|
PRO FEE REPAIR INT S/A/T/E 7.6-12.5CM
|
Facility
OP
|
$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
|
|
|
PRO FEE REPAIR SIMPLE FACE...7.6-12.5
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 12015 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 SIMPLE FACE...7.6-12.5
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 12015 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 SIMPLE S/N/A/G/T/E12.6-20
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
CPT 12005 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: AETNA Commercial |
$137.75
|
| Rate for Payer: AETNA Medicare |
$130.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$137.75
|
| Rate for Payer: BCBS Healthlink |
$130.50
|
| Rate for Payer: BCBS HMK CHIP |
$130.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$130.50
|
| Rate for Payer: BCBS POS |
$137.75
|
| Rate for Payer: BCBS Traditional |
$145.00
|
| Rate for Payer: CASH_PRICE |
$116.00
|
| Rate for Payer: CIGNA Commercial |
$137.75
|
| Rate for Payer: CIGNA Medicare |
$130.50
|
| Rate for Payer: HUMANA Commercial |
$130.50
|
| Rate for Payer: MEDICAID Medicaid |
$133.40
|
| Rate for Payer: MEDICARE Medicare |
$101.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$137.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$140.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$137.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$137.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$123.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$116.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$116.00
|
|
|
PRO FEE REPAIR SIMPLE S/N/A/G/T/E12.6-20
|
Facility
IP
|
$145.00
|
|
|
Service Code
|
CPT 12005 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: AETNA Commercial |
$137.75
|
| Rate for Payer: AETNA Medicare |
$130.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$137.75
|
| Rate for Payer: BCBS Healthlink |
$130.50
|
| Rate for Payer: BCBS HMK CHIP |
$130.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$130.50
|
| Rate for Payer: BCBS POS |
$137.75
|
| Rate for Payer: BCBS Traditional |
$145.00
|
| Rate for Payer: CASH_PRICE |
$116.00
|
| Rate for Payer: CIGNA Commercial |
$137.75
|
| Rate for Payer: CIGNA Medicare |
$130.50
|
| Rate for Payer: HUMANA Commercial |
$130.50
|
| Rate for Payer: MEDICAID Medicaid |
$133.40
|
| Rate for Payer: MEDICARE Medicare |
$101.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$137.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$140.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$137.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$137.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$123.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$116.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$116.00
|
|
|
PRO FEE REPAIR S/N/AX/G/T >30CM
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 12007 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
PRO FEE REPAIR S/N/AX/G/T >30CM
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 12007 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
PRO FEE REPAIR WOUND COMPLEX 1.1-2.5CM
|
Facility
OP
|
$274.00
|
|
|
Service Code
|
CPT 13131 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
PRO FEE REPAIR WOUND COMPLEX 1.1-2.5CM
|
Facility
IP
|
$274.00
|
|
|
Service Code
|
CPT 13131 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| 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
|
|
|
PRO FEE REPAIR WOUND INT=< 2.5
|
Facility
OP
|
$171.00
|
|
|
Service Code
|
CPT 12051 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: AETNA Commercial |
$162.45
|
| Rate for Payer: AETNA Medicare |
$153.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$162.45
|
| Rate for Payer: BCBS Healthlink |
$153.90
|
| Rate for Payer: BCBS HMK CHIP |
$153.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$153.90
|
| Rate for Payer: BCBS POS |
$162.45
|
| Rate for Payer: BCBS Traditional |
$171.00
|
| Rate for Payer: CASH_PRICE |
$136.80
|
| Rate for Payer: CIGNA Commercial |
$162.45
|
| Rate for Payer: CIGNA Medicare |
$153.90
|
| Rate for Payer: HUMANA Commercial |
$153.90
|
| Rate for Payer: MEDICAID Medicaid |
$157.32
|
| Rate for Payer: MEDICARE Medicare |
$119.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$162.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$165.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$162.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$162.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$136.80
|
|
|
PRO FEE REPAIR WOUND INT=< 2.5
|
Facility
IP
|
$171.00
|
|
|
Service Code
|
CPT 12051 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: AETNA Commercial |
$162.45
|
| Rate for Payer: AETNA Medicare |
$153.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$162.45
|
| Rate for Payer: BCBS Healthlink |
$153.90
|
| Rate for Payer: BCBS HMK CHIP |
$153.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$153.90
|
| Rate for Payer: BCBS POS |
$162.45
|
| Rate for Payer: BCBS Traditional |
$171.00
|
| Rate for Payer: CASH_PRICE |
$136.80
|
| Rate for Payer: CIGNA Commercial |
$162.45
|
| Rate for Payer: CIGNA Medicare |
$153.90
|
| Rate for Payer: HUMANA Commercial |
$153.90
|
| Rate for Payer: MEDICAID Medicaid |
$157.32
|
| Rate for Payer: MEDICARE Medicare |
$119.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$162.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$165.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$162.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$162.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$136.80
|
|
|
PRO FEE REPAIR WOUND SIMPLE 2.5CM/LESS
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 12011 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
PRO FEE REPAIR WOUND SIMPLE 2.5CM/LESS
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 12011 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
PRO FEE REPAIR WOUND SIMPLE 2.6-5.0CM
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 12013 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: AETNA Commercial |
$85.50
|
| Rate for Payer: AETNA Medicare |
$81.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$85.50
|
| Rate for Payer: BCBS Healthlink |
$81.00
|
| Rate for Payer: BCBS HMK CHIP |
$81.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.00
|
| Rate for Payer: BCBS POS |
$85.50
|
| Rate for Payer: BCBS Traditional |
$90.00
|
| Rate for Payer: CASH_PRICE |
$72.00
|
| Rate for Payer: CIGNA Commercial |
$85.50
|
| Rate for Payer: CIGNA Medicare |
$81.00
|
| Rate for Payer: HUMANA Commercial |
$81.00
|
| Rate for Payer: MEDICAID Medicaid |
$82.80
|
| Rate for Payer: MEDICARE Medicare |
$63.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$85.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$87.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$85.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$85.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$76.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.00
|
|
|
PRO FEE REPAIR WOUND SIMPLE 2.6-5.0CM
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 12013 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: AETNA Commercial |
$85.50
|
| Rate for Payer: AETNA Medicare |
$81.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$85.50
|
| Rate for Payer: BCBS Healthlink |
$81.00
|
| Rate for Payer: BCBS HMK CHIP |
$81.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.00
|
| Rate for Payer: BCBS POS |
$85.50
|
| Rate for Payer: BCBS Traditional |
$90.00
|
| Rate for Payer: CASH_PRICE |
$72.00
|
| Rate for Payer: CIGNA Commercial |
$85.50
|
| Rate for Payer: CIGNA Medicare |
$81.00
|
| Rate for Payer: HUMANA Commercial |
$81.00
|
| Rate for Payer: MEDICAID Medicaid |
$82.80
|
| Rate for Payer: MEDICARE Medicare |
$63.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$85.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$87.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$85.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$85.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$76.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.00
|
|
|
PRO FEE REPAIR WOUND SIMPLE 5.1-7.5CM
|
Facility
OP
|
$116.00
|
|
|
Service Code
|
CPT 12014 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: AETNA Commercial |
$110.20
|
| Rate for Payer: AETNA Medicare |
$104.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$110.20
|
| Rate for Payer: BCBS Healthlink |
$104.40
|
| Rate for Payer: BCBS HMK CHIP |
$104.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$104.40
|
| Rate for Payer: BCBS POS |
$110.20
|
| Rate for Payer: BCBS Traditional |
$116.00
|
| Rate for Payer: CASH_PRICE |
$92.80
|
| Rate for Payer: CIGNA Commercial |
$110.20
|
| Rate for Payer: CIGNA Medicare |
$104.40
|
| Rate for Payer: HUMANA Commercial |
$104.40
|
| Rate for Payer: MEDICAID Medicaid |
$106.72
|
| Rate for Payer: MEDICARE Medicare |
$81.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$110.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$112.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$110.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$110.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$98.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$92.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$92.80
|
|
|
PRO FEE REPAIR WOUND SIMPLE 5.1-7.5CM
|
Facility
IP
|
$116.00
|
|
|
Service Code
|
CPT 12014 AQ
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: AETNA Commercial |
$110.20
|
| Rate for Payer: AETNA Medicare |
$104.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$110.20
|
| Rate for Payer: BCBS Healthlink |
$104.40
|
| Rate for Payer: BCBS HMK CHIP |
$104.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$104.40
|
| Rate for Payer: BCBS POS |
$110.20
|
| Rate for Payer: BCBS Traditional |
$116.00
|
| Rate for Payer: CASH_PRICE |
$92.80
|
| Rate for Payer: CIGNA Commercial |
$110.20
|
| Rate for Payer: CIGNA Medicare |
$104.40
|
| Rate for Payer: HUMANA Commercial |
$104.40
|
| Rate for Payer: MEDICAID Medicaid |
$106.72
|
| Rate for Payer: MEDICARE Medicare |
$81.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$110.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$112.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$110.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$110.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$98.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$92.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$92.80
|
|
|
PROFEE RF ABLTJ NRV NRVTG SI JT W/I
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: AETNA Commercial |
$494.00
|
| Rate for Payer: AETNA Medicare |
$468.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$494.00
|
| Rate for Payer: BCBS Healthlink |
$468.00
|
| Rate for Payer: BCBS HMK CHIP |
$468.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$468.00
|
| Rate for Payer: BCBS POS |
$494.00
|
| Rate for Payer: BCBS Traditional |
$520.00
|
| Rate for Payer: CASH_PRICE |
$416.00
|
| Rate for Payer: CIGNA Commercial |
$494.00
|
| Rate for Payer: CIGNA Medicare |
$468.00
|
| Rate for Payer: HUMANA Commercial |
$468.00
|
| Rate for Payer: MEDICAID Medicaid |
$478.40
|
| Rate for Payer: MEDICARE Medicare |
$364.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$494.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$504.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$494.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$494.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$442.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$416.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$416.00
|
|
|
PROFEE RF ABLTJ NRV NRVTG SI JT W/I
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: AETNA Commercial |
$494.00
|
| Rate for Payer: AETNA Medicare |
$468.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$494.00
|
| Rate for Payer: BCBS Healthlink |
$468.00
|
| Rate for Payer: BCBS HMK CHIP |
$468.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$468.00
|
| Rate for Payer: BCBS POS |
$494.00
|
| Rate for Payer: BCBS Traditional |
$520.00
|
| Rate for Payer: CASH_PRICE |
$416.00
|
| Rate for Payer: CIGNA Commercial |
$494.00
|
| Rate for Payer: CIGNA Medicare |
$468.00
|
| Rate for Payer: HUMANA Commercial |
$468.00
|
| Rate for Payer: MEDICAID Medicaid |
$478.40
|
| Rate for Payer: MEDICARE Medicare |
$364.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$494.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$504.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$494.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$494.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$442.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$416.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$416.00
|
|
|
PRO FEE STRAPPING OF HAND/FINGER
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
PRO FEE STRAPPING OF HAND/FINGER
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
PRO FEE TRIGGER POINT INJ 3+ 20553
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: AETNA Commercial |
$125.40
|
| Rate for Payer: AETNA Medicare |
$118.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$125.40
|
| Rate for Payer: BCBS Healthlink |
$118.80
|
| Rate for Payer: BCBS HMK CHIP |
$118.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$118.80
|
| Rate for Payer: BCBS POS |
$125.40
|
| Rate for Payer: BCBS Traditional |
$132.00
|
| Rate for Payer: CASH_PRICE |
$105.60
|
| Rate for Payer: CIGNA Commercial |
$125.40
|
| Rate for Payer: CIGNA Medicare |
$118.80
|
| Rate for Payer: HUMANA Commercial |
$118.80
|
| Rate for Payer: MEDICAID Medicaid |
$121.44
|
| Rate for Payer: MEDICARE Medicare |
$92.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$125.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$128.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$125.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$125.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$112.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$105.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$105.60
|
|
|
PRO FEE TRIGGER POINT INJ 3+ 20553
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: AETNA Commercial |
$125.40
|
| Rate for Payer: AETNA Medicare |
$118.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$125.40
|
| Rate for Payer: BCBS Healthlink |
$118.80
|
| Rate for Payer: BCBS HMK CHIP |
$118.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$118.80
|
| Rate for Payer: BCBS POS |
$125.40
|
| Rate for Payer: BCBS Traditional |
$132.00
|
| Rate for Payer: CASH_PRICE |
$105.60
|
| Rate for Payer: CIGNA Commercial |
$125.40
|
| Rate for Payer: CIGNA Medicare |
$118.80
|
| Rate for Payer: HUMANA Commercial |
$118.80
|
| Rate for Payer: MEDICAID Medicaid |
$121.44
|
| Rate for Payer: MEDICARE Medicare |
$92.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$125.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$128.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$125.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$125.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$112.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$105.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$105.60
|
|
|
PRO FEE TRIG PT INJ 1-2 GRPS 20552(SIJ)
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: AETNA Commercial |
$125.40
|
| Rate for Payer: AETNA Medicare |
$118.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$125.40
|
| Rate for Payer: BCBS Healthlink |
$118.80
|
| Rate for Payer: BCBS HMK CHIP |
$118.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$118.80
|
| Rate for Payer: BCBS POS |
$125.40
|
| Rate for Payer: BCBS Traditional |
$132.00
|
| Rate for Payer: CASH_PRICE |
$105.60
|
| Rate for Payer: CIGNA Commercial |
$125.40
|
| Rate for Payer: CIGNA Medicare |
$118.80
|
| Rate for Payer: HUMANA Commercial |
$118.80
|
| Rate for Payer: MEDICAID Medicaid |
$121.44
|
| Rate for Payer: MEDICARE Medicare |
$92.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$125.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$128.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$125.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$125.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$112.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$105.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$105.60
|
|
|
PRO FEE TRIG PT INJ 1-2 GRPS 20552(SIJ)
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: AETNA Commercial |
$125.40
|
| Rate for Payer: AETNA Medicare |
$118.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$125.40
|
| Rate for Payer: BCBS Healthlink |
$118.80
|
| Rate for Payer: BCBS HMK CHIP |
$118.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$118.80
|
| Rate for Payer: BCBS POS |
$125.40
|
| Rate for Payer: BCBS Traditional |
$132.00
|
| Rate for Payer: CASH_PRICE |
$105.60
|
| Rate for Payer: CIGNA Commercial |
$125.40
|
| Rate for Payer: CIGNA Medicare |
$118.80
|
| Rate for Payer: HUMANA Commercial |
$118.80
|
| Rate for Payer: MEDICAID Medicaid |
$121.44
|
| Rate for Payer: MEDICARE Medicare |
$92.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$125.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$128.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$125.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$125.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$112.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$105.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$105.60
|
|
