|
LAB WEST NILE VIRUS IGG (SERUM)
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
LAB WEST NILE VIRUS IGM (SERUM)
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
LAB WEST NILE VIRUS IGM (SERUM)
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
LAC REPAIR CMPLX 2.6<7.5CM
|
Facility
OP
|
$732.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: AETNA Commercial |
$695.40
|
| Rate for Payer: AETNA Medicare |
$658.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$695.40
|
| Rate for Payer: BCBS Healthlink |
$658.80
|
| Rate for Payer: BCBS HMK CHIP |
$658.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$658.80
|
| Rate for Payer: BCBS POS |
$695.40
|
| Rate for Payer: BCBS Traditional |
$732.00
|
| Rate for Payer: CASH_PRICE |
$585.60
|
| Rate for Payer: CIGNA Commercial |
$695.40
|
| Rate for Payer: CIGNA Medicare |
$658.80
|
| Rate for Payer: HUMANA Commercial |
$658.80
|
| Rate for Payer: MEDICAID Medicaid |
$673.44
|
| Rate for Payer: MEDICARE Medicare |
$512.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$695.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$710.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$695.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$695.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$622.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$585.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$585.60
|
|
|
LAC REPAIR CMPLX 2.6<7.5CM
|
Facility
IP
|
$732.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$512.40 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: AETNA Commercial |
$695.40
|
| Rate for Payer: AETNA Medicare |
$658.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$695.40
|
| Rate for Payer: BCBS Healthlink |
$658.80
|
| Rate for Payer: BCBS HMK CHIP |
$658.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$658.80
|
| Rate for Payer: BCBS POS |
$695.40
|
| Rate for Payer: BCBS Traditional |
$732.00
|
| Rate for Payer: CASH_PRICE |
$585.60
|
| Rate for Payer: CIGNA Commercial |
$695.40
|
| Rate for Payer: CIGNA Medicare |
$658.80
|
| Rate for Payer: HUMANA Commercial |
$658.80
|
| Rate for Payer: MEDICAID Medicaid |
$673.44
|
| Rate for Payer: MEDICARE Medicare |
$512.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$695.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$710.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$695.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$695.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$622.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$585.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$585.60
|
|
|
LAC REPAIR COMP 2.6-7.5CM
|
Facility
OP
|
$848.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: AETNA Commercial |
$805.60
|
| Rate for Payer: AETNA Medicare |
$763.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$805.60
|
| Rate for Payer: BCBS Healthlink |
$763.20
|
| Rate for Payer: BCBS HMK CHIP |
$763.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$763.20
|
| Rate for Payer: BCBS POS |
$805.60
|
| Rate for Payer: BCBS Traditional |
$848.00
|
| Rate for Payer: CASH_PRICE |
$678.40
|
| Rate for Payer: CIGNA Commercial |
$805.60
|
| Rate for Payer: CIGNA Medicare |
$763.20
|
| Rate for Payer: HUMANA Commercial |
$763.20
|
| Rate for Payer: MEDICAID Medicaid |
$780.16
|
| Rate for Payer: MEDICARE Medicare |
$593.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$805.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$822.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$805.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$805.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$720.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$678.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$678.40
|
|
|
LAC REPAIR COMP 2.6-7.5CM
|
Facility
IP
|
$848.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: BCBS HMK CHIP |
$763.20
|
| Rate for Payer: AETNA Commercial |
$805.60
|
| Rate for Payer: AETNA Medicare |
$763.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$805.60
|
| Rate for Payer: BCBS Healthlink |
$763.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$763.20
|
| Rate for Payer: BCBS POS |
$805.60
|
| Rate for Payer: BCBS Traditional |
$848.00
|
| Rate for Payer: CASH_PRICE |
$678.40
|
| Rate for Payer: CIGNA Commercial |
$805.60
|
| Rate for Payer: CIGNA Medicare |
$763.20
|
| Rate for Payer: HUMANA Commercial |
$763.20
|
| Rate for Payer: MEDICAID Medicaid |
$780.16
|
| Rate for Payer: MEDICARE Medicare |
$593.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$805.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$822.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$805.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$805.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$720.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$678.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$678.40
|
|
|
LAC REPAIR COMP ADD SCALP/ARM/LEGS
|
Facility
OP
|
$274.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: AETNA Commercial |
$260.30
|
| Rate for Payer: AETNA Medicare |
$246.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$260.30
|
| Rate for Payer: BCBS Healthlink |
$246.60
|
| Rate for Payer: BCBS HMK CHIP |
$246.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$246.60
|
| Rate for Payer: BCBS POS |
$260.30
|
| Rate for Payer: BCBS Traditional |
$274.00
|
| Rate for Payer: CASH_PRICE |
$219.20
|
| Rate for Payer: CIGNA Commercial |
$260.30
|
| Rate for Payer: CIGNA Medicare |
$246.60
|
| Rate for Payer: HUMANA Commercial |
$246.60
|
| Rate for Payer: MEDICAID Medicaid |
$252.08
|
| Rate for Payer: MEDICARE Medicare |
$191.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$260.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$265.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$260.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$260.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$219.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$219.20
|
|
|
LAC REPAIR COMP ADD SCALP/ARM/LEGS
|
Facility
IP
|
$274.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: AETNA Commercial |
$260.30
|
| Rate for Payer: AETNA Medicare |
$246.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$260.30
|
| Rate for Payer: BCBS Healthlink |
$246.60
|
| Rate for Payer: BCBS HMK CHIP |
$246.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$246.60
|
| Rate for Payer: BCBS POS |
$260.30
|
| Rate for Payer: BCBS Traditional |
$274.00
|
| Rate for Payer: CASH_PRICE |
$219.20
|
| Rate for Payer: CIGNA Commercial |
$260.30
|
| Rate for Payer: CIGNA Medicare |
$246.60
|
| Rate for Payer: HUMANA Commercial |
$246.60
|
| Rate for Payer: MEDICAID Medicaid |
$252.08
|
| Rate for Payer: MEDICARE Medicare |
$191.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$260.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$265.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$260.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$260.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$219.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$219.20
|
|
|
LAC REPAIR COMPLEXFC/HND/FT ADD ON =<5CM
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: AETNA Commercial |
$513.00
|
| Rate for Payer: AETNA Medicare |
$486.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$513.00
|
| Rate for Payer: BCBS Healthlink |
$486.00
|
| Rate for Payer: BCBS HMK CHIP |
$486.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$486.00
|
| Rate for Payer: BCBS POS |
$513.00
|
| Rate for Payer: BCBS Traditional |
$540.00
|
| Rate for Payer: CASH_PRICE |
$432.00
|
| Rate for Payer: CIGNA Commercial |
$513.00
|
| Rate for Payer: CIGNA Medicare |
$486.00
|
| Rate for Payer: HUMANA Commercial |
$486.00
|
| Rate for Payer: MEDICAID Medicaid |
$496.80
|
| Rate for Payer: MEDICARE Medicare |
$378.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$513.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$523.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$513.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$513.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$459.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$432.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$432.00
|
|
|
LAC REPAIR COMPLEXFC/HND/FT ADD ON =<5CM
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: BCBS HMK CHIP |
$486.00
|
| Rate for Payer: AETNA Commercial |
$513.00
|
| Rate for Payer: AETNA Medicare |
$486.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$513.00
|
| Rate for Payer: BCBS Healthlink |
$486.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$486.00
|
| Rate for Payer: BCBS POS |
$513.00
|
| Rate for Payer: BCBS Traditional |
$540.00
|
| Rate for Payer: CASH_PRICE |
$432.00
|
| Rate for Payer: CIGNA Commercial |
$513.00
|
| Rate for Payer: CIGNA Medicare |
$486.00
|
| Rate for Payer: HUMANA Commercial |
$486.00
|
| Rate for Payer: MEDICAID Medicaid |
$496.80
|
| Rate for Payer: MEDICARE Medicare |
$378.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$513.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$523.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$513.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$513.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$459.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$432.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$432.00
|
|
|
LAC REPAIR COMPLEX FC/HN/FT 2.6-7.5CM
|
Facility
IP
|
$925.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$647.50 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: AETNA Commercial |
$878.75
|
| Rate for Payer: AETNA Medicare |
$832.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$878.75
|
| Rate for Payer: BCBS Healthlink |
$832.50
|
| Rate for Payer: BCBS HMK CHIP |
$832.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$832.50
|
| Rate for Payer: BCBS POS |
$878.75
|
| Rate for Payer: BCBS Traditional |
$925.00
|
| Rate for Payer: CASH_PRICE |
$740.00
|
| Rate for Payer: CIGNA Commercial |
$878.75
|
| Rate for Payer: CIGNA Medicare |
$832.50
|
| Rate for Payer: HUMANA Commercial |
$832.50
|
| Rate for Payer: MEDICAID Medicaid |
$851.00
|
| Rate for Payer: MEDICARE Medicare |
$647.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$878.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$897.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$878.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$878.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$786.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$740.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$740.00
|
|
|
LAC REPAIR COMPLEX FC/HN/FT 2.6-7.5CM
|
Facility
OP
|
$925.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$647.50 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: AETNA Commercial |
$878.75
|
| Rate for Payer: AETNA Medicare |
$832.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$878.75
|
| Rate for Payer: BCBS Healthlink |
$832.50
|
| Rate for Payer: BCBS HMK CHIP |
$832.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$832.50
|
| Rate for Payer: BCBS POS |
$878.75
|
| Rate for Payer: BCBS Traditional |
$925.00
|
| Rate for Payer: CASH_PRICE |
$740.00
|
| Rate for Payer: CIGNA Commercial |
$878.75
|
| Rate for Payer: CIGNA Medicare |
$832.50
|
| Rate for Payer: HUMANA Commercial |
$832.50
|
| Rate for Payer: MEDICAID Medicaid |
$851.00
|
| Rate for Payer: MEDICARE Medicare |
$647.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$878.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$897.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$878.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$878.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$786.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$740.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$740.00
|
|
|
LAC REPAIR COMPL FAC/GENIT/H/F 1.1-2.5CM
|
Facility
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: AETNA Commercial |
$1,396.50
|
| Rate for Payer: AETNA Medicare |
$1,323.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,396.50
|
| Rate for Payer: BCBS Healthlink |
$1,323.00
|
| Rate for Payer: BCBS HMK CHIP |
$1,323.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,323.00
|
| Rate for Payer: BCBS POS |
$1,396.50
|
| Rate for Payer: BCBS Traditional |
$1,470.00
|
| Rate for Payer: CASH_PRICE |
$1,176.00
|
| Rate for Payer: CIGNA Commercial |
$1,396.50
|
| Rate for Payer: CIGNA Medicare |
$1,323.00
|
| Rate for Payer: HUMANA Commercial |
$1,323.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,352.40
|
| Rate for Payer: MEDICARE Medicare |
$1,029.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,396.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,425.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,396.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,396.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,249.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,176.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,176.00
|
|
|
LAC REPAIR COMPL FAC/GENIT/H/F 1.1-2.5CM
|
Facility
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,323.00
|
| Rate for Payer: AETNA Commercial |
$1,396.50
|
| Rate for Payer: AETNA Medicare |
$1,323.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,396.50
|
| Rate for Payer: BCBS Healthlink |
$1,323.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,323.00
|
| Rate for Payer: BCBS POS |
$1,396.50
|
| Rate for Payer: BCBS Traditional |
$1,470.00
|
| Rate for Payer: CASH_PRICE |
$1,176.00
|
| Rate for Payer: CIGNA Commercial |
$1,396.50
|
| Rate for Payer: CIGNA Medicare |
$1,323.00
|
| Rate for Payer: HUMANA Commercial |
$1,323.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,352.40
|
| Rate for Payer: MEDICARE Medicare |
$1,029.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,396.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,425.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,396.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,396.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,249.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,176.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,176.00
|
|
|
LAC REPAIR IN F/E/E/N/L 2.6-5.0CM
|
Facility
OP
|
$571.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
LAC REPAIR IN F/E/E/N/L 2.6-5.0CM
|
Facility
IP
|
$571.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
LAC REPAIR INTERM S/A/T/E 2.6CM-7.5CM
|
Facility
OP
|
$612.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: AETNA Commercial |
$581.40
|
| Rate for Payer: AETNA Medicare |
$550.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$581.40
|
| Rate for Payer: BCBS Healthlink |
$550.80
|
| Rate for Payer: BCBS HMK CHIP |
$550.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$550.80
|
| Rate for Payer: BCBS POS |
$581.40
|
| Rate for Payer: BCBS Traditional |
$612.00
|
| Rate for Payer: CASH_PRICE |
$489.60
|
| Rate for Payer: CIGNA Commercial |
$581.40
|
| Rate for Payer: CIGNA Medicare |
$550.80
|
| Rate for Payer: HUMANA Commercial |
$550.80
|
| Rate for Payer: MEDICAID Medicaid |
$563.04
|
| Rate for Payer: MEDICARE Medicare |
$428.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$581.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$593.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$581.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$581.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$520.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$489.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$489.60
|
|
|
LAC REPAIR INTERM S/A/T/E 2.6CM-7.5CM
|
Facility
IP
|
$612.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: BCBS HMK CHIP |
$550.80
|
| Rate for Payer: AETNA Commercial |
$581.40
|
| Rate for Payer: AETNA Medicare |
$550.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$581.40
|
| Rate for Payer: BCBS Healthlink |
$550.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$550.80
|
| Rate for Payer: BCBS POS |
$581.40
|
| Rate for Payer: BCBS Traditional |
$612.00
|
| Rate for Payer: CASH_PRICE |
$489.60
|
| Rate for Payer: CIGNA Commercial |
$581.40
|
| Rate for Payer: CIGNA Medicare |
$550.80
|
| Rate for Payer: HUMANA Commercial |
$550.80
|
| Rate for Payer: MEDICAID Medicaid |
$563.04
|
| Rate for Payer: MEDICARE Medicare |
$428.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$581.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$593.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$581.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$581.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$520.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$489.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$489.60
|
|
|
LAC REPAIR INT F/E/E/N/L 5.1-7.5CM
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
LAC REPAIR INT F/E/E/N/L 5.1-7.5CM
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
LAC REPAIR INT F/E/E/N/L 7.6-12.5CM
|
Facility
OP
|
$623.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: AETNA Commercial |
$591.85
|
| Rate for Payer: AETNA Medicare |
$560.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$591.85
|
| Rate for Payer: BCBS Healthlink |
$560.70
|
| Rate for Payer: BCBS HMK CHIP |
$560.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$560.70
|
| Rate for Payer: BCBS POS |
$591.85
|
| Rate for Payer: BCBS Traditional |
$623.00
|
| Rate for Payer: CASH_PRICE |
$498.40
|
| Rate for Payer: CIGNA Commercial |
$591.85
|
| Rate for Payer: CIGNA Medicare |
$560.70
|
| Rate for Payer: HUMANA Commercial |
$560.70
|
| Rate for Payer: MEDICAID Medicaid |
$573.16
|
| Rate for Payer: MEDICARE Medicare |
$436.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$591.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$604.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$591.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$591.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$529.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$498.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$498.40
|
|
|
LAC REPAIR INT F/E/E/N/L 7.6-12.5CM
|
Facility
IP
|
$623.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: AETNA Commercial |
$591.85
|
| Rate for Payer: AETNA Medicare |
$560.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$591.85
|
| Rate for Payer: BCBS Healthlink |
$560.70
|
| Rate for Payer: BCBS HMK CHIP |
$560.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$560.70
|
| Rate for Payer: BCBS POS |
$591.85
|
| Rate for Payer: BCBS Traditional |
$623.00
|
| Rate for Payer: CASH_PRICE |
$498.40
|
| Rate for Payer: CIGNA Commercial |
$591.85
|
| Rate for Payer: CIGNA Medicare |
$560.70
|
| Rate for Payer: HUMANA Commercial |
$560.70
|
| Rate for Payer: MEDICAID Medicaid |
$573.16
|
| Rate for Payer: MEDICARE Medicare |
$436.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$591.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$604.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$591.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$591.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$529.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$498.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$498.40
|
|
|
LAC REPAIR INT F/E/E/N/L/M =<2.5CM
|
Facility
OP
|
$536.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: AETNA Commercial |
$509.20
|
| Rate for Payer: AETNA Medicare |
$482.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$509.20
|
| Rate for Payer: BCBS Healthlink |
$482.40
|
| Rate for Payer: BCBS HMK CHIP |
$482.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$482.40
|
| Rate for Payer: BCBS POS |
$509.20
|
| Rate for Payer: BCBS Traditional |
$536.00
|
| Rate for Payer: CASH_PRICE |
$428.80
|
| Rate for Payer: CIGNA Commercial |
$509.20
|
| Rate for Payer: CIGNA Medicare |
$482.40
|
| Rate for Payer: HUMANA Commercial |
$482.40
|
| Rate for Payer: MEDICAID Medicaid |
$493.12
|
| Rate for Payer: MEDICARE Medicare |
$375.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$509.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$519.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$509.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$509.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$455.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$428.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$428.80
|
|
|
LAC REPAIR INT F/E/E/N/L/M =<2.5CM
|
Facility
IP
|
$536.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: BCBS HMK CHIP |
$482.40
|
| Rate for Payer: AETNA Commercial |
$509.20
|
| Rate for Payer: AETNA Medicare |
$482.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$509.20
|
| Rate for Payer: BCBS Healthlink |
$482.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$482.40
|
| Rate for Payer: BCBS POS |
$509.20
|
| Rate for Payer: BCBS Traditional |
$536.00
|
| Rate for Payer: CASH_PRICE |
$428.80
|
| Rate for Payer: CIGNA Commercial |
$509.20
|
| Rate for Payer: CIGNA Medicare |
$482.40
|
| Rate for Payer: HUMANA Commercial |
$482.40
|
| Rate for Payer: MEDICAID Medicaid |
$493.12
|
| Rate for Payer: MEDICARE Medicare |
$375.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$509.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$519.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$509.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$509.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$455.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$428.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$428.80
|
|
