|
HEPATITIS B SURFACE AG SCREEN (006510)
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
HEPATITIS B SURFACE ANTIBODY (006395)
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
HEPATITIS B SURFACE ANTIBODY (006395)
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
HEPATITIS C VIRUS ANTIBODY (140659)
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
HEPATITIS C VIRUS ANTIBODY (140659)
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
HEPATITIS C VIRUS FIBROSURE (550123)
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: AETNA Commercial |
$374.30
|
| Rate for Payer: AETNA Medicare |
$354.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$374.30
|
| Rate for Payer: BCBS Healthlink |
$354.60
|
| Rate for Payer: BCBS HMK CHIP |
$354.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$354.60
|
| Rate for Payer: BCBS POS |
$374.30
|
| Rate for Payer: BCBS Traditional |
$394.00
|
| Rate for Payer: CASH_PRICE |
$315.20
|
| Rate for Payer: CIGNA Commercial |
$374.30
|
| Rate for Payer: CIGNA Medicare |
$354.60
|
| Rate for Payer: HUMANA Commercial |
$354.60
|
| Rate for Payer: MEDICAID Medicaid |
$362.48
|
| Rate for Payer: MEDICARE Medicare |
$275.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$374.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$382.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$374.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$374.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$334.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$315.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$315.20
|
|
|
HEPATITIS C VIRUS FIBROSURE (550123)
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: BCBS HMK CHIP |
$354.60
|
| Rate for Payer: AETNA Commercial |
$374.30
|
| Rate for Payer: AETNA Medicare |
$354.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$374.30
|
| Rate for Payer: BCBS Healthlink |
$354.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$354.60
|
| Rate for Payer: BCBS POS |
$374.30
|
| Rate for Payer: BCBS Traditional |
$394.00
|
| Rate for Payer: CASH_PRICE |
$315.20
|
| Rate for Payer: CIGNA Commercial |
$374.30
|
| Rate for Payer: CIGNA Medicare |
$354.60
|
| Rate for Payer: HUMANA Commercial |
$354.60
|
| Rate for Payer: MEDICAID Medicaid |
$362.48
|
| Rate for Payer: MEDICARE Medicare |
$275.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$374.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$382.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$374.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$374.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$334.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$315.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$315.20
|
|
|
HEP B CORE AB TOTAL W/ RFLX IGM (160101)
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
HEP B CORE AB TOTAL W/ RFLX IGM (160101)
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
HIP DISLOCATION CLOSED W/O ANESTH
|
Facility
OP
|
$1,005.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$703.50 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: AETNA Commercial |
$954.75
|
| Rate for Payer: AETNA Medicare |
$904.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$954.75
|
| Rate for Payer: BCBS Healthlink |
$904.50
|
| Rate for Payer: BCBS HMK CHIP |
$904.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$904.50
|
| Rate for Payer: BCBS POS |
$954.75
|
| Rate for Payer: BCBS Traditional |
$1,005.00
|
| Rate for Payer: CASH_PRICE |
$804.00
|
| Rate for Payer: CIGNA Commercial |
$954.75
|
| Rate for Payer: CIGNA Medicare |
$904.50
|
| Rate for Payer: HUMANA Commercial |
$904.50
|
| Rate for Payer: MEDICAID Medicaid |
$924.60
|
| Rate for Payer: MEDICARE Medicare |
$703.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$954.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$974.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$954.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$954.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$854.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$804.00
|
|
|
HIP DISLOCATION CLOSED W/O ANESTH
|
Facility
IP
|
$1,005.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$703.50 |
| Max. Negotiated Rate |
$1,005.00 |
| Rate for Payer: AETNA Commercial |
$954.75
|
| Rate for Payer: AETNA Medicare |
$904.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$954.75
|
| Rate for Payer: BCBS Healthlink |
$904.50
|
| Rate for Payer: BCBS HMK CHIP |
$904.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$904.50
|
| Rate for Payer: BCBS POS |
$954.75
|
| Rate for Payer: BCBS Traditional |
$1,005.00
|
| Rate for Payer: CASH_PRICE |
$804.00
|
| Rate for Payer: CIGNA Commercial |
$954.75
|
| Rate for Payer: CIGNA Medicare |
$904.50
|
| Rate for Payer: HUMANA Commercial |
$904.50
|
| Rate for Payer: MEDICAID Medicaid |
$924.60
|
| Rate for Payer: MEDICARE Medicare |
$703.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$954.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$974.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$954.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$954.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$854.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$804.00
|
|
|
HIV-1 RNA QUANTITATIVE, PCR (550880)
|
Facility
IP
|
$1,154.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$807.80 |
| Max. Negotiated Rate |
$1,154.00 |
| Rate for Payer: AETNA Commercial |
$1,096.30
|
| Rate for Payer: AETNA Medicare |
$1,038.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,096.30
|
| Rate for Payer: BCBS Healthlink |
$1,038.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,038.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,038.60
|
| Rate for Payer: BCBS POS |
$1,096.30
|
| Rate for Payer: BCBS Traditional |
$1,154.00
|
| Rate for Payer: CASH_PRICE |
$923.20
|
| Rate for Payer: CIGNA Commercial |
$1,096.30
|
| Rate for Payer: CIGNA Medicare |
$1,038.60
|
| Rate for Payer: HUMANA Commercial |
$1,038.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,061.68
|
| Rate for Payer: MEDICARE Medicare |
$807.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,096.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,119.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,096.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,096.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$980.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$923.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$923.20
|
|
|
HIV-1 RNA QUANTITATIVE, PCR (550880)
|
Facility
OP
|
$1,154.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$807.80 |
| Max. Negotiated Rate |
$1,154.00 |
| Rate for Payer: AETNA Commercial |
$1,096.30
|
| Rate for Payer: AETNA Medicare |
$1,038.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,096.30
|
| Rate for Payer: BCBS Healthlink |
$1,038.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,038.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,038.60
|
| Rate for Payer: BCBS POS |
$1,096.30
|
| Rate for Payer: BCBS Traditional |
$1,154.00
|
| Rate for Payer: CASH_PRICE |
$923.20
|
| Rate for Payer: CIGNA Commercial |
$1,096.30
|
| Rate for Payer: CIGNA Medicare |
$1,038.60
|
| Rate for Payer: HUMANA Commercial |
$1,038.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,061.68
|
| Rate for Payer: MEDICARE Medicare |
$807.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,096.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,119.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,096.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,096.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$980.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$923.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$923.20
|
|
|
HIV AG/AB COMBO W/ REFLEX (083935)
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
HIV AG/AB COMBO W/ REFLEX (083935)
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
HLA B27 DISEASE ASSOCIATION (006924)
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
HLA B27 DISEASE ASSOCIATION (006924)
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 81374
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
HOLTER 1-47HR APPLY/RECORD/DISCONNECT
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
HOLTER 1-47HR APPLY/RECORD/DISCONNECT
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
HOLTER 1-47HR SCAN ANALY W/REP- MEDICAID
|
Facility
OP
|
$405.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: AETNA Commercial |
$384.75
|
| Rate for Payer: AETNA Medicare |
$364.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$384.75
|
| Rate for Payer: BCBS Healthlink |
$364.50
|
| Rate for Payer: BCBS HMK CHIP |
$364.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$364.50
|
| Rate for Payer: BCBS POS |
$384.75
|
| Rate for Payer: BCBS Traditional |
$405.00
|
| Rate for Payer: CASH_PRICE |
$324.00
|
| Rate for Payer: CIGNA Commercial |
$384.75
|
| Rate for Payer: CIGNA Medicare |
$364.50
|
| Rate for Payer: HUMANA Commercial |
$364.50
|
| Rate for Payer: MEDICAID Medicaid |
$372.60
|
| Rate for Payer: MEDICARE Medicare |
$283.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$384.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$392.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$384.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$384.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$344.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$324.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$324.00
|
|
|
HOLTER 1-47HR SCAN ANALY W/REP- MEDICAID
|
Facility
IP
|
$405.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: BCBS HMK CHIP |
$364.50
|
| Rate for Payer: AETNA Commercial |
$384.75
|
| Rate for Payer: AETNA Medicare |
$364.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$384.75
|
| Rate for Payer: BCBS Healthlink |
$364.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$364.50
|
| Rate for Payer: BCBS POS |
$384.75
|
| Rate for Payer: BCBS Traditional |
$405.00
|
| Rate for Payer: CASH_PRICE |
$324.00
|
| Rate for Payer: CIGNA Commercial |
$384.75
|
| Rate for Payer: CIGNA Medicare |
$364.50
|
| Rate for Payer: HUMANA Commercial |
$364.50
|
| Rate for Payer: MEDICAID Medicaid |
$372.60
|
| Rate for Payer: MEDICARE Medicare |
$283.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$384.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$392.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$384.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$384.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$344.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$324.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$324.00
|
|
|
HOLTER 48HR-7DAY APPLY/RECORD/DISCONNECT
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
HOLTER 48HR-7DAY APPLY/RECORD/DISCONNECT
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
HOLTER 48HR-7DAY SCAN ANALY W/REP - MD
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
HOLTER 48HR-7DAY SCAN ANALY W/REP - MD
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
20230201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
