|
INJ ADMIN ALLERGY/MULTI
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
INJ ADMIN ALLERGY/SINGLE
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
INJ ADMIN ALLERGY/SINGLE
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
INJ ADMIN IMM EA ADDTL SNGL/CMB (90472)
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
INJ ADMIN IMM EA ADDTL SNGL/CMB (90472)
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
INJ ADMIN IMMUNIZ INITIAL-CLINIC(90471)
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
INJ ADMIN IMMUNIZ INITIAL-CLINIC(90471)
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
INJ ADMIN INFLUENZA VACCINE
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
INJ ADMIN INFLUENZA VACCINE
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
INJ ADMIN IV MED
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 90784
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| Rate for Payer: AETNA Commercial |
$34.20
|
| Rate for Payer: AETNA Medicare |
$32.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.20
|
| Rate for Payer: BCBS Healthlink |
$32.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.40
|
| Rate for Payer: BCBS POS |
$34.20
|
| Rate for Payer: BCBS Traditional |
$36.00
|
| Rate for Payer: CASH_PRICE |
$28.80
|
| Rate for Payer: CIGNA Commercial |
$34.20
|
| Rate for Payer: CIGNA Medicare |
$32.40
|
| Rate for Payer: HUMANA Commercial |
$32.40
|
| Rate for Payer: MEDICAID Medicaid |
$33.12
|
| Rate for Payer: MEDICARE Medicare |
$25.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.80
|
|
|
INJ ADMIN IV MED
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 90784
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: AETNA Commercial |
$34.20
|
| Rate for Payer: AETNA Medicare |
$32.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.20
|
| Rate for Payer: BCBS Healthlink |
$32.40
|
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.40
|
| Rate for Payer: BCBS POS |
$34.20
|
| Rate for Payer: BCBS Traditional |
$36.00
|
| Rate for Payer: CASH_PRICE |
$28.80
|
| Rate for Payer: CIGNA Commercial |
$34.20
|
| Rate for Payer: CIGNA Medicare |
$32.40
|
| Rate for Payer: HUMANA Commercial |
$32.40
|
| Rate for Payer: MEDICAID Medicaid |
$33.12
|
| Rate for Payer: MEDICARE Medicare |
$25.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.80
|
|
|
INJ ADMIN OF PNEUMOCOCCAL VACCINE
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: AETNA Commercial |
$38.00
|
| Rate for Payer: AETNA Medicare |
$36.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.00
|
| Rate for Payer: BCBS Healthlink |
$36.00
|
| Rate for Payer: BCBS HMK CHIP |
$36.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.00
|
| Rate for Payer: BCBS POS |
$38.00
|
| Rate for Payer: BCBS Traditional |
$40.00
|
| Rate for Payer: CASH_PRICE |
$32.00
|
| Rate for Payer: CIGNA Commercial |
$38.00
|
| Rate for Payer: CIGNA Medicare |
$36.00
|
| Rate for Payer: HUMANA Commercial |
$36.00
|
| Rate for Payer: MEDICAID Medicaid |
$36.80
|
| Rate for Payer: MEDICARE Medicare |
$28.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$38.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.00
|
|
|
INJ ADMIN OF PNEUMOCOCCAL VACCINE
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: AETNA Commercial |
$38.00
|
| Rate for Payer: AETNA Medicare |
$36.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.00
|
| Rate for Payer: BCBS Healthlink |
$36.00
|
| Rate for Payer: BCBS HMK CHIP |
$36.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.00
|
| Rate for Payer: BCBS POS |
$38.00
|
| Rate for Payer: BCBS Traditional |
$40.00
|
| Rate for Payer: CASH_PRICE |
$32.00
|
| Rate for Payer: CIGNA Commercial |
$38.00
|
| Rate for Payer: CIGNA Medicare |
$36.00
|
| Rate for Payer: HUMANA Commercial |
$36.00
|
| Rate for Payer: MEDICAID Medicaid |
$36.80
|
| Rate for Payer: MEDICARE Medicare |
$28.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$38.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.00
|
|
|
INJ ADMIN OF STATE VACCINE SINGLE
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
INJ ADMIN OF STATE VACCINE SINGLE
|
Facility
IP
|
$14.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
INJ ADMIN THERAPEUTIC/DIAGNOSTIC (96372)
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
INJ ADMIN THERAPEUTIC/DIAGNOSTIC (96372)
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
INJ ANCEF,CEFAZOLIN 1 GM IM (1000 MG)
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
INJ ANCEF,CEFAZOLIN 1 GM IM (1000 MG)
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT J0690
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
INJ AND/OR ASPIRATION JOINT INJ SMALL
|
Facility
IP
|
$374.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: AETNA Commercial |
$355.30
|
| Rate for Payer: AETNA Medicare |
$336.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$355.30
|
| Rate for Payer: BCBS Healthlink |
$336.60
|
| Rate for Payer: BCBS HMK CHIP |
$336.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$336.60
|
| Rate for Payer: BCBS POS |
$355.30
|
| Rate for Payer: BCBS Traditional |
$374.00
|
| Rate for Payer: CASH_PRICE |
$299.20
|
| Rate for Payer: CIGNA Commercial |
$355.30
|
| Rate for Payer: CIGNA Medicare |
$336.60
|
| Rate for Payer: HUMANA Commercial |
$336.60
|
| Rate for Payer: MEDICAID Medicaid |
$344.08
|
| Rate for Payer: MEDICARE Medicare |
$261.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$355.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$362.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$355.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$355.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$317.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$299.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$299.20
|
|
|
INJ AND/OR ASPIRATION JOINT INJ SMALL
|
Facility
OP
|
$374.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: AETNA Commercial |
$355.30
|
| Rate for Payer: AETNA Medicare |
$336.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$355.30
|
| Rate for Payer: BCBS Healthlink |
$336.60
|
| Rate for Payer: BCBS HMK CHIP |
$336.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$336.60
|
| Rate for Payer: BCBS POS |
$355.30
|
| Rate for Payer: BCBS Traditional |
$374.00
|
| Rate for Payer: CASH_PRICE |
$299.20
|
| Rate for Payer: CIGNA Commercial |
$355.30
|
| Rate for Payer: CIGNA Medicare |
$336.60
|
| Rate for Payer: HUMANA Commercial |
$336.60
|
| Rate for Payer: MEDICAID Medicaid |
$344.08
|
| Rate for Payer: MEDICARE Medicare |
$261.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$355.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$362.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$355.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$355.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$317.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$299.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$299.20
|
|
|
INJ AND/OR ASPIR JOINT INJ INTERM 20605
|
Facility
IP
|
$421.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: AETNA Commercial |
$399.95
|
| Rate for Payer: AETNA Medicare |
$378.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.95
|
| Rate for Payer: BCBS Healthlink |
$378.90
|
| Rate for Payer: BCBS HMK CHIP |
$378.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.90
|
| Rate for Payer: BCBS POS |
$399.95
|
| Rate for Payer: BCBS Traditional |
$421.00
|
| Rate for Payer: CASH_PRICE |
$336.80
|
| Rate for Payer: CIGNA Commercial |
$399.95
|
| Rate for Payer: CIGNA Medicare |
$378.90
|
| Rate for Payer: HUMANA Commercial |
$378.90
|
| Rate for Payer: MEDICAID Medicaid |
$387.32
|
| Rate for Payer: MEDICARE Medicare |
$294.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$408.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.80
|
|
|
INJ AND/OR ASPIR JOINT INJ INTERM 20605
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: AETNA Commercial |
$399.95
|
| Rate for Payer: AETNA Medicare |
$378.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.95
|
| Rate for Payer: BCBS Healthlink |
$378.90
|
| Rate for Payer: BCBS HMK CHIP |
$378.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.90
|
| Rate for Payer: BCBS POS |
$399.95
|
| Rate for Payer: BCBS Traditional |
$421.00
|
| Rate for Payer: CASH_PRICE |
$336.80
|
| Rate for Payer: CIGNA Commercial |
$399.95
|
| Rate for Payer: CIGNA Medicare |
$378.90
|
| Rate for Payer: HUMANA Commercial |
$378.90
|
| Rate for Payer: MEDICAID Medicaid |
$387.32
|
| Rate for Payer: MEDICARE Medicare |
$294.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$408.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.80
|
|
|
INJ AND/OR ASPIR JOINT LG 20610
|
Facility
OP
|
$599.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$419.30 |
| Max. Negotiated Rate |
$599.00 |
| Rate for Payer: AETNA Commercial |
$569.05
|
| Rate for Payer: AETNA Medicare |
$539.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$569.05
|
| Rate for Payer: BCBS Healthlink |
$539.10
|
| Rate for Payer: BCBS HMK CHIP |
$539.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$539.10
|
| Rate for Payer: BCBS POS |
$569.05
|
| Rate for Payer: BCBS Traditional |
$599.00
|
| Rate for Payer: CASH_PRICE |
$479.20
|
| Rate for Payer: CIGNA Commercial |
$569.05
|
| Rate for Payer: CIGNA Medicare |
$539.10
|
| Rate for Payer: HUMANA Commercial |
$539.10
|
| Rate for Payer: MEDICAID Medicaid |
$551.08
|
| Rate for Payer: MEDICARE Medicare |
$419.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$569.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$581.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$569.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$569.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$509.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$479.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$479.20
|
|
|
INJ AND/OR ASPIR JOINT LG 20610
|
Facility
IP
|
$599.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$419.30 |
| Max. Negotiated Rate |
$599.00 |
| Rate for Payer: BCBS HMK CHIP |
$539.10
|
| Rate for Payer: AETNA Commercial |
$569.05
|
| Rate for Payer: AETNA Medicare |
$539.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$569.05
|
| Rate for Payer: BCBS Healthlink |
$539.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$539.10
|
| Rate for Payer: BCBS POS |
$569.05
|
| Rate for Payer: BCBS Traditional |
$599.00
|
| Rate for Payer: CASH_PRICE |
$479.20
|
| Rate for Payer: CIGNA Commercial |
$569.05
|
| Rate for Payer: CIGNA Medicare |
$539.10
|
| Rate for Payer: HUMANA Commercial |
$539.10
|
| Rate for Payer: MEDICAID Medicaid |
$551.08
|
| Rate for Payer: MEDICARE Medicare |
$419.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$569.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$581.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$569.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$569.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$509.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$479.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$479.20
|
|
