|
ER REPAIR INT F/E/E/N/L 7.6-12.5CM
|
Facility
IP
|
$623.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: BCBS HMK CHIP |
$560.70
|
| Rate for Payer: AETNA Commercial |
$591.85
|
| Rate for Payer: AETNA Medicare |
$560.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$591.85
|
| Rate for Payer: BCBS Healthlink |
$560.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$560.70
|
| Rate for Payer: BCBS POS |
$591.85
|
| Rate for Payer: BCBS Traditional |
$623.00
|
| Rate for Payer: CASH_PRICE |
$498.40
|
| Rate for Payer: CIGNA Commercial |
$591.85
|
| Rate for Payer: CIGNA Medicare |
$560.70
|
| Rate for Payer: HUMANA Commercial |
$560.70
|
| Rate for Payer: MEDICAID Medicaid |
$573.16
|
| Rate for Payer: MEDICARE Medicare |
$436.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$591.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$604.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$591.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$591.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$529.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$498.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$498.40
|
|
|
ER REPAIR INT F/E/E/N/L 7.6-12.5CM
|
Facility
OP
|
$623.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: AETNA Commercial |
$591.85
|
| Rate for Payer: AETNA Medicare |
$560.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$591.85
|
| Rate for Payer: BCBS Healthlink |
$560.70
|
| Rate for Payer: BCBS HMK CHIP |
$560.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$560.70
|
| Rate for Payer: BCBS POS |
$591.85
|
| Rate for Payer: BCBS Traditional |
$623.00
|
| Rate for Payer: CASH_PRICE |
$498.40
|
| Rate for Payer: CIGNA Commercial |
$591.85
|
| Rate for Payer: CIGNA Medicare |
$560.70
|
| Rate for Payer: HUMANA Commercial |
$560.70
|
| Rate for Payer: MEDICAID Medicaid |
$573.16
|
| Rate for Payer: MEDICARE Medicare |
$436.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$591.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$604.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$591.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$591.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$529.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$498.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$498.40
|
|
|
ER REPAIR INT F/E/E/N/L/M=<2.5CM
|
Facility
OP
|
$536.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: AETNA Commercial |
$509.20
|
| Rate for Payer: AETNA Medicare |
$482.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$509.20
|
| Rate for Payer: BCBS Healthlink |
$482.40
|
| Rate for Payer: BCBS HMK CHIP |
$482.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$482.40
|
| Rate for Payer: BCBS POS |
$509.20
|
| Rate for Payer: BCBS Traditional |
$536.00
|
| Rate for Payer: CASH_PRICE |
$428.80
|
| Rate for Payer: CIGNA Commercial |
$509.20
|
| Rate for Payer: CIGNA Medicare |
$482.40
|
| Rate for Payer: HUMANA Commercial |
$482.40
|
| Rate for Payer: MEDICAID Medicaid |
$493.12
|
| Rate for Payer: MEDICARE Medicare |
$375.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$509.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$519.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$509.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$509.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$455.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$428.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$428.80
|
|
|
ER REPAIR INT F/E/E/N/L/M=<2.5CM
|
Facility
IP
|
$536.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: AETNA Commercial |
$509.20
|
| Rate for Payer: AETNA Medicare |
$482.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$509.20
|
| Rate for Payer: BCBS Healthlink |
$482.40
|
| Rate for Payer: BCBS HMK CHIP |
$482.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$482.40
|
| Rate for Payer: BCBS POS |
$509.20
|
| Rate for Payer: BCBS Traditional |
$536.00
|
| Rate for Payer: CASH_PRICE |
$428.80
|
| Rate for Payer: CIGNA Commercial |
$509.20
|
| Rate for Payer: CIGNA Medicare |
$482.40
|
| Rate for Payer: HUMANA Commercial |
$482.40
|
| Rate for Payer: MEDICAID Medicaid |
$493.12
|
| Rate for Payer: MEDICARE Medicare |
$375.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$509.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$519.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$509.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$509.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$455.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$428.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$428.80
|
|
|
ER REPAIR INT N/H/F/G =<2.5CM
|
Facility
IP
|
$456.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: BCBS HMK CHIP |
$410.40
|
| Rate for Payer: AETNA Commercial |
$433.20
|
| Rate for Payer: AETNA Medicare |
$410.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$433.20
|
| Rate for Payer: BCBS Healthlink |
$410.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$410.40
|
| Rate for Payer: BCBS POS |
$433.20
|
| Rate for Payer: BCBS Traditional |
$456.00
|
| Rate for Payer: CASH_PRICE |
$364.80
|
| Rate for Payer: CIGNA Commercial |
$433.20
|
| Rate for Payer: CIGNA Medicare |
$410.40
|
| Rate for Payer: HUMANA Commercial |
$410.40
|
| Rate for Payer: MEDICAID Medicaid |
$419.52
|
| Rate for Payer: MEDICARE Medicare |
$319.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$433.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$442.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$433.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$433.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$387.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$364.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$364.80
|
|
|
ER REPAIR INT N/H/F/G =<2.5CM
|
Facility
OP
|
$456.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: AETNA Commercial |
$433.20
|
| Rate for Payer: AETNA Medicare |
$410.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$433.20
|
| Rate for Payer: BCBS Healthlink |
$410.40
|
| Rate for Payer: BCBS HMK CHIP |
$410.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$410.40
|
| Rate for Payer: BCBS POS |
$433.20
|
| Rate for Payer: BCBS Traditional |
$456.00
|
| Rate for Payer: CASH_PRICE |
$364.80
|
| Rate for Payer: CIGNA Commercial |
$433.20
|
| Rate for Payer: CIGNA Medicare |
$410.40
|
| Rate for Payer: HUMANA Commercial |
$410.40
|
| Rate for Payer: MEDICAID Medicaid |
$419.52
|
| Rate for Payer: MEDICARE Medicare |
$319.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$433.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$442.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$433.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$433.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$387.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$364.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$364.80
|
|
|
ER REPAIR INT N/H/F/G 2.6-7.5CM
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: AETNA Commercial |
$475.00
|
| Rate for Payer: AETNA Medicare |
$450.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$475.00
|
| Rate for Payer: BCBS Healthlink |
$450.00
|
| Rate for Payer: BCBS HMK CHIP |
$450.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$450.00
|
| Rate for Payer: BCBS POS |
$475.00
|
| Rate for Payer: BCBS Traditional |
$500.00
|
| Rate for Payer: CASH_PRICE |
$400.00
|
| Rate for Payer: CIGNA Commercial |
$475.00
|
| Rate for Payer: CIGNA Medicare |
$450.00
|
| Rate for Payer: HUMANA Commercial |
$450.00
|
| Rate for Payer: MEDICAID Medicaid |
$460.00
|
| Rate for Payer: MEDICARE Medicare |
$350.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$475.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$485.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$475.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$475.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$425.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$400.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$400.00
|
|
|
ER REPAIR INT N/H/F/G 2.6-7.5CM
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: AETNA Commercial |
$475.00
|
| Rate for Payer: AETNA Medicare |
$450.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$475.00
|
| Rate for Payer: BCBS Healthlink |
$450.00
|
| Rate for Payer: BCBS HMK CHIP |
$450.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$450.00
|
| Rate for Payer: BCBS POS |
$475.00
|
| Rate for Payer: BCBS Traditional |
$500.00
|
| Rate for Payer: CASH_PRICE |
$400.00
|
| Rate for Payer: CIGNA Commercial |
$475.00
|
| Rate for Payer: CIGNA Medicare |
$450.00
|
| Rate for Payer: HUMANA Commercial |
$450.00
|
| Rate for Payer: MEDICAID Medicaid |
$460.00
|
| Rate for Payer: MEDICARE Medicare |
$350.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$475.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$485.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$475.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$475.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$425.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$400.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$400.00
|
|
|
ER REPAIR INT S/A/T/E 12.6-20CM
|
Facility
OP
|
$759.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$531.30 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: AETNA Commercial |
$721.05
|
| Rate for Payer: AETNA Medicare |
$683.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$721.05
|
| Rate for Payer: BCBS Healthlink |
$683.10
|
| Rate for Payer: BCBS HMK CHIP |
$683.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$683.10
|
| Rate for Payer: BCBS POS |
$721.05
|
| Rate for Payer: BCBS Traditional |
$759.00
|
| Rate for Payer: CASH_PRICE |
$607.20
|
| Rate for Payer: CIGNA Commercial |
$721.05
|
| Rate for Payer: CIGNA Medicare |
$683.10
|
| Rate for Payer: HUMANA Commercial |
$683.10
|
| Rate for Payer: MEDICAID Medicaid |
$698.28
|
| Rate for Payer: MEDICARE Medicare |
$531.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$721.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$736.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$721.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$721.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$645.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$607.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$607.20
|
|
|
ER REPAIR INT S/A/T/E 12.6-20CM
|
Facility
IP
|
$759.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$531.30 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: AETNA Commercial |
$721.05
|
| Rate for Payer: AETNA Medicare |
$683.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$721.05
|
| Rate for Payer: BCBS Healthlink |
$683.10
|
| Rate for Payer: BCBS HMK CHIP |
$683.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$683.10
|
| Rate for Payer: BCBS POS |
$721.05
|
| Rate for Payer: BCBS Traditional |
$759.00
|
| Rate for Payer: CASH_PRICE |
$607.20
|
| Rate for Payer: CIGNA Commercial |
$721.05
|
| Rate for Payer: CIGNA Medicare |
$683.10
|
| Rate for Payer: HUMANA Commercial |
$683.10
|
| Rate for Payer: MEDICAID Medicaid |
$698.28
|
| Rate for Payer: MEDICARE Medicare |
$531.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$721.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$736.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$721.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$721.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$645.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$607.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$607.20
|
|
|
ER REPAIR INT S/A/T/E =<2.5CM
|
Facility
OP
|
$557.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$389.90 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: AETNA Commercial |
$529.15
|
| Rate for Payer: AETNA Medicare |
$501.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$529.15
|
| Rate for Payer: BCBS Healthlink |
$501.30
|
| Rate for Payer: BCBS HMK CHIP |
$501.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$501.30
|
| Rate for Payer: BCBS POS |
$529.15
|
| Rate for Payer: BCBS Traditional |
$557.00
|
| Rate for Payer: CASH_PRICE |
$445.60
|
| Rate for Payer: CIGNA Commercial |
$529.15
|
| Rate for Payer: CIGNA Medicare |
$501.30
|
| Rate for Payer: HUMANA Commercial |
$501.30
|
| Rate for Payer: MEDICAID Medicaid |
$512.44
|
| Rate for Payer: MEDICARE Medicare |
$389.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$529.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$540.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$529.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$529.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$473.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$445.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$445.60
|
|
|
ER REPAIR INT S/A/T/E =<2.5CM
|
Facility
IP
|
$557.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$389.90 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: BCBS HMK CHIP |
$501.30
|
| Rate for Payer: AETNA Commercial |
$529.15
|
| Rate for Payer: AETNA Medicare |
$501.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$529.15
|
| Rate for Payer: BCBS Healthlink |
$501.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$501.30
|
| Rate for Payer: BCBS POS |
$529.15
|
| Rate for Payer: BCBS Traditional |
$557.00
|
| Rate for Payer: CASH_PRICE |
$445.60
|
| Rate for Payer: CIGNA Commercial |
$529.15
|
| Rate for Payer: CIGNA Medicare |
$501.30
|
| Rate for Payer: HUMANA Commercial |
$501.30
|
| Rate for Payer: MEDICAID Medicaid |
$512.44
|
| Rate for Payer: MEDICARE Medicare |
$389.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$529.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$540.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$529.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$529.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$473.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$445.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$445.60
|
|
|
ER REPAIR INT S/A/T/E 2.6-7.5CM
|
Facility
OP
|
$612.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: AETNA Commercial |
$581.40
|
| Rate for Payer: AETNA Medicare |
$550.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$581.40
|
| Rate for Payer: BCBS Healthlink |
$550.80
|
| Rate for Payer: BCBS HMK CHIP |
$550.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$550.80
|
| Rate for Payer: BCBS POS |
$581.40
|
| Rate for Payer: BCBS Traditional |
$612.00
|
| Rate for Payer: CASH_PRICE |
$489.60
|
| Rate for Payer: CIGNA Commercial |
$581.40
|
| Rate for Payer: CIGNA Medicare |
$550.80
|
| Rate for Payer: HUMANA Commercial |
$550.80
|
| Rate for Payer: MEDICAID Medicaid |
$563.04
|
| Rate for Payer: MEDICARE Medicare |
$428.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$581.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$593.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$581.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$581.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$520.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$489.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$489.60
|
|
|
ER REPAIR INT S/A/T/E 2.6-7.5CM
|
Facility
IP
|
$612.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: BCBS HMK CHIP |
$550.80
|
| Rate for Payer: AETNA Commercial |
$581.40
|
| Rate for Payer: AETNA Medicare |
$550.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$581.40
|
| Rate for Payer: BCBS Healthlink |
$550.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$550.80
|
| Rate for Payer: BCBS POS |
$581.40
|
| Rate for Payer: BCBS Traditional |
$612.00
|
| Rate for Payer: CASH_PRICE |
$489.60
|
| Rate for Payer: CIGNA Commercial |
$581.40
|
| Rate for Payer: CIGNA Medicare |
$550.80
|
| Rate for Payer: HUMANA Commercial |
$550.80
|
| Rate for Payer: MEDICAID Medicaid |
$563.04
|
| Rate for Payer: MEDICARE Medicare |
$428.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$581.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$593.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$581.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$581.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$520.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$489.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$489.60
|
|
|
ER REPAIR INT S/A/T/E 7.6-12CM
|
Facility
IP
|
$690.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: AETNA Commercial |
$655.50
|
| Rate for Payer: AETNA Medicare |
$621.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$655.50
|
| Rate for Payer: BCBS Healthlink |
$621.00
|
| Rate for Payer: BCBS HMK CHIP |
$621.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.00
|
| Rate for Payer: BCBS POS |
$655.50
|
| Rate for Payer: BCBS Traditional |
$690.00
|
| Rate for Payer: CASH_PRICE |
$552.00
|
| Rate for Payer: CIGNA Commercial |
$655.50
|
| Rate for Payer: CIGNA Medicare |
$621.00
|
| Rate for Payer: HUMANA Commercial |
$621.00
|
| Rate for Payer: MEDICAID Medicaid |
$634.80
|
| Rate for Payer: MEDICARE Medicare |
$483.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$655.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$669.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$655.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$655.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$586.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.00
|
|
|
ER REPAIR INT S/A/T/E 7.6-12CM
|
Facility
OP
|
$690.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: AETNA Commercial |
$655.50
|
| Rate for Payer: AETNA Medicare |
$621.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$655.50
|
| Rate for Payer: BCBS Healthlink |
$621.00
|
| Rate for Payer: BCBS HMK CHIP |
$621.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.00
|
| Rate for Payer: BCBS POS |
$655.50
|
| Rate for Payer: BCBS Traditional |
$690.00
|
| Rate for Payer: CASH_PRICE |
$552.00
|
| Rate for Payer: CIGNA Commercial |
$655.50
|
| Rate for Payer: CIGNA Medicare |
$621.00
|
| Rate for Payer: HUMANA Commercial |
$621.00
|
| Rate for Payer: MEDICAID Medicaid |
$634.80
|
| Rate for Payer: MEDICARE Medicare |
$483.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$655.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$669.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$655.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$655.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$586.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.00
|
|
|
ER REPAIR LACERATION OF PALATE UP 2CM
|
Facility
OP
|
$516.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$361.20 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: AETNA Commercial |
$490.20
|
| Rate for Payer: AETNA Medicare |
$464.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$490.20
|
| Rate for Payer: BCBS Healthlink |
$464.40
|
| Rate for Payer: BCBS HMK CHIP |
$464.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$464.40
|
| Rate for Payer: BCBS POS |
$490.20
|
| Rate for Payer: BCBS Traditional |
$516.00
|
| Rate for Payer: CASH_PRICE |
$412.80
|
| Rate for Payer: CIGNA Commercial |
$490.20
|
| Rate for Payer: CIGNA Medicare |
$464.40
|
| Rate for Payer: HUMANA Commercial |
$464.40
|
| Rate for Payer: MEDICAID Medicaid |
$474.72
|
| Rate for Payer: MEDICARE Medicare |
$361.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$490.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$500.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$490.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$490.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$438.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$412.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$412.80
|
|
|
ER REPAIR LACERATION OF PALATE UP 2CM
|
Facility
IP
|
$516.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$361.20 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: AETNA Commercial |
$490.20
|
| Rate for Payer: AETNA Medicare |
$464.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$490.20
|
| Rate for Payer: BCBS Healthlink |
$464.40
|
| Rate for Payer: BCBS HMK CHIP |
$464.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$464.40
|
| Rate for Payer: BCBS POS |
$490.20
|
| Rate for Payer: BCBS Traditional |
$516.00
|
| Rate for Payer: CASH_PRICE |
$412.80
|
| Rate for Payer: CIGNA Commercial |
$490.20
|
| Rate for Payer: CIGNA Medicare |
$464.40
|
| Rate for Payer: HUMANA Commercial |
$464.40
|
| Rate for Payer: MEDICAID Medicaid |
$474.72
|
| Rate for Payer: MEDICARE Medicare |
$361.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$490.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$500.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$490.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$490.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$438.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$412.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$412.80
|
|
|
ER REPAIR SIMPLE =<2.5CM
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
ER REPAIR SIMPLE =<2.5CM
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
ER REPAIR SIMPLE 2.6-7.5CM
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
ER REPAIR SIMPLE 2.6-7.5CM
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
ER REPAIR SIMPLE 7.6-12.5CM
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
ER REPAIR SIMPLE 7.6-12.5CM
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
ER REPAIR SIMPLE CLOSURE BY ADHESIVE
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: AETNA Commercial |
$188.10
|
| Rate for Payer: AETNA Medicare |
$178.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$188.10
|
| Rate for Payer: BCBS Healthlink |
$178.20
|
| Rate for Payer: BCBS HMK CHIP |
$178.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$178.20
|
| Rate for Payer: BCBS POS |
$188.10
|
| Rate for Payer: BCBS Traditional |
$198.00
|
| Rate for Payer: CASH_PRICE |
$158.40
|
| Rate for Payer: CIGNA Commercial |
$188.10
|
| Rate for Payer: CIGNA Medicare |
$178.20
|
| Rate for Payer: HUMANA Commercial |
$178.20
|
| Rate for Payer: MEDICAID Medicaid |
$182.16
|
| Rate for Payer: MEDICARE Medicare |
$138.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$188.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$192.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$188.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$188.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$168.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$158.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$158.40
|
|
