|
ER REMOVE FB UPPER ARM ELBOW AREA
|
Facility
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$861.00 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: AETNA Commercial |
$1,168.50
|
| Rate for Payer: AETNA Medicare |
$1,107.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,168.50
|
| Rate for Payer: BCBS Healthlink |
$1,107.00
|
| Rate for Payer: BCBS HMK CHIP |
$1,107.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,107.00
|
| Rate for Payer: BCBS POS |
$1,168.50
|
| Rate for Payer: BCBS Traditional |
$1,230.00
|
| Rate for Payer: CASH_PRICE |
$984.00
|
| Rate for Payer: CIGNA Commercial |
$1,168.50
|
| Rate for Payer: CIGNA Medicare |
$1,107.00
|
| Rate for Payer: HUMANA Commercial |
$1,107.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,131.60
|
| Rate for Payer: MEDICARE Medicare |
$861.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,168.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,193.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,168.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,168.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,045.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$984.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$984.00
|
|
|
ER REMOVE FOREIGN BODY
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: AETNA Commercial |
$472.15
|
| Rate for Payer: AETNA Medicare |
$447.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$472.15
|
| Rate for Payer: BCBS Healthlink |
$447.30
|
| Rate for Payer: BCBS HMK CHIP |
$447.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$447.30
|
| Rate for Payer: BCBS POS |
$472.15
|
| Rate for Payer: BCBS Traditional |
$497.00
|
| Rate for Payer: CASH_PRICE |
$397.60
|
| Rate for Payer: CIGNA Commercial |
$472.15
|
| Rate for Payer: CIGNA Medicare |
$447.30
|
| Rate for Payer: HUMANA Commercial |
$447.30
|
| Rate for Payer: MEDICAID Medicaid |
$457.24
|
| Rate for Payer: MEDICARE Medicare |
$347.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$472.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$482.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$472.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$472.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$422.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$397.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$397.60
|
|
|
ER REMOVE FOREIGN BODY
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: BCBS HMK CHIP |
$447.30
|
| Rate for Payer: AETNA Commercial |
$472.15
|
| Rate for Payer: AETNA Medicare |
$447.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$472.15
|
| Rate for Payer: BCBS Healthlink |
$447.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$447.30
|
| Rate for Payer: BCBS POS |
$472.15
|
| Rate for Payer: BCBS Traditional |
$497.00
|
| Rate for Payer: CASH_PRICE |
$397.60
|
| Rate for Payer: CIGNA Commercial |
$472.15
|
| Rate for Payer: CIGNA Medicare |
$447.30
|
| Rate for Payer: HUMANA Commercial |
$447.30
|
| Rate for Payer: MEDICAID Medicaid |
$457.24
|
| Rate for Payer: MEDICARE Medicare |
$347.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$472.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$482.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$472.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$472.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$422.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$397.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$397.60
|
|
|
ER REMOVE FOREIGN BODY EYELID EXT CONJ
|
Facility
OP
|
$222.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: AETNA Commercial |
$210.90
|
| Rate for Payer: AETNA Medicare |
$199.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$210.90
|
| Rate for Payer: BCBS Healthlink |
$199.80
|
| Rate for Payer: BCBS HMK CHIP |
$199.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$199.80
|
| Rate for Payer: BCBS POS |
$210.90
|
| Rate for Payer: BCBS Traditional |
$222.00
|
| Rate for Payer: CASH_PRICE |
$177.60
|
| Rate for Payer: CIGNA Commercial |
$210.90
|
| Rate for Payer: CIGNA Medicare |
$199.80
|
| Rate for Payer: HUMANA Commercial |
$199.80
|
| Rate for Payer: MEDICAID Medicaid |
$204.24
|
| Rate for Payer: MEDICARE Medicare |
$155.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$210.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$215.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$210.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$210.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$188.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$177.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$177.60
|
|
|
ER REMOVE FOREIGN BODY EYELID EXT CONJ
|
Facility
IP
|
$222.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: AETNA Commercial |
$210.90
|
| Rate for Payer: AETNA Medicare |
$199.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$210.90
|
| Rate for Payer: BCBS Healthlink |
$199.80
|
| Rate for Payer: BCBS HMK CHIP |
$199.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$199.80
|
| Rate for Payer: BCBS POS |
$210.90
|
| Rate for Payer: BCBS Traditional |
$222.00
|
| Rate for Payer: CASH_PRICE |
$177.60
|
| Rate for Payer: CIGNA Commercial |
$210.90
|
| Rate for Payer: CIGNA Medicare |
$199.80
|
| Rate for Payer: HUMANA Commercial |
$199.80
|
| Rate for Payer: MEDICAID Medicaid |
$204.24
|
| Rate for Payer: MEDICARE Medicare |
$155.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$210.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$215.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$210.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$210.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$188.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$177.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$177.60
|
|
|
ER REMOVE NASAL FOREIGN BODY
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AETNA Commercial |
$184.30
|
| Rate for Payer: AETNA Medicare |
$174.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$184.30
|
| Rate for Payer: BCBS Healthlink |
$174.60
|
| Rate for Payer: BCBS HMK CHIP |
$174.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$174.60
|
| Rate for Payer: BCBS POS |
$184.30
|
| Rate for Payer: BCBS Traditional |
$194.00
|
| Rate for Payer: CASH_PRICE |
$155.20
|
| Rate for Payer: CIGNA Commercial |
$184.30
|
| Rate for Payer: CIGNA Medicare |
$174.60
|
| Rate for Payer: HUMANA Commercial |
$174.60
|
| Rate for Payer: MEDICAID Medicaid |
$178.48
|
| Rate for Payer: MEDICARE Medicare |
$135.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$184.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$188.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$184.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$184.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$155.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$155.20
|
|
|
ER REMOVE NASAL FOREIGN BODY
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: BCBS HMK CHIP |
$174.60
|
| Rate for Payer: AETNA Commercial |
$184.30
|
| Rate for Payer: AETNA Medicare |
$174.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$184.30
|
| Rate for Payer: BCBS Healthlink |
$174.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$174.60
|
| Rate for Payer: BCBS POS |
$184.30
|
| Rate for Payer: BCBS Traditional |
$194.00
|
| Rate for Payer: CASH_PRICE |
$155.20
|
| Rate for Payer: CIGNA Commercial |
$184.30
|
| Rate for Payer: CIGNA Medicare |
$174.60
|
| Rate for Payer: HUMANA Commercial |
$174.60
|
| Rate for Payer: MEDICAID Medicaid |
$178.48
|
| Rate for Payer: MEDICARE Medicare |
$135.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$184.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$188.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$184.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$184.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$155.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$155.20
|
|
|
ER REMOV FOREIGN BODY EMBEDED EYLID EXT
|
Facility
OP
|
$519.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.30 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: AETNA Commercial |
$493.05
|
| Rate for Payer: AETNA Medicare |
$467.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$493.05
|
| Rate for Payer: BCBS Healthlink |
$467.10
|
| Rate for Payer: BCBS HMK CHIP |
$467.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$467.10
|
| Rate for Payer: BCBS POS |
$493.05
|
| Rate for Payer: BCBS Traditional |
$519.00
|
| Rate for Payer: CASH_PRICE |
$415.20
|
| Rate for Payer: CIGNA Commercial |
$493.05
|
| Rate for Payer: CIGNA Medicare |
$467.10
|
| Rate for Payer: HUMANA Commercial |
$467.10
|
| Rate for Payer: MEDICAID Medicaid |
$477.48
|
| Rate for Payer: MEDICARE Medicare |
$363.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$493.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$503.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$493.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$493.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$441.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$415.20
|
|
|
ER REMOV FOREIGN BODY EMBEDED EYLID EXT
|
Facility
IP
|
$519.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.30 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: AETNA Commercial |
$493.05
|
| Rate for Payer: AETNA Medicare |
$467.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$493.05
|
| Rate for Payer: BCBS Healthlink |
$467.10
|
| Rate for Payer: BCBS HMK CHIP |
$467.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$467.10
|
| Rate for Payer: BCBS POS |
$493.05
|
| Rate for Payer: BCBS Traditional |
$519.00
|
| Rate for Payer: CASH_PRICE |
$415.20
|
| Rate for Payer: CIGNA Commercial |
$493.05
|
| Rate for Payer: CIGNA Medicare |
$467.10
|
| Rate for Payer: HUMANA Commercial |
$467.10
|
| Rate for Payer: MEDICAID Medicaid |
$477.48
|
| Rate for Payer: MEDICARE Medicare |
$363.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$493.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$503.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$493.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$493.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$441.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$415.20
|
|
|
ER REPAIR COMPLEX 1.1-2.5 CM
|
Facility
IP
|
$692.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.40 |
| Max. Negotiated Rate |
$692.00 |
| Rate for Payer: AETNA Commercial |
$657.40
|
| Rate for Payer: AETNA Medicare |
$622.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$657.40
|
| Rate for Payer: BCBS Healthlink |
$622.80
|
| Rate for Payer: BCBS HMK CHIP |
$622.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$622.80
|
| Rate for Payer: BCBS POS |
$657.40
|
| Rate for Payer: BCBS Traditional |
$692.00
|
| Rate for Payer: CASH_PRICE |
$553.60
|
| Rate for Payer: CIGNA Commercial |
$657.40
|
| Rate for Payer: CIGNA Medicare |
$622.80
|
| Rate for Payer: HUMANA Commercial |
$622.80
|
| Rate for Payer: MEDICAID Medicaid |
$636.64
|
| Rate for Payer: MEDICARE Medicare |
$484.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$657.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$671.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$657.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$657.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$588.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$553.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$553.60
|
|
|
ER REPAIR COMPLEX 1.1-2.5 CM
|
Facility
OP
|
$692.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.40 |
| Max. Negotiated Rate |
$692.00 |
| Rate for Payer: AETNA Commercial |
$657.40
|
| Rate for Payer: AETNA Medicare |
$622.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$657.40
|
| Rate for Payer: BCBS Healthlink |
$622.80
|
| Rate for Payer: BCBS HMK CHIP |
$622.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$622.80
|
| Rate for Payer: BCBS POS |
$657.40
|
| Rate for Payer: BCBS Traditional |
$692.00
|
| Rate for Payer: CASH_PRICE |
$553.60
|
| Rate for Payer: CIGNA Commercial |
$657.40
|
| Rate for Payer: CIGNA Medicare |
$622.80
|
| Rate for Payer: HUMANA Commercial |
$622.80
|
| Rate for Payer: MEDICAID Medicaid |
$636.64
|
| Rate for Payer: MEDICARE Medicare |
$484.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$657.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$671.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$657.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$657.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$588.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$553.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$553.60
|
|
|
ER REPAIR COMPLEX 1.1CM TO 2.5 SCALP, AR
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: AETNA Commercial |
$640.30
|
| Rate for Payer: AETNA Medicare |
$606.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$640.30
|
| Rate for Payer: BCBS Healthlink |
$606.60
|
| Rate for Payer: BCBS HMK CHIP |
$606.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$606.60
|
| Rate for Payer: BCBS POS |
$640.30
|
| Rate for Payer: BCBS Traditional |
$674.00
|
| Rate for Payer: CASH_PRICE |
$539.20
|
| Rate for Payer: CIGNA Commercial |
$640.30
|
| Rate for Payer: CIGNA Medicare |
$606.60
|
| Rate for Payer: HUMANA Commercial |
$606.60
|
| Rate for Payer: MEDICAID Medicaid |
$620.08
|
| Rate for Payer: MEDICARE Medicare |
$471.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$640.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$653.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$640.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$640.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$572.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$539.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$539.20
|
|
|
ER REPAIR COMPLEX 1.1CM TO 2.5 SCALP, AR
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$674.00 |
| Rate for Payer: BCBS HMK CHIP |
$606.60
|
| Rate for Payer: AETNA Commercial |
$640.30
|
| Rate for Payer: AETNA Medicare |
$606.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$640.30
|
| Rate for Payer: BCBS Healthlink |
$606.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$606.60
|
| Rate for Payer: BCBS POS |
$640.30
|
| Rate for Payer: BCBS Traditional |
$674.00
|
| Rate for Payer: CASH_PRICE |
$539.20
|
| Rate for Payer: CIGNA Commercial |
$640.30
|
| Rate for Payer: CIGNA Medicare |
$606.60
|
| Rate for Payer: HUMANA Commercial |
$606.60
|
| Rate for Payer: MEDICAID Medicaid |
$620.08
|
| Rate for Payer: MEDICARE Medicare |
$471.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$640.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$653.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$640.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$640.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$572.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$539.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$539.20
|
|
|
ER REPAIR COMPLEX 2.6CM TO 7.5CM
|
Facility
IP
|
$848.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: AETNA Commercial |
$805.60
|
| Rate for Payer: AETNA Medicare |
$763.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$805.60
|
| Rate for Payer: BCBS Healthlink |
$763.20
|
| Rate for Payer: BCBS HMK CHIP |
$763.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$763.20
|
| Rate for Payer: BCBS POS |
$805.60
|
| Rate for Payer: BCBS Traditional |
$848.00
|
| Rate for Payer: CASH_PRICE |
$678.40
|
| Rate for Payer: CIGNA Commercial |
$805.60
|
| Rate for Payer: CIGNA Medicare |
$763.20
|
| Rate for Payer: HUMANA Commercial |
$763.20
|
| Rate for Payer: MEDICAID Medicaid |
$780.16
|
| Rate for Payer: MEDICARE Medicare |
$593.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$805.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$822.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$805.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$805.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$720.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$678.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$678.40
|
|
|
ER REPAIR COMPLEX 2.6CM TO 7.5CM
|
Facility
OP
|
$848.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: AETNA Commercial |
$805.60
|
| Rate for Payer: AETNA Medicare |
$763.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$805.60
|
| Rate for Payer: BCBS Healthlink |
$763.20
|
| Rate for Payer: BCBS HMK CHIP |
$763.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$763.20
|
| Rate for Payer: BCBS POS |
$805.60
|
| Rate for Payer: BCBS Traditional |
$848.00
|
| Rate for Payer: CASH_PRICE |
$678.40
|
| Rate for Payer: CIGNA Commercial |
$805.60
|
| Rate for Payer: CIGNA Medicare |
$763.20
|
| Rate for Payer: HUMANA Commercial |
$763.20
|
| Rate for Payer: MEDICAID Medicaid |
$780.16
|
| Rate for Payer: MEDICARE Medicare |
$593.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$805.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$822.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$805.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$805.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$720.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$678.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$678.40
|
|
|
ER REPAIR COMPLEX EA ADDTL 5CM OR LESS
|
Facility
OP
|
$848.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: AETNA Commercial |
$805.60
|
| Rate for Payer: AETNA Medicare |
$763.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$805.60
|
| Rate for Payer: BCBS Healthlink |
$763.20
|
| Rate for Payer: BCBS HMK CHIP |
$763.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$763.20
|
| Rate for Payer: BCBS POS |
$805.60
|
| Rate for Payer: BCBS Traditional |
$848.00
|
| Rate for Payer: CASH_PRICE |
$678.40
|
| Rate for Payer: CIGNA Commercial |
$805.60
|
| Rate for Payer: CIGNA Medicare |
$763.20
|
| Rate for Payer: HUMANA Commercial |
$763.20
|
| Rate for Payer: MEDICAID Medicaid |
$780.16
|
| Rate for Payer: MEDICARE Medicare |
$593.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$805.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$822.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$805.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$805.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$720.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$678.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$678.40
|
|
|
ER REPAIR COMPLEX EA ADDTL 5CM OR LESS
|
Facility
IP
|
$848.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: BCBS HMK CHIP |
$763.20
|
| Rate for Payer: AETNA Commercial |
$805.60
|
| Rate for Payer: AETNA Medicare |
$763.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$805.60
|
| Rate for Payer: BCBS Healthlink |
$763.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$763.20
|
| Rate for Payer: BCBS POS |
$805.60
|
| Rate for Payer: BCBS Traditional |
$848.00
|
| Rate for Payer: CASH_PRICE |
$678.40
|
| Rate for Payer: CIGNA Commercial |
$805.60
|
| Rate for Payer: CIGNA Medicare |
$763.20
|
| Rate for Payer: HUMANA Commercial |
$763.20
|
| Rate for Payer: MEDICAID Medicaid |
$780.16
|
| Rate for Payer: MEDICARE Medicare |
$593.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$805.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$822.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$805.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$805.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$720.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$678.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$678.40
|
|
|
ER REPAIR COMPLEX FC/HN 2.6 TO 7.5CM
|
Facility
OP
|
$925.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$647.50 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: AETNA Commercial |
$878.75
|
| Rate for Payer: AETNA Medicare |
$832.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$878.75
|
| Rate for Payer: BCBS Healthlink |
$832.50
|
| Rate for Payer: BCBS HMK CHIP |
$832.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$832.50
|
| Rate for Payer: BCBS POS |
$878.75
|
| Rate for Payer: BCBS Traditional |
$925.00
|
| Rate for Payer: CASH_PRICE |
$740.00
|
| Rate for Payer: CIGNA Commercial |
$878.75
|
| Rate for Payer: CIGNA Medicare |
$832.50
|
| Rate for Payer: HUMANA Commercial |
$832.50
|
| Rate for Payer: MEDICAID Medicaid |
$851.00
|
| Rate for Payer: MEDICARE Medicare |
$647.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$878.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$897.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$878.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$878.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$786.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$740.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$740.00
|
|
|
ER REPAIR COMPLEX FC/HN 2.6 TO 7.5CM
|
Facility
IP
|
$925.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$647.50 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: AETNA Commercial |
$878.75
|
| Rate for Payer: AETNA Medicare |
$832.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$878.75
|
| Rate for Payer: BCBS Healthlink |
$832.50
|
| Rate for Payer: BCBS HMK CHIP |
$832.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$832.50
|
| Rate for Payer: BCBS POS |
$878.75
|
| Rate for Payer: BCBS Traditional |
$925.00
|
| Rate for Payer: CASH_PRICE |
$740.00
|
| Rate for Payer: CIGNA Commercial |
$878.75
|
| Rate for Payer: CIGNA Medicare |
$832.50
|
| Rate for Payer: HUMANA Commercial |
$832.50
|
| Rate for Payer: MEDICAID Medicaid |
$851.00
|
| Rate for Payer: MEDICARE Medicare |
$647.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$878.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$897.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$878.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$878.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$786.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$740.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$740.00
|
|
|
ER REPAIR COMPLEX FC/HNDS/FTADD ON =<5CM
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: AETNA Commercial |
$513.00
|
| Rate for Payer: AETNA Medicare |
$486.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$513.00
|
| Rate for Payer: BCBS Healthlink |
$486.00
|
| Rate for Payer: BCBS HMK CHIP |
$486.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$486.00
|
| Rate for Payer: BCBS POS |
$513.00
|
| Rate for Payer: BCBS Traditional |
$540.00
|
| Rate for Payer: CASH_PRICE |
$432.00
|
| Rate for Payer: CIGNA Commercial |
$513.00
|
| Rate for Payer: CIGNA Medicare |
$486.00
|
| Rate for Payer: HUMANA Commercial |
$486.00
|
| Rate for Payer: MEDICAID Medicaid |
$496.80
|
| Rate for Payer: MEDICARE Medicare |
$378.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$513.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$523.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$513.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$513.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$459.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$432.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$432.00
|
|
|
ER REPAIR COMPLEX FC/HNDS/FTADD ON =<5CM
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: BCBS HMK CHIP |
$486.00
|
| Rate for Payer: AETNA Commercial |
$513.00
|
| Rate for Payer: AETNA Medicare |
$486.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$513.00
|
| Rate for Payer: BCBS Healthlink |
$486.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$486.00
|
| Rate for Payer: BCBS POS |
$513.00
|
| Rate for Payer: BCBS Traditional |
$540.00
|
| Rate for Payer: CASH_PRICE |
$432.00
|
| Rate for Payer: CIGNA Commercial |
$513.00
|
| Rate for Payer: CIGNA Medicare |
$486.00
|
| Rate for Payer: HUMANA Commercial |
$486.00
|
| Rate for Payer: MEDICAID Medicaid |
$496.80
|
| Rate for Payer: MEDICARE Medicare |
$378.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$513.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$523.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$513.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$513.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$459.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$432.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$432.00
|
|
|
ER REPAIR INT F,E,E,N,L 2.5 TO 5CM
|
Facility
IP
|
$571.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
ER REPAIR INT F,E,E,N,L 2.5 TO 5CM
|
Facility
OP
|
$571.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
ER REPAIR INT, F/E/E/N/L 5.1-7.5CM
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
ER REPAIR INT, F/E/E/N/L 5.1-7.5CM
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
