|
ER REPAIR SIMPLE CLOSURE BY ADHESIVE
|
Facility
IP
|
$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: BCBS HMK CHIP |
$178.20
|
| 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 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
|
|
|
ER REPAIR SIMPLE FACE/EAR/LIP 5.1-7.5
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
ER REPAIR SIMPLE FACE/EAR/LIP 5.1-7.5
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
ER REPAIR SIMPLE FACE,EARS 2.5 CM/LESS
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
ER REPAIR SIMPLE FACE,EARS 2.5 CM/LESS
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
ER REPAIR SIMPLE FACE,EARS 2.6 TO 5.0 CM
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: BCBS HMK CHIP |
$360.00
|
| Rate for Payer: AETNA Commercial |
$380.00
|
| Rate for Payer: AETNA Medicare |
$360.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$380.00
|
| Rate for Payer: BCBS Healthlink |
$360.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$360.00
|
| Rate for Payer: BCBS POS |
$380.00
|
| Rate for Payer: BCBS Traditional |
$400.00
|
| Rate for Payer: CASH_PRICE |
$320.00
|
| Rate for Payer: CIGNA Commercial |
$380.00
|
| Rate for Payer: CIGNA Medicare |
$360.00
|
| Rate for Payer: HUMANA Commercial |
$360.00
|
| Rate for Payer: MEDICAID Medicaid |
$368.00
|
| Rate for Payer: MEDICARE Medicare |
$280.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$380.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$388.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$380.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$320.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$320.00
|
|
|
ER REPAIR SIMPLE FACE,EARS 2.6 TO 5.0 CM
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: AETNA Commercial |
$380.00
|
| Rate for Payer: AETNA Medicare |
$360.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$380.00
|
| Rate for Payer: BCBS Healthlink |
$360.00
|
| Rate for Payer: BCBS HMK CHIP |
$360.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$360.00
|
| Rate for Payer: BCBS POS |
$380.00
|
| Rate for Payer: BCBS Traditional |
$400.00
|
| Rate for Payer: CASH_PRICE |
$320.00
|
| Rate for Payer: CIGNA Commercial |
$380.00
|
| Rate for Payer: CIGNA Medicare |
$360.00
|
| Rate for Payer: HUMANA Commercial |
$360.00
|
| Rate for Payer: MEDICAID Medicaid |
$368.00
|
| Rate for Payer: MEDICARE Medicare |
$280.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$380.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$388.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$380.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$380.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$320.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$320.00
|
|
|
ER REPAIR SIMPLE FACE,EARS...7.6-12.5CM
|
Facility
OP
|
$481.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: AETNA Commercial |
$456.95
|
| Rate for Payer: AETNA Medicare |
$432.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$456.95
|
| Rate for Payer: BCBS Healthlink |
$432.90
|
| Rate for Payer: BCBS HMK CHIP |
$432.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$432.90
|
| Rate for Payer: BCBS POS |
$456.95
|
| Rate for Payer: BCBS Traditional |
$481.00
|
| Rate for Payer: CASH_PRICE |
$384.80
|
| Rate for Payer: CIGNA Commercial |
$456.95
|
| Rate for Payer: CIGNA Medicare |
$432.90
|
| Rate for Payer: HUMANA Commercial |
$432.90
|
| Rate for Payer: MEDICAID Medicaid |
$442.52
|
| Rate for Payer: MEDICARE Medicare |
$336.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$456.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$466.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$456.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$456.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$408.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$384.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$384.80
|
|
|
ER REPAIR SIMPLE FACE,EARS...7.6-12.5CM
|
Facility
IP
|
$481.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: AETNA Commercial |
$456.95
|
| Rate for Payer: AETNA Medicare |
$432.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$456.95
|
| Rate for Payer: BCBS Healthlink |
$432.90
|
| Rate for Payer: BCBS HMK CHIP |
$432.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$432.90
|
| Rate for Payer: BCBS POS |
$456.95
|
| Rate for Payer: BCBS Traditional |
$481.00
|
| Rate for Payer: CASH_PRICE |
$384.80
|
| Rate for Payer: CIGNA Commercial |
$456.95
|
| Rate for Payer: CIGNA Medicare |
$432.90
|
| Rate for Payer: HUMANA Commercial |
$432.90
|
| Rate for Payer: MEDICAID Medicaid |
$442.52
|
| Rate for Payer: MEDICARE Medicare |
$336.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$456.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$466.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$456.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$456.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$408.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$384.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$384.80
|
|
|
ER REPAIR SIMPLE S/N/A/E/T<30CM
|
Facility
OP
|
$404.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: AETNA Commercial |
$383.80
|
| Rate for Payer: AETNA Medicare |
$363.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$383.80
|
| Rate for Payer: BCBS Healthlink |
$363.60
|
| Rate for Payer: BCBS HMK CHIP |
$363.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$363.60
|
| Rate for Payer: BCBS POS |
$383.80
|
| Rate for Payer: BCBS Traditional |
$404.00
|
| Rate for Payer: CASH_PRICE |
$323.20
|
| Rate for Payer: CIGNA Commercial |
$383.80
|
| Rate for Payer: CIGNA Medicare |
$363.60
|
| Rate for Payer: HUMANA Commercial |
$363.60
|
| Rate for Payer: MEDICAID Medicaid |
$371.68
|
| Rate for Payer: MEDICARE Medicare |
$282.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$383.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$391.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$383.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$383.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$343.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$323.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$323.20
|
|
|
ER REPAIR SIMPLE S/N/A/E/T<30CM
|
Facility
IP
|
$404.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: AETNA Commercial |
$383.80
|
| Rate for Payer: AETNA Medicare |
$363.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$383.80
|
| Rate for Payer: BCBS Healthlink |
$363.60
|
| Rate for Payer: BCBS HMK CHIP |
$363.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$363.60
|
| Rate for Payer: BCBS POS |
$383.80
|
| Rate for Payer: BCBS Traditional |
$404.00
|
| Rate for Payer: CASH_PRICE |
$323.20
|
| Rate for Payer: CIGNA Commercial |
$383.80
|
| Rate for Payer: CIGNA Medicare |
$363.60
|
| Rate for Payer: HUMANA Commercial |
$363.60
|
| Rate for Payer: MEDICAID Medicaid |
$371.68
|
| Rate for Payer: MEDICARE Medicare |
$282.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$383.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$391.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$383.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$383.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$343.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$323.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$323.20
|
|
|
ER REPAIR SIMPLE S/N/A/HF 20.1-30CM
|
Facility
OP
|
$399.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: AETNA Commercial |
$379.05
|
| Rate for Payer: AETNA Medicare |
$359.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$379.05
|
| Rate for Payer: BCBS Healthlink |
$359.10
|
| Rate for Payer: BCBS HMK CHIP |
$359.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$359.10
|
| Rate for Payer: BCBS POS |
$379.05
|
| Rate for Payer: BCBS Traditional |
$399.00
|
| Rate for Payer: CASH_PRICE |
$319.20
|
| Rate for Payer: CIGNA Commercial |
$379.05
|
| Rate for Payer: CIGNA Medicare |
$359.10
|
| Rate for Payer: HUMANA Commercial |
$359.10
|
| Rate for Payer: MEDICAID Medicaid |
$367.08
|
| Rate for Payer: MEDICARE Medicare |
$279.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$379.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$387.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$379.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$379.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$339.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$319.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$319.20
|
|
|
ER REPAIR SIMPLE S/N/A/HF 20.1-30CM
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: BCBS HMK CHIP |
$359.10
|
| Rate for Payer: AETNA Commercial |
$379.05
|
| Rate for Payer: AETNA Medicare |
$359.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$379.05
|
| Rate for Payer: BCBS Healthlink |
$359.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$359.10
|
| Rate for Payer: BCBS POS |
$379.05
|
| Rate for Payer: BCBS Traditional |
$399.00
|
| Rate for Payer: CASH_PRICE |
$319.20
|
| Rate for Payer: CIGNA Commercial |
$379.05
|
| Rate for Payer: CIGNA Medicare |
$359.10
|
| Rate for Payer: HUMANA Commercial |
$359.10
|
| Rate for Payer: MEDICAID Medicaid |
$367.08
|
| Rate for Payer: MEDICARE Medicare |
$279.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$379.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$387.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$379.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$379.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$339.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$319.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$319.20
|
|
|
ER REPAIR SIM,S/N/T/HF 12.6 TO 20CM
|
Facility
IP
|
$377.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$377.00 |
| Rate for Payer: BCBS HMK CHIP |
$339.30
|
| Rate for Payer: AETNA Commercial |
$358.15
|
| Rate for Payer: AETNA Medicare |
$339.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$358.15
|
| Rate for Payer: BCBS Healthlink |
$339.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$339.30
|
| Rate for Payer: BCBS POS |
$358.15
|
| Rate for Payer: BCBS Traditional |
$377.00
|
| Rate for Payer: CASH_PRICE |
$301.60
|
| Rate for Payer: CIGNA Commercial |
$358.15
|
| Rate for Payer: CIGNA Medicare |
$339.30
|
| Rate for Payer: HUMANA Commercial |
$339.30
|
| Rate for Payer: MEDICAID Medicaid |
$346.84
|
| Rate for Payer: MEDICARE Medicare |
$263.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$358.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$365.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$358.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$358.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$320.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$301.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$301.60
|
|
|
ER REPAIR SIM,S/N/T/HF 12.6 TO 20CM
|
Facility
OP
|
$377.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$377.00 |
| Rate for Payer: AETNA Commercial |
$358.15
|
| Rate for Payer: AETNA Medicare |
$339.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$358.15
|
| Rate for Payer: BCBS Healthlink |
$339.30
|
| Rate for Payer: BCBS HMK CHIP |
$339.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$339.30
|
| Rate for Payer: BCBS POS |
$358.15
|
| Rate for Payer: BCBS Traditional |
$377.00
|
| Rate for Payer: CASH_PRICE |
$301.60
|
| Rate for Payer: CIGNA Commercial |
$358.15
|
| Rate for Payer: CIGNA Medicare |
$339.30
|
| Rate for Payer: HUMANA Commercial |
$339.30
|
| Rate for Payer: MEDICAID Medicaid |
$346.84
|
| Rate for Payer: MEDICARE Medicare |
$263.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$358.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$365.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$358.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$358.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$320.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$301.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$301.60
|
|
|
ER ROOM/OPO EVALUATION FROM CLINIC
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
ER ROOM/OPO EVALUATION FROM CLINIC
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
ER ROOM/OP ROOM BRIEF
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 99281 25
|
| 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 ROOM/OP ROOM BRIEF
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 99281 25
|
| 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 ROOM/OP ROOM COMPREHENSIVE
|
Facility
OP
|
$1,720.00
|
|
|
Service Code
|
CPT 99285 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,204.00 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: AETNA Commercial |
$1,634.00
|
| Rate for Payer: AETNA Medicare |
$1,548.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,634.00
|
| Rate for Payer: BCBS Healthlink |
$1,548.00
|
| Rate for Payer: BCBS HMK CHIP |
$1,548.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,548.00
|
| Rate for Payer: BCBS POS |
$1,634.00
|
| Rate for Payer: BCBS Traditional |
$1,720.00
|
| Rate for Payer: CASH_PRICE |
$1,376.00
|
| Rate for Payer: CIGNA Commercial |
$1,634.00
|
| Rate for Payer: CIGNA Medicare |
$1,548.00
|
| Rate for Payer: HUMANA Commercial |
$1,548.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,582.40
|
| Rate for Payer: MEDICARE Medicare |
$1,204.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,634.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,668.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,634.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,634.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,462.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,376.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,376.00
|
|
|
ER ROOM/OP ROOM COMPREHENSIVE
|
Facility
IP
|
$1,720.00
|
|
|
Service Code
|
CPT 99285 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,204.00 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,548.00
|
| Rate for Payer: AETNA Commercial |
$1,634.00
|
| Rate for Payer: AETNA Medicare |
$1,548.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,634.00
|
| Rate for Payer: BCBS Healthlink |
$1,548.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,548.00
|
| Rate for Payer: BCBS POS |
$1,634.00
|
| Rate for Payer: BCBS Traditional |
$1,720.00
|
| Rate for Payer: CASH_PRICE |
$1,376.00
|
| Rate for Payer: CIGNA Commercial |
$1,634.00
|
| Rate for Payer: CIGNA Medicare |
$1,548.00
|
| Rate for Payer: HUMANA Commercial |
$1,548.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,582.40
|
| Rate for Payer: MEDICARE Medicare |
$1,204.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,634.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,668.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,634.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,634.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,462.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,376.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,376.00
|
|
|
ER ROOM/OP ROOM EXTENDED
|
Facility
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 99284 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$806.40 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: AETNA Commercial |
$1,094.40
|
| Rate for Payer: AETNA Medicare |
$1,036.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,094.40
|
| Rate for Payer: BCBS Healthlink |
$1,036.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,036.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,036.80
|
| Rate for Payer: BCBS POS |
$1,094.40
|
| Rate for Payer: BCBS Traditional |
$1,152.00
|
| Rate for Payer: CASH_PRICE |
$921.60
|
| Rate for Payer: CIGNA Commercial |
$1,094.40
|
| Rate for Payer: CIGNA Medicare |
$1,036.80
|
| Rate for Payer: HUMANA Commercial |
$1,036.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,059.84
|
| Rate for Payer: MEDICARE Medicare |
$806.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,094.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,117.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,094.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,094.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$979.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$921.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$921.60
|
|
|
ER ROOM/OP ROOM EXTENDED
|
Facility
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 99284 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$806.40 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: AETNA Commercial |
$1,094.40
|
| Rate for Payer: AETNA Medicare |
$1,036.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,094.40
|
| Rate for Payer: BCBS Healthlink |
$1,036.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,036.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,036.80
|
| Rate for Payer: BCBS POS |
$1,094.40
|
| Rate for Payer: BCBS Traditional |
$1,152.00
|
| Rate for Payer: CASH_PRICE |
$921.60
|
| Rate for Payer: CIGNA Commercial |
$1,094.40
|
| Rate for Payer: CIGNA Medicare |
$1,036.80
|
| Rate for Payer: HUMANA Commercial |
$1,036.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,059.84
|
| Rate for Payer: MEDICARE Medicare |
$806.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,094.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,117.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,094.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,094.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$979.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$921.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$921.60
|
|
|
ER ROOM/OP ROOM INTERMEDIATE
|
Facility
OP
|
$715.00
|
|
|
Service Code
|
CPT 99283 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$500.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: AETNA Commercial |
$679.25
|
| Rate for Payer: AETNA Medicare |
$643.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$679.25
|
| Rate for Payer: BCBS Healthlink |
$643.50
|
| Rate for Payer: BCBS HMK CHIP |
$643.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$643.50
|
| Rate for Payer: BCBS POS |
$679.25
|
| Rate for Payer: BCBS Traditional |
$715.00
|
| Rate for Payer: CASH_PRICE |
$572.00
|
| Rate for Payer: CIGNA Commercial |
$679.25
|
| Rate for Payer: CIGNA Medicare |
$643.50
|
| Rate for Payer: HUMANA Commercial |
$643.50
|
| Rate for Payer: MEDICAID Medicaid |
$657.80
|
| Rate for Payer: MEDICARE Medicare |
$500.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$679.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$693.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$679.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$679.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$607.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$572.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$572.00
|
|
|
ER ROOM/OP ROOM INTERMEDIATE
|
Facility
IP
|
$715.00
|
|
|
Service Code
|
CPT 99283 25
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$500.50 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: BCBS HMK CHIP |
$643.50
|
| Rate for Payer: AETNA Commercial |
$679.25
|
| Rate for Payer: AETNA Medicare |
$643.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$679.25
|
| Rate for Payer: BCBS Healthlink |
$643.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$643.50
|
| Rate for Payer: BCBS POS |
$679.25
|
| Rate for Payer: BCBS Traditional |
$715.00
|
| Rate for Payer: CASH_PRICE |
$572.00
|
| Rate for Payer: CIGNA Commercial |
$679.25
|
| Rate for Payer: CIGNA Medicare |
$643.50
|
| Rate for Payer: HUMANA Commercial |
$643.50
|
| Rate for Payer: MEDICAID Medicaid |
$657.80
|
| Rate for Payer: MEDICARE Medicare |
$500.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$679.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$693.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$679.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$679.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$607.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$572.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$572.00
|
|
