|
LAC REPAIR INT N/H/F/G =<2.5CM
|
Facility
IP
|
$456.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: AETNA Commercial |
$433.20
|
| Rate for Payer: AETNA Medicare |
$410.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$433.20
|
| Rate for Payer: BCBS Healthlink |
$410.40
|
| Rate for Payer: BCBS HMK CHIP |
$410.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$410.40
|
| Rate for Payer: BCBS POS |
$433.20
|
| Rate for Payer: BCBS Traditional |
$456.00
|
| Rate for Payer: CASH_PRICE |
$364.80
|
| Rate for Payer: CIGNA Commercial |
$433.20
|
| Rate for Payer: CIGNA Medicare |
$410.40
|
| Rate for Payer: HUMANA Commercial |
$410.40
|
| Rate for Payer: MEDICAID Medicaid |
$419.52
|
| Rate for Payer: MEDICARE Medicare |
$319.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$433.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$442.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$433.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$433.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$387.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$364.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$364.80
|
|
|
LAC REPAIR INT N/H/F/G =<2.5CM
|
Facility
OP
|
$456.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: AETNA Commercial |
$433.20
|
| Rate for Payer: AETNA Medicare |
$410.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$433.20
|
| Rate for Payer: BCBS Healthlink |
$410.40
|
| Rate for Payer: BCBS HMK CHIP |
$410.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$410.40
|
| Rate for Payer: BCBS POS |
$433.20
|
| Rate for Payer: BCBS Traditional |
$456.00
|
| Rate for Payer: CASH_PRICE |
$364.80
|
| Rate for Payer: CIGNA Commercial |
$433.20
|
| Rate for Payer: CIGNA Medicare |
$410.40
|
| Rate for Payer: HUMANA Commercial |
$410.40
|
| Rate for Payer: MEDICAID Medicaid |
$419.52
|
| Rate for Payer: MEDICARE Medicare |
$319.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$433.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$442.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$433.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$433.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$387.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$364.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$364.80
|
|
|
LAC REPAIR INT N/H/F/G 2.6-7.5CM
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: AETNA Commercial |
$475.00
|
| Rate for Payer: AETNA Medicare |
$450.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$475.00
|
| Rate for Payer: BCBS Healthlink |
$450.00
|
| Rate for Payer: BCBS HMK CHIP |
$450.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$450.00
|
| Rate for Payer: BCBS POS |
$475.00
|
| Rate for Payer: BCBS Traditional |
$500.00
|
| Rate for Payer: CASH_PRICE |
$400.00
|
| Rate for Payer: CIGNA Commercial |
$475.00
|
| Rate for Payer: CIGNA Medicare |
$450.00
|
| Rate for Payer: HUMANA Commercial |
$450.00
|
| Rate for Payer: MEDICAID Medicaid |
$460.00
|
| Rate for Payer: MEDICARE Medicare |
$350.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$475.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$485.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$475.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$475.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$425.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$400.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$400.00
|
|
|
LAC REPAIR INT N/H/F/G 2.6-7.5CM
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: BCBS HMK CHIP |
$450.00
|
| Rate for Payer: AETNA Commercial |
$475.00
|
| Rate for Payer: AETNA Medicare |
$450.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$475.00
|
| Rate for Payer: BCBS Healthlink |
$450.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$450.00
|
| Rate for Payer: BCBS POS |
$475.00
|
| Rate for Payer: BCBS Traditional |
$500.00
|
| Rate for Payer: CASH_PRICE |
$400.00
|
| Rate for Payer: CIGNA Commercial |
$475.00
|
| Rate for Payer: CIGNA Medicare |
$450.00
|
| Rate for Payer: HUMANA Commercial |
$450.00
|
| Rate for Payer: MEDICAID Medicaid |
$460.00
|
| Rate for Payer: MEDICARE Medicare |
$350.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$475.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$485.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$475.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$475.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$425.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$400.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$400.00
|
|
|
LAC REPAIR INT N/H/F/XTG 7.6-12.5CM
|
Facility
IP
|
$627.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: AETNA Commercial |
$595.65
|
| Rate for Payer: AETNA Medicare |
$564.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$595.65
|
| Rate for Payer: BCBS Healthlink |
$564.30
|
| Rate for Payer: BCBS HMK CHIP |
$564.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$564.30
|
| Rate for Payer: BCBS POS |
$595.65
|
| Rate for Payer: BCBS Traditional |
$627.00
|
| Rate for Payer: CASH_PRICE |
$501.60
|
| Rate for Payer: CIGNA Commercial |
$595.65
|
| Rate for Payer: CIGNA Medicare |
$564.30
|
| Rate for Payer: HUMANA Commercial |
$564.30
|
| Rate for Payer: MEDICAID Medicaid |
$576.84
|
| Rate for Payer: MEDICARE Medicare |
$438.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$595.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$608.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$595.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$595.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$532.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$501.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$501.60
|
|
|
LAC REPAIR INT N/H/F/XTG 7.6-12.5CM
|
Facility
OP
|
$627.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: AETNA Commercial |
$595.65
|
| Rate for Payer: AETNA Medicare |
$564.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$595.65
|
| Rate for Payer: BCBS Healthlink |
$564.30
|
| Rate for Payer: BCBS HMK CHIP |
$564.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$564.30
|
| Rate for Payer: BCBS POS |
$595.65
|
| Rate for Payer: BCBS Traditional |
$627.00
|
| Rate for Payer: CASH_PRICE |
$501.60
|
| Rate for Payer: CIGNA Commercial |
$595.65
|
| Rate for Payer: CIGNA Medicare |
$564.30
|
| Rate for Payer: HUMANA Commercial |
$564.30
|
| Rate for Payer: MEDICAID Medicaid |
$576.84
|
| Rate for Payer: MEDICARE Medicare |
$438.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$595.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$608.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$595.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$595.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$532.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$501.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$501.60
|
|
|
LAC REPAIR INT S/A/T/E=<2.5CM
|
Facility
OP
|
$557.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$389.90 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: AETNA Commercial |
$529.15
|
| Rate for Payer: AETNA Medicare |
$501.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$529.15
|
| Rate for Payer: BCBS Healthlink |
$501.30
|
| Rate for Payer: BCBS HMK CHIP |
$501.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$501.30
|
| Rate for Payer: BCBS POS |
$529.15
|
| Rate for Payer: BCBS Traditional |
$557.00
|
| Rate for Payer: CASH_PRICE |
$445.60
|
| Rate for Payer: CIGNA Commercial |
$529.15
|
| Rate for Payer: CIGNA Medicare |
$501.30
|
| Rate for Payer: HUMANA Commercial |
$501.30
|
| Rate for Payer: MEDICAID Medicaid |
$512.44
|
| Rate for Payer: MEDICARE Medicare |
$389.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$529.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$540.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$529.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$529.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$473.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$445.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$445.60
|
|
|
LAC REPAIR INT S/A/T/E=<2.5CM
|
Facility
IP
|
$557.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$389.90 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: AETNA Commercial |
$529.15
|
| Rate for Payer: AETNA Medicare |
$501.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$529.15
|
| Rate for Payer: BCBS Healthlink |
$501.30
|
| Rate for Payer: BCBS HMK CHIP |
$501.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$501.30
|
| Rate for Payer: BCBS POS |
$529.15
|
| Rate for Payer: BCBS Traditional |
$557.00
|
| Rate for Payer: CASH_PRICE |
$445.60
|
| Rate for Payer: CIGNA Commercial |
$529.15
|
| Rate for Payer: CIGNA Medicare |
$501.30
|
| Rate for Payer: HUMANA Commercial |
$501.30
|
| Rate for Payer: MEDICAID Medicaid |
$512.44
|
| Rate for Payer: MEDICARE Medicare |
$389.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$529.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$540.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$529.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$529.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$473.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$445.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$445.60
|
|
|
LAC REPAIR INT S/A/T/E 7.6-12.5CM
|
Facility
IP
|
$690.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: BCBS HMK CHIP |
$621.00
|
| Rate for Payer: AETNA Commercial |
$655.50
|
| Rate for Payer: AETNA Medicare |
$621.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$655.50
|
| Rate for Payer: BCBS Healthlink |
$621.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.00
|
| Rate for Payer: BCBS POS |
$655.50
|
| Rate for Payer: BCBS Traditional |
$690.00
|
| Rate for Payer: CASH_PRICE |
$552.00
|
| Rate for Payer: CIGNA Commercial |
$655.50
|
| Rate for Payer: CIGNA Medicare |
$621.00
|
| Rate for Payer: HUMANA Commercial |
$621.00
|
| Rate for Payer: MEDICAID Medicaid |
$634.80
|
| Rate for Payer: MEDICARE Medicare |
$483.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$655.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$669.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$655.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$655.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$586.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.00
|
|
|
LAC REPAIR INT S/A/T/E 7.6-12.5CM
|
Facility
OP
|
$690.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: AETNA Commercial |
$655.50
|
| Rate for Payer: AETNA Medicare |
$621.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$655.50
|
| Rate for Payer: BCBS Healthlink |
$621.00
|
| Rate for Payer: BCBS HMK CHIP |
$621.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.00
|
| Rate for Payer: BCBS POS |
$655.50
|
| Rate for Payer: BCBS Traditional |
$690.00
|
| Rate for Payer: CASH_PRICE |
$552.00
|
| Rate for Payer: CIGNA Commercial |
$655.50
|
| Rate for Payer: CIGNA Medicare |
$621.00
|
| Rate for Payer: HUMANA Commercial |
$621.00
|
| Rate for Payer: MEDICAID Medicaid |
$634.80
|
| Rate for Payer: MEDICARE Medicare |
$483.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$655.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$669.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$655.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$655.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$586.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.00
|
|
|
LAC REPAIR SIMPLE=<2.5CM
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
LAC REPAIR SIMPLE=<2.5CM
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
LAC REPAIR SIMPLE 2.6CM-7.5CM
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| 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 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
|
|
|
LAC REPAIR SIMPLE 2.6CM-7.5CM
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
LAC REPAIR SIMPLE >30 CM
|
Facility
OP
|
$404.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: AETNA Commercial |
$383.80
|
| Rate for Payer: AETNA Medicare |
$363.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$383.80
|
| Rate for Payer: BCBS Healthlink |
$363.60
|
| Rate for Payer: BCBS HMK CHIP |
$363.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$363.60
|
| Rate for Payer: BCBS POS |
$383.80
|
| Rate for Payer: BCBS Traditional |
$404.00
|
| Rate for Payer: CASH_PRICE |
$323.20
|
| Rate for Payer: CIGNA Commercial |
$383.80
|
| Rate for Payer: CIGNA Medicare |
$363.60
|
| Rate for Payer: HUMANA Commercial |
$363.60
|
| Rate for Payer: MEDICAID Medicaid |
$371.68
|
| Rate for Payer: MEDICARE Medicare |
$282.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$383.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$391.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$383.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$383.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$343.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$323.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$323.20
|
|
|
LAC REPAIR SIMPLE >30 CM
|
Facility
IP
|
$404.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: AETNA Commercial |
$383.80
|
| Rate for Payer: AETNA Medicare |
$363.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$383.80
|
| Rate for Payer: BCBS Healthlink |
$363.60
|
| Rate for Payer: BCBS HMK CHIP |
$363.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$363.60
|
| Rate for Payer: BCBS POS |
$383.80
|
| Rate for Payer: BCBS Traditional |
$404.00
|
| Rate for Payer: CASH_PRICE |
$323.20
|
| Rate for Payer: CIGNA Commercial |
$383.80
|
| Rate for Payer: CIGNA Medicare |
$363.60
|
| Rate for Payer: HUMANA Commercial |
$363.60
|
| Rate for Payer: MEDICAID Medicaid |
$371.68
|
| Rate for Payer: MEDICARE Medicare |
$282.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$383.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$391.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$383.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$383.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$343.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$323.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$323.20
|
|
|
LAC REPAIR SIMPLE 7.6-12.5CM
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
LAC REPAIR SIMPLE 7.6-12.5CM
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
LAC REPAIR SIMPLE FACIAL/EAR 2.6CM-5.0CM
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: BCBS HMK CHIP |
$360.00
|
| Rate for Payer: AETNA Commercial |
$380.00
|
| Rate for Payer: AETNA Medicare |
$360.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$380.00
|
| Rate for Payer: BCBS Healthlink |
$360.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$360.00
|
| Rate for Payer: BCBS POS |
$380.00
|
| Rate for Payer: BCBS Traditional |
$400.00
|
| Rate for Payer: CASH_PRICE |
$320.00
|
| Rate for Payer: CIGNA Commercial |
$380.00
|
| Rate for Payer: CIGNA Medicare |
$360.00
|
| Rate for Payer: HUMANA Commercial |
$360.00
|
| Rate for Payer: MEDICAID Medicaid |
$368.00
|
| Rate for Payer: MEDICARE Medicare |
$280.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$380.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$388.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$380.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$320.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$320.00
|
|
|
LAC REPAIR SIMPLE FACIAL/EAR 2.6CM-5.0CM
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: AETNA Commercial |
$380.00
|
| Rate for Payer: AETNA Medicare |
$360.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$380.00
|
| Rate for Payer: BCBS Healthlink |
$360.00
|
| Rate for Payer: BCBS HMK CHIP |
$360.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$360.00
|
| Rate for Payer: BCBS POS |
$380.00
|
| Rate for Payer: BCBS Traditional |
$400.00
|
| Rate for Payer: CASH_PRICE |
$320.00
|
| Rate for Payer: CIGNA Commercial |
$380.00
|
| Rate for Payer: CIGNA Medicare |
$360.00
|
| Rate for Payer: HUMANA Commercial |
$360.00
|
| Rate for Payer: MEDICAID Medicaid |
$368.00
|
| Rate for Payer: MEDICARE Medicare |
$280.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$380.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$388.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$380.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$320.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$320.00
|
|
|
LAC REPAIR SIMPLE FACIAL/EAR7.6CM-12.5CM
|
Facility
IP
|
$481.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: AETNA Commercial |
$456.95
|
| Rate for Payer: AETNA Medicare |
$432.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$456.95
|
| Rate for Payer: BCBS Healthlink |
$432.90
|
| Rate for Payer: BCBS HMK CHIP |
$432.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$432.90
|
| Rate for Payer: BCBS POS |
$456.95
|
| Rate for Payer: BCBS Traditional |
$481.00
|
| Rate for Payer: CASH_PRICE |
$384.80
|
| Rate for Payer: CIGNA Commercial |
$456.95
|
| Rate for Payer: CIGNA Medicare |
$432.90
|
| Rate for Payer: HUMANA Commercial |
$432.90
|
| Rate for Payer: MEDICAID Medicaid |
$442.52
|
| Rate for Payer: MEDICARE Medicare |
$336.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$456.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$466.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$456.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$456.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$408.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$384.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$384.80
|
|
|
LAC REPAIR SIMPLE FACIAL/EAR7.6CM-12.5CM
|
Facility
OP
|
$481.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: AETNA Commercial |
$456.95
|
| Rate for Payer: AETNA Medicare |
$432.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$456.95
|
| Rate for Payer: BCBS Healthlink |
$432.90
|
| Rate for Payer: BCBS HMK CHIP |
$432.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$432.90
|
| Rate for Payer: BCBS POS |
$456.95
|
| Rate for Payer: BCBS Traditional |
$481.00
|
| Rate for Payer: CASH_PRICE |
$384.80
|
| Rate for Payer: CIGNA Commercial |
$456.95
|
| Rate for Payer: CIGNA Medicare |
$432.90
|
| Rate for Payer: HUMANA Commercial |
$432.90
|
| Rate for Payer: MEDICAID Medicaid |
$442.52
|
| Rate for Payer: MEDICARE Medicare |
$336.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$456.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$466.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$456.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$456.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$408.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$384.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$384.80
|
|
|
LAC REPAIR SIMPLE FACIAL/EARS 5.1-7.5CM
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
LAC REPAIR SIMPLE FACIAL/EARS 5.1-7.5CM
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
LAC REPAIR SIMPLE OF FACE,EARS >2.5
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
