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$650.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$582.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$548.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$548.00
|
|
|
FX CLOSED DISTAL PHLANG W/O MANIPULATION
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: AETNA Commercial |
$532.00
|
| Rate for Payer: AETNA Medicare |
$504.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$532.00
|
| Rate for Payer: BCBS Healthlink |
$504.00
|
| Rate for Payer: BCBS HMK CHIP |
$504.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$504.00
|
| Rate for Payer: BCBS POS |
$532.00
|
| Rate for Payer: BCBS Traditional |
$560.00
|
| Rate for Payer: CASH_PRICE |
$448.00
|
| Rate for Payer: CIGNA Commercial |
$532.00
|
| Rate for Payer: CIGNA Medicare |
$504.00
|
| Rate for Payer: HUMANA Commercial |
$504.00
|
| Rate for Payer: MEDICAID Medicaid |
$515.20
|
| Rate for Payer: MEDICARE Medicare |
$392.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$532.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$543.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$532.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$532.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$476.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$448.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$448.00
|
|
|
FX CLOSED DISTAL PHLANG W/O MANIPULATION
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: BCBS HMK CHIP |
$504.00
|
| Rate for Payer: AETNA Commercial |
$532.00
|
| Rate for Payer: AETNA Medicare |
$504.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$532.00
|
| Rate for Payer: BCBS Healthlink |
$504.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$504.00
|
| Rate for Payer: BCBS POS |
$532.00
|
| Rate for Payer: BCBS Traditional |
$560.00
|
| Rate for Payer: CASH_PRICE |
$448.00
|
| Rate for Payer: CIGNA Commercial |
$532.00
|
| Rate for Payer: CIGNA Medicare |
$504.00
|
| Rate for Payer: HUMANA Commercial |
$504.00
|
| Rate for Payer: MEDICAID Medicaid |
$515.20
|
| Rate for Payer: MEDICARE Medicare |
$392.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$532.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$543.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$532.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$532.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$476.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$448.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$448.00
|
|
|
FX CLOSED DISTAL RADIAL W/O MANIPUL
|
Facility
OP
|
$615.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: AETNA Commercial |
$584.25
|
| Rate for Payer: AETNA Medicare |
$553.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$584.25
|
| Rate for Payer: BCBS Healthlink |
$553.50
|
| Rate for Payer: BCBS HMK CHIP |
$553.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$553.50
|
| Rate for Payer: BCBS POS |
$584.25
|
| Rate for Payer: BCBS Traditional |
$615.00
|
| Rate for Payer: CASH_PRICE |
$492.00
|
| Rate for Payer: CIGNA Commercial |
$584.25
|
| Rate for Payer: CIGNA Medicare |
$553.50
|
| Rate for Payer: HUMANA Commercial |
$553.50
|
| Rate for Payer: MEDICAID Medicaid |
$565.80
|
| Rate for Payer: MEDICARE Medicare |
$430.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$584.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$596.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$584.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$584.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$522.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$492.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$492.00
|
|
|
FX CLOSED DISTAL RADIAL W/O MANIPUL
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: AETNA Commercial |
$584.25
|
| Rate for Payer: AETNA Medicare |
$553.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$584.25
|
| Rate for Payer: BCBS Healthlink |
$553.50
|
| Rate for Payer: BCBS HMK CHIP |
$553.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$553.50
|
| Rate for Payer: BCBS POS |
$584.25
|
| Rate for Payer: BCBS Traditional |
$615.00
|
| Rate for Payer: CASH_PRICE |
$492.00
|
| Rate for Payer: CIGNA Commercial |
$584.25
|
| Rate for Payer: CIGNA Medicare |
$553.50
|
| Rate for Payer: HUMANA Commercial |
$553.50
|
| Rate for Payer: MEDICAID Medicaid |
$565.80
|
| Rate for Payer: MEDICARE Medicare |
$430.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$584.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$596.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$584.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$584.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$522.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$492.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$492.00
|
|
|
FX CLOSED FIBULA PROXIMAL/SHAFT W/O MAN
|
Facility
IP
|
$656.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: BCBS HMK CHIP |
$590.40
|
| Rate for Payer: AETNA Commercial |
$623.20
|
| Rate for Payer: AETNA Medicare |
$590.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$623.20
|
| Rate for Payer: BCBS Healthlink |
$590.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$590.40
|
| Rate for Payer: BCBS POS |
$623.20
|
| Rate for Payer: BCBS Traditional |
$656.00
|
| Rate for Payer: CASH_PRICE |
$524.80
|
| Rate for Payer: CIGNA Commercial |
$623.20
|
| Rate for Payer: CIGNA Medicare |
$590.40
|
| Rate for Payer: HUMANA Commercial |
$590.40
|
| Rate for Payer: MEDICAID Medicaid |
$603.52
|
| Rate for Payer: MEDICARE Medicare |
$459.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$623.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$636.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$623.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$623.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$557.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$524.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$524.80
|
|
|
FX CLOSED FIBULA PROXIMAL/SHAFT W/O MAN
|
Facility
OP
|
$656.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: AETNA Commercial |
$623.20
|
| Rate for Payer: AETNA Medicare |
$590.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$623.20
|
| Rate for Payer: BCBS Healthlink |
$590.40
|
| Rate for Payer: BCBS HMK CHIP |
$590.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$590.40
|
| Rate for Payer: BCBS POS |
$623.20
|
| Rate for Payer: BCBS Traditional |
$656.00
|
| Rate for Payer: CASH_PRICE |
$524.80
|
| Rate for Payer: CIGNA Commercial |
$623.20
|
| Rate for Payer: CIGNA Medicare |
$590.40
|
| Rate for Payer: HUMANA Commercial |
$590.40
|
| Rate for Payer: MEDICAID Medicaid |
$603.52
|
| Rate for Payer: MEDICARE Medicare |
$459.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$623.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$636.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$623.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$623.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$557.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$524.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$524.80
|
|
|
FX CLOSED METACARPAL SINGLE W/O MANIPUL
|
Facility
OP
|
$531.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$371.70 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: AETNA Commercial |
$504.45
|
| Rate for Payer: AETNA Medicare |
$477.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$504.45
|
| Rate for Payer: BCBS Healthlink |
$477.90
|
| Rate for Payer: BCBS HMK CHIP |
$477.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$477.90
|
| Rate for Payer: BCBS POS |
$504.45
|
| Rate for Payer: BCBS Traditional |
$531.00
|
| Rate for Payer: CASH_PRICE |
$424.80
|
| Rate for Payer: CIGNA Commercial |
$504.45
|
| Rate for Payer: CIGNA Medicare |
$477.90
|
| Rate for Payer: HUMANA Commercial |
$477.90
|
| Rate for Payer: MEDICAID Medicaid |
$488.52
|
| Rate for Payer: MEDICARE Medicare |
$371.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$504.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$515.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$504.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$504.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$451.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$424.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$424.80
|
|
|
FX CLOSED METACARPAL SINGLE W/O MANIPUL
|
Facility
IP
|
$531.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$371.70 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: AETNA Commercial |
$504.45
|
| Rate for Payer: AETNA Medicare |
$477.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$504.45
|
| Rate for Payer: BCBS Healthlink |
$477.90
|
| Rate for Payer: BCBS HMK CHIP |
$477.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$477.90
|
| Rate for Payer: BCBS POS |
$504.45
|
| Rate for Payer: BCBS Traditional |
$531.00
|
| Rate for Payer: CASH_PRICE |
$424.80
|
| Rate for Payer: CIGNA Commercial |
$504.45
|
| Rate for Payer: CIGNA Medicare |
$477.90
|
| Rate for Payer: HUMANA Commercial |
$477.90
|
| Rate for Payer: MEDICAID Medicaid |
$488.52
|
| Rate for Payer: MEDICARE Medicare |
$371.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$504.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$515.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$504.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$504.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$451.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$424.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$424.80
|
|
|
FX CLOSED METATARSAL W/O MANIPULATION
|
Facility
IP
|
$552.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: BCBS HMK CHIP |
$496.80
|
| Rate for Payer: AETNA Commercial |
$524.40
|
| Rate for Payer: AETNA Medicare |
$496.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$524.40
|
| Rate for Payer: BCBS Healthlink |
$496.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$496.80
|
| Rate for Payer: BCBS POS |
$524.40
|
| Rate for Payer: BCBS Traditional |
$552.00
|
| Rate for Payer: CASH_PRICE |
$441.60
|
| Rate for Payer: CIGNA Commercial |
$524.40
|
| Rate for Payer: CIGNA Medicare |
$496.80
|
| Rate for Payer: HUMANA Commercial |
$496.80
|
| Rate for Payer: MEDICAID Medicaid |
$507.84
|
| Rate for Payer: MEDICARE Medicare |
$386.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$524.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$535.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$524.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$524.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$469.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$441.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$441.60
|
|
|
FX CLOSED METATARSAL W/O MANIPULATION
|
Facility
OP
|
$552.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: AETNA Commercial |
$524.40
|
| Rate for Payer: AETNA Medicare |
$496.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$524.40
|
| Rate for Payer: BCBS Healthlink |
$496.80
|
| Rate for Payer: BCBS HMK CHIP |
$496.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$496.80
|
| Rate for Payer: BCBS POS |
$524.40
|
| Rate for Payer: BCBS Traditional |
$552.00
|
| Rate for Payer: CASH_PRICE |
$441.60
|
| Rate for Payer: CIGNA Commercial |
$524.40
|
| Rate for Payer: CIGNA Medicare |
$496.80
|
| Rate for Payer: HUMANA Commercial |
$496.80
|
| Rate for Payer: MEDICAID Medicaid |
$507.84
|
| Rate for Payer: MEDICARE Medicare |
$386.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$524.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$535.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$524.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$524.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$469.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$441.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$441.60
|
|
|
FX CLOSED PATELLA/KNEE CAP
|
Facility
IP
|
$552.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: AETNA Commercial |
$524.40
|
| Rate for Payer: AETNA Medicare |
$496.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$524.40
|
| Rate for Payer: BCBS Healthlink |
$496.80
|
| Rate for Payer: BCBS HMK CHIP |
$496.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$496.80
|
| Rate for Payer: BCBS POS |
$524.40
|
| Rate for Payer: BCBS Traditional |
$552.00
|
| Rate for Payer: CASH_PRICE |
$441.60
|
| Rate for Payer: CIGNA Commercial |
$524.40
|
| Rate for Payer: CIGNA Medicare |
$496.80
|
| Rate for Payer: HUMANA Commercial |
$496.80
|
| Rate for Payer: MEDICAID Medicaid |
$507.84
|
| Rate for Payer: MEDICARE Medicare |
$386.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$524.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$535.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$524.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$524.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$469.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$441.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$441.60
|
|
|
FX CLOSED PATELLA/KNEE CAP
|
Facility
OP
|
$552.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: AETNA Commercial |
$524.40
|
| Rate for Payer: AETNA Medicare |
$496.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$524.40
|
| Rate for Payer: BCBS Healthlink |
$496.80
|
| Rate for Payer: BCBS HMK CHIP |
$496.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$496.80
|
| Rate for Payer: BCBS POS |
$524.40
|
| Rate for Payer: BCBS Traditional |
$552.00
|
| Rate for Payer: CASH_PRICE |
$441.60
|
| Rate for Payer: CIGNA Commercial |
$524.40
|
| Rate for Payer: CIGNA Medicare |
$496.80
|
| Rate for Payer: HUMANA Commercial |
$496.80
|
| Rate for Payer: MEDICAID Medicaid |
$507.84
|
| Rate for Payer: MEDICARE Medicare |
$386.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$524.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$535.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$524.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$524.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$469.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$441.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$441.60
|
|
|
FX CLOSED PHALAN/PROX/MIDDLE W/O MANIPUL
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
|
FX CLOSED PHALAN/PROX/MIDDLE W/O MANIPUL
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
|
FX CLOSED RADIAL SHAFT W/O MANIPUL
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 25500
|
| 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
|
|
|
FX CLOSED RADIAL SHAFT W/O MANIPUL
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 25500
|
| 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
|
|
|
FX CLOSED TARSAL W/O MANIPULATION
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: AETNA Commercial |
$552.90
|
| Rate for Payer: AETNA Medicare |
$523.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$552.90
|
| Rate for Payer: BCBS Healthlink |
$523.80
|
| Rate for Payer: BCBS HMK CHIP |
$523.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$523.80
|
| Rate for Payer: BCBS POS |
$552.90
|
| Rate for Payer: BCBS Traditional |
$582.00
|
| Rate for Payer: CASH_PRICE |
$465.60
|
| Rate for Payer: CIGNA Commercial |
$552.90
|
| Rate for Payer: CIGNA Medicare |
$523.80
|
| Rate for Payer: HUMANA Commercial |
$523.80
|
| Rate for Payer: MEDICAID Medicaid |
$535.44
|
| Rate for Payer: MEDICARE Medicare |
$407.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$552.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$564.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$552.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$552.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$494.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$465.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$465.60
|
|
|
FX CLOSED TARSAL W/O MANIPULATION
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: BCBS HMK CHIP |
$523.80
|
| Rate for Payer: AETNA Commercial |
$552.90
|
| Rate for Payer: AETNA Medicare |
$523.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$552.90
|
| Rate for Payer: BCBS Healthlink |
$523.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$523.80
|
| Rate for Payer: BCBS POS |
$552.90
|
| Rate for Payer: BCBS Traditional |
$582.00
|
| Rate for Payer: CASH_PRICE |
$465.60
|
| Rate for Payer: CIGNA Commercial |
$552.90
|
| Rate for Payer: CIGNA Medicare |
$523.80
|
| Rate for Payer: HUMANA Commercial |
$523.80
|
| Rate for Payer: MEDICAID Medicaid |
$535.44
|
| Rate for Payer: MEDICARE Medicare |
$407.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$552.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$564.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$552.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$552.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$494.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$465.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$465.60
|
|
|
FX CLOSED TIBIAL PROXIMAL PLATEAU
|
Facility
IP
|
$820.00
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: BCBS HMK CHIP |
$738.00
|
| Rate for Payer: AETNA Commercial |
$779.00
|
| Rate for Payer: AETNA Medicare |
$738.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$779.00
|
| Rate for Payer: BCBS Healthlink |
$738.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$738.00
|
| Rate for Payer: BCBS POS |
$779.00
|
| Rate for Payer: BCBS Traditional |
$820.00
|
| Rate for Payer: CASH_PRICE |
$656.00
|
| Rate for Payer: CIGNA Commercial |
$779.00
|
| Rate for Payer: CIGNA Medicare |
$738.00
|
| Rate for Payer: HUMANA Commercial |
$738.00
|
| Rate for Payer: MEDICAID Medicaid |
$754.40
|
| Rate for Payer: MEDICARE Medicare |
$574.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$779.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$795.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$779.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$779.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$697.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$656.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$656.00
|
|
|
FX CLOSED TIBIAL PROXIMAL PLATEAU
|
Facility
OP
|
$820.00
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: AETNA Commercial |
$779.00
|
| Rate for Payer: AETNA Medicare |
$738.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$779.00
|
| Rate for Payer: BCBS Healthlink |
$738.00
|
| Rate for Payer: BCBS HMK CHIP |
$738.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$738.00
|
| Rate for Payer: BCBS POS |
$779.00
|
| Rate for Payer: BCBS Traditional |
$820.00
|
| Rate for Payer: CASH_PRICE |
$656.00
|
| Rate for Payer: CIGNA Commercial |
$779.00
|
| Rate for Payer: CIGNA Medicare |
$738.00
|
| Rate for Payer: HUMANA Commercial |
$738.00
|
| Rate for Payer: MEDICAID Medicaid |
$754.40
|
| Rate for Payer: MEDICARE Medicare |
$574.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$779.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$795.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$779.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$779.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$697.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$656.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$656.00
|
|
|
FX CLOSED TIBIA SHAFT W/O MANIPULA
|
Facility
IP
|
$823.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$576.10 |
| Max. Negotiated Rate |
$823.00 |
| Rate for Payer: AETNA Commercial |
$781.85
|
| Rate for Payer: AETNA Medicare |
$740.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$781.85
|
| Rate for Payer: BCBS Healthlink |
$740.70
|
| Rate for Payer: BCBS HMK CHIP |
$740.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$740.70
|
| Rate for Payer: BCBS POS |
$781.85
|
| Rate for Payer: BCBS Traditional |
$823.00
|
| Rate for Payer: CASH_PRICE |
$658.40
|
| Rate for Payer: CIGNA Commercial |
$781.85
|
| Rate for Payer: CIGNA Medicare |
$740.70
|
| Rate for Payer: HUMANA Commercial |
$740.70
|
| Rate for Payer: MEDICAID Medicaid |
$757.16
|
| Rate for Payer: MEDICARE Medicare |
$576.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$781.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$798.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$781.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$781.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$699.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$658.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$658.40
|
|
