|
US 3D RENDERING W/INTERPRET POST PROCE
|
Facility
OP
|
$657.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$459.90 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: AETNA Commercial |
$624.15
|
| Rate for Payer: AETNA Medicare |
$591.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$624.15
|
| Rate for Payer: BCBS Healthlink |
$591.30
|
| Rate for Payer: BCBS HMK CHIP |
$591.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$591.30
|
| Rate for Payer: BCBS POS |
$624.15
|
| Rate for Payer: BCBS Traditional |
$657.00
|
| Rate for Payer: CASH_PRICE |
$525.60
|
| Rate for Payer: CIGNA Commercial |
$624.15
|
| Rate for Payer: CIGNA Medicare |
$591.30
|
| Rate for Payer: HUMANA Commercial |
$591.30
|
| Rate for Payer: MEDICAID Medicaid |
$604.44
|
| Rate for Payer: MEDICARE Medicare |
$459.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$624.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$637.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$624.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$624.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$558.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$525.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$525.60
|
|
|
US 3D RENDERING W/INTERPRET POST PROCE
|
Facility
IP
|
$657.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$459.90 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: AETNA Commercial |
$624.15
|
| Rate for Payer: AETNA Medicare |
$591.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$624.15
|
| Rate for Payer: BCBS Healthlink |
$591.30
|
| Rate for Payer: BCBS HMK CHIP |
$591.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$591.30
|
| Rate for Payer: BCBS POS |
$624.15
|
| Rate for Payer: BCBS Traditional |
$657.00
|
| Rate for Payer: CASH_PRICE |
$525.60
|
| Rate for Payer: CIGNA Commercial |
$624.15
|
| Rate for Payer: CIGNA Medicare |
$591.30
|
| Rate for Payer: HUMANA Commercial |
$591.30
|
| Rate for Payer: MEDICAID Medicaid |
$604.44
|
| Rate for Payer: MEDICARE Medicare |
$459.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$624.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$637.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$624.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$624.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$558.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$525.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$525.60
|
|
|
US 3D RENDER W/INTERP&POSTPROC DIFF WORK
|
Facility
IP
|
$835.00
|
|
|
Service Code
|
CPT 76377 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$584.50 |
| Max. Negotiated Rate |
$835.00 |
| Rate for Payer: AETNA Commercial |
$793.25
|
| Rate for Payer: AETNA Medicare |
$751.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$793.25
|
| Rate for Payer: BCBS Healthlink |
$751.50
|
| Rate for Payer: BCBS HMK CHIP |
$751.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$751.50
|
| Rate for Payer: BCBS POS |
$793.25
|
| Rate for Payer: BCBS Traditional |
$835.00
|
| Rate for Payer: CASH_PRICE |
$668.00
|
| Rate for Payer: CIGNA Commercial |
$793.25
|
| Rate for Payer: CIGNA Medicare |
$751.50
|
| Rate for Payer: HUMANA Commercial |
$751.50
|
| Rate for Payer: MEDICAID Medicaid |
$768.20
|
| Rate for Payer: MEDICARE Medicare |
$584.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$793.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$809.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$793.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$793.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$709.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$668.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$668.00
|
|
|
US 3D RENDER W/INTERP&POSTPROC DIFF WORK
|
Facility
OP
|
$835.00
|
|
|
Service Code
|
CPT 76377 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$584.50 |
| Max. Negotiated Rate |
$835.00 |
| Rate for Payer: AETNA Commercial |
$793.25
|
| Rate for Payer: AETNA Medicare |
$751.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$793.25
|
| Rate for Payer: BCBS Healthlink |
$751.50
|
| Rate for Payer: BCBS HMK CHIP |
$751.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$751.50
|
| Rate for Payer: BCBS POS |
$793.25
|
| Rate for Payer: BCBS Traditional |
$835.00
|
| Rate for Payer: CASH_PRICE |
$668.00
|
| Rate for Payer: CIGNA Commercial |
$793.25
|
| Rate for Payer: CIGNA Medicare |
$751.50
|
| Rate for Payer: HUMANA Commercial |
$751.50
|
| Rate for Payer: MEDICAID Medicaid |
$768.20
|
| Rate for Payer: MEDICARE Medicare |
$584.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$793.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$809.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$793.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$793.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$709.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$668.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$668.00
|
|
|
US ABDOMEN COMPLETE
|
Facility
IP
|
$563.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$394.10 |
| Max. Negotiated Rate |
$563.00 |
| Rate for Payer: AETNA Commercial |
$534.85
|
| Rate for Payer: AETNA Medicare |
$506.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$534.85
|
| Rate for Payer: BCBS Healthlink |
$506.70
|
| Rate for Payer: BCBS HMK CHIP |
$506.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$506.70
|
| Rate for Payer: BCBS POS |
$534.85
|
| Rate for Payer: BCBS Traditional |
$563.00
|
| Rate for Payer: CASH_PRICE |
$450.40
|
| Rate for Payer: CIGNA Commercial |
$534.85
|
| Rate for Payer: CIGNA Medicare |
$506.70
|
| Rate for Payer: HUMANA Commercial |
$506.70
|
| Rate for Payer: MEDICAID Medicaid |
$517.96
|
| Rate for Payer: MEDICARE Medicare |
$394.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$534.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$546.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$534.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$534.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$478.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$450.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$450.40
|
|
|
US ABDOMEN COMPLETE
|
Facility
OP
|
$563.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$394.10 |
| Max. Negotiated Rate |
$563.00 |
| Rate for Payer: AETNA Commercial |
$534.85
|
| Rate for Payer: AETNA Medicare |
$506.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$534.85
|
| Rate for Payer: BCBS Healthlink |
$506.70
|
| Rate for Payer: BCBS HMK CHIP |
$506.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$506.70
|
| Rate for Payer: BCBS POS |
$534.85
|
| Rate for Payer: BCBS Traditional |
$563.00
|
| Rate for Payer: CASH_PRICE |
$450.40
|
| Rate for Payer: CIGNA Commercial |
$534.85
|
| Rate for Payer: CIGNA Medicare |
$506.70
|
| Rate for Payer: HUMANA Commercial |
$506.70
|
| Rate for Payer: MEDICAID Medicaid |
$517.96
|
| Rate for Payer: MEDICARE Medicare |
$394.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$534.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$546.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$534.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$534.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$478.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$450.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$450.40
|
|
|
US ABDOMEN DOPP LMT
|
Facility
OP
|
$471.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$329.70 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: AETNA Commercial |
$447.45
|
| Rate for Payer: AETNA Medicare |
$423.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$447.45
|
| Rate for Payer: BCBS Healthlink |
$423.90
|
| Rate for Payer: BCBS HMK CHIP |
$423.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$423.90
|
| Rate for Payer: BCBS POS |
$447.45
|
| Rate for Payer: BCBS Traditional |
$471.00
|
| Rate for Payer: CASH_PRICE |
$376.80
|
| Rate for Payer: CIGNA Commercial |
$447.45
|
| Rate for Payer: CIGNA Medicare |
$423.90
|
| Rate for Payer: HUMANA Commercial |
$423.90
|
| Rate for Payer: MEDICAID Medicaid |
$433.32
|
| Rate for Payer: MEDICARE Medicare |
$329.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$447.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$456.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$447.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$447.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$400.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$376.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$376.80
|
|
|
US ABDOMEN DOPP LMT
|
Facility
IP
|
$471.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$329.70 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: AETNA Commercial |
$447.45
|
| Rate for Payer: AETNA Medicare |
$423.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$447.45
|
| Rate for Payer: BCBS Healthlink |
$423.90
|
| Rate for Payer: BCBS HMK CHIP |
$423.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$423.90
|
| Rate for Payer: BCBS POS |
$447.45
|
| Rate for Payer: BCBS Traditional |
$471.00
|
| Rate for Payer: CASH_PRICE |
$376.80
|
| Rate for Payer: CIGNA Commercial |
$447.45
|
| Rate for Payer: CIGNA Medicare |
$423.90
|
| Rate for Payer: HUMANA Commercial |
$423.90
|
| Rate for Payer: MEDICAID Medicaid |
$433.32
|
| Rate for Payer: MEDICARE Medicare |
$329.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$447.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$456.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$447.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$447.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$400.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$376.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$376.80
|
|
|
US ABDOMEN LIMITED
|
Facility
IP
|
$418.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$292.60 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: AETNA Commercial |
$397.10
|
| Rate for Payer: AETNA Medicare |
$376.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$397.10
|
| Rate for Payer: BCBS Healthlink |
$376.20
|
| Rate for Payer: BCBS HMK CHIP |
$376.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$376.20
|
| Rate for Payer: BCBS POS |
$397.10
|
| Rate for Payer: BCBS Traditional |
$418.00
|
| Rate for Payer: CASH_PRICE |
$334.40
|
| Rate for Payer: CIGNA Commercial |
$397.10
|
| Rate for Payer: CIGNA Medicare |
$376.20
|
| Rate for Payer: HUMANA Commercial |
$376.20
|
| Rate for Payer: MEDICAID Medicaid |
$384.56
|
| Rate for Payer: MEDICARE Medicare |
$292.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$397.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$405.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$397.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$397.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$355.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$334.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$334.40
|
|
|
US ABDOMEN LIMITED
|
Facility
OP
|
$418.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$292.60 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: AETNA Commercial |
$397.10
|
| Rate for Payer: AETNA Medicare |
$376.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$397.10
|
| Rate for Payer: BCBS Healthlink |
$376.20
|
| Rate for Payer: BCBS HMK CHIP |
$376.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$376.20
|
| Rate for Payer: BCBS POS |
$397.10
|
| Rate for Payer: BCBS Traditional |
$418.00
|
| Rate for Payer: CASH_PRICE |
$334.40
|
| Rate for Payer: CIGNA Commercial |
$397.10
|
| Rate for Payer: CIGNA Medicare |
$376.20
|
| Rate for Payer: HUMANA Commercial |
$376.20
|
| Rate for Payer: MEDICAID Medicaid |
$384.56
|
| Rate for Payer: MEDICARE Medicare |
$292.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$397.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$405.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$397.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$397.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$355.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$334.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$334.40
|
|
|
US ABDOMINAL AORTA REAL TIME SCREEN STUD
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 76706 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
US ABDOMINAL AORTA REAL TIME SCREEN STUD
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 76706 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
US ABI
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
US ABI
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
US AORTA SCREEN/MC
|
Facility
IP
|
$353.00
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: AETNA Commercial |
$335.35
|
| Rate for Payer: AETNA Medicare |
$317.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$335.35
|
| Rate for Payer: BCBS Healthlink |
$317.70
|
| Rate for Payer: BCBS HMK CHIP |
$317.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$317.70
|
| Rate for Payer: BCBS POS |
$335.35
|
| Rate for Payer: BCBS Traditional |
$353.00
|
| Rate for Payer: CASH_PRICE |
$282.40
|
| Rate for Payer: CIGNA Commercial |
$335.35
|
| Rate for Payer: CIGNA Medicare |
$317.70
|
| Rate for Payer: HUMANA Commercial |
$317.70
|
| Rate for Payer: MEDICAID Medicaid |
$324.76
|
| Rate for Payer: MEDICARE Medicare |
$247.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$335.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$342.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$335.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$335.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$282.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$282.40
|
|
|
US AORTA SCREEN/MC
|
Facility
OP
|
$353.00
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: AETNA Commercial |
$335.35
|
| Rate for Payer: AETNA Medicare |
$317.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$335.35
|
| Rate for Payer: BCBS Healthlink |
$317.70
|
| Rate for Payer: BCBS HMK CHIP |
$317.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$317.70
|
| Rate for Payer: BCBS POS |
$335.35
|
| Rate for Payer: BCBS Traditional |
$353.00
|
| Rate for Payer: CASH_PRICE |
$282.40
|
| Rate for Payer: CIGNA Commercial |
$335.35
|
| Rate for Payer: CIGNA Medicare |
$317.70
|
| Rate for Payer: HUMANA Commercial |
$317.70
|
| Rate for Payer: MEDICAID Medicaid |
$324.76
|
| Rate for Payer: MEDICARE Medicare |
$247.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$335.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$342.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$335.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$335.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$282.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$282.40
|
|
|
US ARTERY BYPASS GRAFT
|
Facility
IP
|
$353.00
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: AETNA Commercial |
$335.35
|
| Rate for Payer: AETNA Medicare |
$317.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$335.35
|
| Rate for Payer: BCBS Healthlink |
$317.70
|
| Rate for Payer: BCBS HMK CHIP |
$317.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$317.70
|
| Rate for Payer: BCBS POS |
$335.35
|
| Rate for Payer: BCBS Traditional |
$353.00
|
| Rate for Payer: CASH_PRICE |
$282.40
|
| Rate for Payer: CIGNA Commercial |
$335.35
|
| Rate for Payer: CIGNA Medicare |
$317.70
|
| Rate for Payer: HUMANA Commercial |
$317.70
|
| Rate for Payer: MEDICAID Medicaid |
$324.76
|
| Rate for Payer: MEDICARE Medicare |
$247.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$335.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$342.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$335.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$335.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$282.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$282.40
|
|
|
US ARTERY BYPASS GRAFT
|
Facility
OP
|
$353.00
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: AETNA Commercial |
$335.35
|
| Rate for Payer: AETNA Medicare |
$317.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$335.35
|
| Rate for Payer: BCBS Healthlink |
$317.70
|
| Rate for Payer: BCBS HMK CHIP |
$317.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$317.70
|
| Rate for Payer: BCBS POS |
$335.35
|
| Rate for Payer: BCBS Traditional |
$353.00
|
| Rate for Payer: CASH_PRICE |
$282.40
|
| Rate for Payer: CIGNA Commercial |
$335.35
|
| Rate for Payer: CIGNA Medicare |
$317.70
|
| Rate for Payer: HUMANA Commercial |
$317.70
|
| Rate for Payer: MEDICAID Medicaid |
$324.76
|
| Rate for Payer: MEDICARE Medicare |
$247.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$335.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$342.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$335.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$335.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$282.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$282.40
|
|
|
US BLADDER PRE/POST
|
Facility
OP
|
$217.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$151.90 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$206.15
|
| Rate for Payer: AETNA Commercial |
$206.15
|
| Rate for Payer: AETNA Medicare |
$195.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$206.15
|
| Rate for Payer: BCBS Healthlink |
$195.30
|
| Rate for Payer: BCBS HMK CHIP |
$195.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$195.30
|
| Rate for Payer: BCBS POS |
$206.15
|
| Rate for Payer: BCBS Traditional |
$217.00
|
| Rate for Payer: CASH_PRICE |
$173.60
|
| Rate for Payer: CIGNA Commercial |
$206.15
|
| Rate for Payer: CIGNA Medicare |
$195.30
|
| Rate for Payer: HUMANA Commercial |
$195.30
|
| Rate for Payer: MEDICAID Medicaid |
$199.64
|
| Rate for Payer: MEDICARE Medicare |
$151.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$210.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$206.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$206.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$184.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$173.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$173.60
|
|
|
US BLADDER PRE/POST
|
Facility
IP
|
$217.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$151.90 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: AETNA Commercial |
$206.15
|
| Rate for Payer: AETNA Medicare |
$195.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$206.15
|
| Rate for Payer: BCBS Healthlink |
$195.30
|
| Rate for Payer: BCBS HMK CHIP |
$195.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$195.30
|
| Rate for Payer: BCBS POS |
$206.15
|
| Rate for Payer: BCBS Traditional |
$217.00
|
| Rate for Payer: CASH_PRICE |
$173.60
|
| Rate for Payer: CIGNA Commercial |
$206.15
|
| Rate for Payer: CIGNA Medicare |
$195.30
|
| Rate for Payer: HUMANA Commercial |
$195.30
|
| Rate for Payer: MEDICAID Medicaid |
$199.64
|
| Rate for Payer: MEDICARE Medicare |
$151.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$206.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$210.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$206.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$206.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$184.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$173.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$173.60
|
|
|
US BLADDER SCANNER POST
|
Facility
OP
|
$142.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: AETNA Commercial |
$134.90
|
| Rate for Payer: AETNA Medicare |
$127.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$134.90
|
| Rate for Payer: BCBS Healthlink |
$127.80
|
| Rate for Payer: BCBS HMK CHIP |
$127.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$127.80
|
| Rate for Payer: BCBS POS |
$134.90
|
| Rate for Payer: BCBS Traditional |
$142.00
|
| Rate for Payer: CASH_PRICE |
$113.60
|
| Rate for Payer: CIGNA Commercial |
$134.90
|
| Rate for Payer: CIGNA Medicare |
$127.80
|
| Rate for Payer: HUMANA Commercial |
$127.80
|
| Rate for Payer: MEDICAID Medicaid |
$130.64
|
| Rate for Payer: MEDICARE Medicare |
$99.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$134.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$137.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$134.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$134.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$120.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$113.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$113.60
|
|
|
US BLADDER SCANNER POST
|
Facility
IP
|
$142.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: AETNA Commercial |
$134.90
|
| Rate for Payer: AETNA Medicare |
$127.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$134.90
|
| Rate for Payer: BCBS Healthlink |
$127.80
|
| Rate for Payer: BCBS HMK CHIP |
$127.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$127.80
|
| Rate for Payer: BCBS POS |
$134.90
|
| Rate for Payer: BCBS Traditional |
$142.00
|
| Rate for Payer: CASH_PRICE |
$113.60
|
| Rate for Payer: CIGNA Commercial |
$134.90
|
| Rate for Payer: CIGNA Medicare |
$127.80
|
| Rate for Payer: HUMANA Commercial |
$127.80
|
| Rate for Payer: MEDICAID Medicaid |
$130.64
|
| Rate for Payer: MEDICARE Medicare |
$99.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$134.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$137.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$134.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$134.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$120.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$113.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$113.60
|
|
|
US BREAST
|
Facility
IP
|
$281.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: AETNA Commercial |
$266.95
|
| Rate for Payer: AETNA Medicare |
$252.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$266.95
|
| Rate for Payer: BCBS Healthlink |
$252.90
|
| Rate for Payer: BCBS HMK CHIP |
$252.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$252.90
|
| Rate for Payer: BCBS POS |
$266.95
|
| Rate for Payer: BCBS Traditional |
$281.00
|
| Rate for Payer: CASH_PRICE |
$224.80
|
| Rate for Payer: CIGNA Commercial |
$266.95
|
| Rate for Payer: CIGNA Medicare |
$252.90
|
| Rate for Payer: HUMANA Commercial |
$252.90
|
| Rate for Payer: MEDICAID Medicaid |
$258.52
|
| Rate for Payer: MEDICARE Medicare |
$196.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$266.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$272.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$266.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$266.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$238.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$224.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$224.80
|
|
|
US BREAST
|
Facility
OP
|
$281.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$266.95
|
| Rate for Payer: AETNA Commercial |
$266.95
|
| Rate for Payer: AETNA Medicare |
$252.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$266.95
|
| Rate for Payer: BCBS Healthlink |
$252.90
|
| Rate for Payer: BCBS HMK CHIP |
$252.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$252.90
|
| Rate for Payer: BCBS POS |
$266.95
|
| Rate for Payer: BCBS Traditional |
$281.00
|
| Rate for Payer: CASH_PRICE |
$224.80
|
| Rate for Payer: CIGNA Commercial |
$266.95
|
| Rate for Payer: CIGNA Medicare |
$252.90
|
| Rate for Payer: HUMANA Commercial |
$252.90
|
| Rate for Payer: MEDICAID Medicaid |
$258.52
|
| Rate for Payer: MEDICARE Medicare |
$196.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$272.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$266.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$266.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$238.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$224.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$224.80
|
|
|
US BREAST UNI REAL TIME WITH IMAGE LIMIT
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 76642 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$343.70 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: AETNA Commercial |
$466.45
|
| Rate for Payer: AETNA Medicare |
$441.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$466.45
|
| Rate for Payer: BCBS Healthlink |
$441.90
|
| Rate for Payer: BCBS HMK CHIP |
$441.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$441.90
|
| Rate for Payer: BCBS POS |
$466.45
|
| Rate for Payer: BCBS Traditional |
$491.00
|
| Rate for Payer: CASH_PRICE |
$392.80
|
| Rate for Payer: CIGNA Commercial |
$466.45
|
| Rate for Payer: CIGNA Medicare |
$441.90
|
| Rate for Payer: HUMANA Commercial |
$441.90
|
| Rate for Payer: MEDICAID Medicaid |
$451.72
|
| Rate for Payer: MEDICARE Medicare |
$343.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$466.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$476.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$466.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$466.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$417.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$392.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$392.80
|
|
