|
PRO FEE PVB THORACIC ADD ON LEVEL
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
CPT 64462
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
PRO FEE PVB THORACIC ADD ON LEVEL
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
CPT 64462
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
PRO FEE REDUCTION DISTAL FRACTURE RAD
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: AETNA Commercial |
$190.00
|
| Rate for Payer: AETNA Medicare |
$180.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.00
|
| Rate for Payer: BCBS Healthlink |
$180.00
|
| Rate for Payer: BCBS HMK CHIP |
$180.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.00
|
| Rate for Payer: BCBS POS |
$190.00
|
| Rate for Payer: BCBS Traditional |
$200.00
|
| Rate for Payer: CASH_PRICE |
$160.00
|
| Rate for Payer: CIGNA Commercial |
$190.00
|
| Rate for Payer: CIGNA Medicare |
$180.00
|
| Rate for Payer: HUMANA Commercial |
$180.00
|
| Rate for Payer: MEDICAID Medicaid |
$184.00
|
| Rate for Payer: MEDICARE Medicare |
$140.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.00
|
|
|
PRO FEE REDUCTION DISTAL FRACTURE RAD
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: AETNA Commercial |
$190.00
|
| Rate for Payer: AETNA Medicare |
$180.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.00
|
| Rate for Payer: BCBS Healthlink |
$180.00
|
| Rate for Payer: BCBS HMK CHIP |
$180.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.00
|
| Rate for Payer: BCBS POS |
$190.00
|
| Rate for Payer: BCBS Traditional |
$200.00
|
| Rate for Payer: CASH_PRICE |
$160.00
|
| Rate for Payer: CIGNA Commercial |
$190.00
|
| Rate for Payer: CIGNA Medicare |
$180.00
|
| Rate for Payer: HUMANA Commercial |
$180.00
|
| Rate for Payer: MEDICAID Medicaid |
$184.00
|
| Rate for Payer: MEDICARE Medicare |
$140.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.00
|
|
|
PRO FEE REPAIR F/E/E/N/LNTERM 2.6-5.0CM
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT 12052 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
PRO FEE REPAIR F/E/E/N/LNTERM 2.6-5.0CM
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT 12052 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
PRO FEE REPAIR INT =< 2.5CM
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 12041 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
PRO FEE REPAIR INT =< 2.5CM
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 12041 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
PRO FEE REPAIR INTF/E/E/N/L 12.6-20.0CM
|
Facility
OP
|
$331.00
|
|
|
Service Code
|
CPT 12055 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$231.70 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: AETNA Commercial |
$314.45
|
| Rate for Payer: AETNA Medicare |
$297.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$314.45
|
| Rate for Payer: BCBS Healthlink |
$297.90
|
| Rate for Payer: BCBS HMK CHIP |
$297.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$297.90
|
| Rate for Payer: BCBS POS |
$314.45
|
| Rate for Payer: BCBS Traditional |
$331.00
|
| Rate for Payer: CASH_PRICE |
$264.80
|
| Rate for Payer: CIGNA Commercial |
$314.45
|
| Rate for Payer: CIGNA Medicare |
$297.90
|
| Rate for Payer: HUMANA Commercial |
$297.90
|
| Rate for Payer: MEDICAID Medicaid |
$304.52
|
| Rate for Payer: MEDICARE Medicare |
$231.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$314.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$321.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$314.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$314.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$281.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$264.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$264.80
|
|
|
PRO FEE REPAIR INTF/E/E/N/L 12.6-20.0CM
|
Facility
IP
|
$331.00
|
|
|
Service Code
|
CPT 12055 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$231.70 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: AETNA Commercial |
$314.45
|
| Rate for Payer: AETNA Medicare |
$297.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$314.45
|
| Rate for Payer: BCBS Healthlink |
$297.90
|
| Rate for Payer: BCBS HMK CHIP |
$297.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$297.90
|
| Rate for Payer: BCBS POS |
$314.45
|
| Rate for Payer: BCBS Traditional |
$331.00
|
| Rate for Payer: CASH_PRICE |
$264.80
|
| Rate for Payer: CIGNA Commercial |
$314.45
|
| Rate for Payer: CIGNA Medicare |
$297.90
|
| Rate for Payer: HUMANA Commercial |
$297.90
|
| Rate for Payer: MEDICAID Medicaid |
$304.52
|
| Rate for Payer: MEDICARE Medicare |
$231.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$314.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$321.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$314.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$314.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$281.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$264.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$264.80
|
|
|
PRO FEE REPAIR INT F/E/E/N/L 5.1-7.5CM
|
Facility
OP
|
$232.00
|
|
|
Service Code
|
CPT 12053 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: AETNA Commercial |
$220.40
|
| Rate for Payer: AETNA Medicare |
$208.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$220.40
|
| Rate for Payer: BCBS Healthlink |
$208.80
|
| Rate for Payer: BCBS HMK CHIP |
$208.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$208.80
|
| Rate for Payer: BCBS POS |
$220.40
|
| Rate for Payer: BCBS Traditional |
$232.00
|
| Rate for Payer: CASH_PRICE |
$185.60
|
| Rate for Payer: CIGNA Commercial |
$220.40
|
| Rate for Payer: CIGNA Medicare |
$208.80
|
| Rate for Payer: HUMANA Commercial |
$208.80
|
| Rate for Payer: MEDICAID Medicaid |
$213.44
|
| Rate for Payer: MEDICARE Medicare |
$162.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$220.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$225.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$220.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$220.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$197.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$185.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$185.60
|
|
|
PRO FEE REPAIR INT F/E/E/N/L 5.1-7.5CM
|
Facility
IP
|
$232.00
|
|
|
Service Code
|
CPT 12053 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: AETNA Commercial |
$220.40
|
| Rate for Payer: AETNA Medicare |
$208.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$220.40
|
| Rate for Payer: BCBS Healthlink |
$208.80
|
| Rate for Payer: BCBS HMK CHIP |
$208.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$208.80
|
| Rate for Payer: BCBS POS |
$220.40
|
| Rate for Payer: BCBS Traditional |
$232.00
|
| Rate for Payer: CASH_PRICE |
$185.60
|
| Rate for Payer: CIGNA Commercial |
$220.40
|
| Rate for Payer: CIGNA Medicare |
$208.80
|
| Rate for Payer: HUMANA Commercial |
$208.80
|
| Rate for Payer: MEDICAID Medicaid |
$213.44
|
| Rate for Payer: MEDICARE Medicare |
$162.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$220.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$225.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$220.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$220.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$197.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$185.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$185.60
|
|
|
PRO FEE REPAIR INT F/E/E/N/L 7.6-12.5CM
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 12054 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
PRO FEE REPAIR INT F/E/E/N/L 7.6-12.5CM
|
Facility
OP
|
$233.00
|
|
|
Service Code
|
CPT 12054 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
PRO FEE REPAIR INT N/H/F/EXTG 7.6-12.5CM
|
Facility
OP
|
$231.00
|
|
|
Service Code
|
CPT 12044 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: AETNA Commercial |
$219.45
|
| Rate for Payer: AETNA Medicare |
$207.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$219.45
|
| Rate for Payer: BCBS Healthlink |
$207.90
|
| Rate for Payer: BCBS HMK CHIP |
$207.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$207.90
|
| Rate for Payer: BCBS POS |
$219.45
|
| Rate for Payer: BCBS Traditional |
$231.00
|
| Rate for Payer: CASH_PRICE |
$184.80
|
| Rate for Payer: CIGNA Commercial |
$219.45
|
| Rate for Payer: CIGNA Medicare |
$207.90
|
| Rate for Payer: HUMANA Commercial |
$207.90
|
| Rate for Payer: MEDICAID Medicaid |
$212.52
|
| Rate for Payer: MEDICARE Medicare |
$161.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$219.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$224.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$219.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$219.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$196.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$184.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$184.80
|
|
|
PRO FEE REPAIR INT N/H/F/EXTG 7.6-12.5CM
|
Facility
IP
|
$231.00
|
|
|
Service Code
|
CPT 12044 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: AETNA Commercial |
$219.45
|
| Rate for Payer: AETNA Medicare |
$207.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$219.45
|
| Rate for Payer: BCBS Healthlink |
$207.90
|
| Rate for Payer: BCBS HMK CHIP |
$207.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$207.90
|
| Rate for Payer: BCBS POS |
$219.45
|
| Rate for Payer: BCBS Traditional |
$231.00
|
| Rate for Payer: CASH_PRICE |
$184.80
|
| Rate for Payer: CIGNA Commercial |
$219.45
|
| Rate for Payer: CIGNA Medicare |
$207.90
|
| Rate for Payer: HUMANA Commercial |
$207.90
|
| Rate for Payer: MEDICAID Medicaid |
$212.52
|
| Rate for Payer: MEDICARE Medicare |
$161.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$219.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$224.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$219.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$219.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$196.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$184.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$184.80
|
|
|
PRO FEE REPAIR INT N/H/F/G 2.5-7.5CM
|
Facility
OP
|
$205.00
|
|
|
Service Code
|
CPT 12042 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: AETNA Commercial |
$194.75
|
| Rate for Payer: AETNA Medicare |
$184.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$194.75
|
| Rate for Payer: BCBS Healthlink |
$184.50
|
| Rate for Payer: BCBS HMK CHIP |
$184.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$184.50
|
| Rate for Payer: BCBS POS |
$194.75
|
| Rate for Payer: BCBS Traditional |
$205.00
|
| Rate for Payer: CASH_PRICE |
$164.00
|
| Rate for Payer: CIGNA Commercial |
$194.75
|
| Rate for Payer: CIGNA Medicare |
$184.50
|
| Rate for Payer: HUMANA Commercial |
$184.50
|
| Rate for Payer: MEDICAID Medicaid |
$188.60
|
| Rate for Payer: MEDICARE Medicare |
$143.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$194.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$198.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$194.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$194.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$174.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.00
|
|
|
PRO FEE REPAIR INT N/H/F/G 2.5-7.5CM
|
Facility
IP
|
$205.00
|
|
|
Service Code
|
CPT 12042 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$205.00 |
| Rate for Payer: AETNA Commercial |
$194.75
|
| Rate for Payer: AETNA Medicare |
$184.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$194.75
|
| Rate for Payer: BCBS Healthlink |
$184.50
|
| Rate for Payer: BCBS HMK CHIP |
$184.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$184.50
|
| Rate for Payer: BCBS POS |
$194.75
|
| Rate for Payer: BCBS Traditional |
$205.00
|
| Rate for Payer: CASH_PRICE |
$164.00
|
| Rate for Payer: CIGNA Commercial |
$194.75
|
| Rate for Payer: CIGNA Medicare |
$184.50
|
| Rate for Payer: HUMANA Commercial |
$184.50
|
| Rate for Payer: MEDICAID Medicaid |
$188.60
|
| Rate for Payer: MEDICARE Medicare |
$143.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$194.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$198.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$194.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$194.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$174.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.00
|
|
|
PRO FEE REPAIR INT S/A/T/E 12.6-20.CM
|
Facility
IP
|
$257.00
|
|
|
Service Code
|
CPT 12035 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
PRO FEE REPAIR INT S/A/T/E 12.6-20.CM
|
Facility
OP
|
$257.00
|
|
|
Service Code
|
CPT 12035 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
PRO FEE REPAIR INT S/A/T/E<2.5CM
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 12031 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
PRO FEE REPAIR INT S/A/T/E<2.5CM
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 12031 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
PRO FEE REPAIR INT S/A/T/E 2.6-7.5CM
|
Facility
IP
|
$185.00
|
|
|
Service Code
|
CPT 12032 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
PRO FEE REPAIR INT S/A/T/E 2.6-7.5CM
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 12032 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
PRO FEE REPAIR INT S/A/T/E 7.6-12.5CM
|
Facility
IP
|
$219.00
|
|
|
Service Code
|
CPT 12034 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: AETNA Commercial |
$208.05
|
| Rate for Payer: AETNA Medicare |
$197.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$208.05
|
| Rate for Payer: BCBS Healthlink |
$197.10
|
| Rate for Payer: BCBS HMK CHIP |
$197.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$197.10
|
| Rate for Payer: BCBS POS |
$208.05
|
| Rate for Payer: BCBS Traditional |
$219.00
|
| Rate for Payer: CASH_PRICE |
$175.20
|
| Rate for Payer: CIGNA Commercial |
$208.05
|
| Rate for Payer: CIGNA Medicare |
$197.10
|
| Rate for Payer: HUMANA Commercial |
$197.10
|
| Rate for Payer: MEDICAID Medicaid |
$201.48
|
| Rate for Payer: MEDICARE Medicare |
$153.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$208.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$212.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$208.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$208.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$186.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$175.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$175.20
|
|
