|
US BREAST UNI REAL TIME WITH IMAGE LIMIT
|
Facility
OP
|
$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
|
|
|
US CAROTID BILATERAL
|
Facility
OP
|
$655.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$458.50 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$622.25
|
| Rate for Payer: AETNA Commercial |
$622.25
|
| Rate for Payer: AETNA Medicare |
$589.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$622.25
|
| Rate for Payer: BCBS Healthlink |
$589.50
|
| Rate for Payer: BCBS HMK CHIP |
$589.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$589.50
|
| Rate for Payer: BCBS POS |
$622.25
|
| Rate for Payer: BCBS Traditional |
$655.00
|
| Rate for Payer: CASH_PRICE |
$524.00
|
| Rate for Payer: CIGNA Commercial |
$622.25
|
| Rate for Payer: CIGNA Medicare |
$589.50
|
| Rate for Payer: HUMANA Commercial |
$589.50
|
| Rate for Payer: MEDICAID Medicaid |
$602.60
|
| Rate for Payer: MEDICARE Medicare |
$458.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$635.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$622.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$622.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$556.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$524.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$524.00
|
|
|
US CAROTID BILATERAL
|
Facility
IP
|
$655.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$458.50 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: AETNA Commercial |
$622.25
|
| Rate for Payer: AETNA Medicare |
$589.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$622.25
|
| Rate for Payer: BCBS Healthlink |
$589.50
|
| Rate for Payer: BCBS HMK CHIP |
$589.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$589.50
|
| Rate for Payer: BCBS POS |
$622.25
|
| Rate for Payer: BCBS Traditional |
$655.00
|
| Rate for Payer: CASH_PRICE |
$524.00
|
| Rate for Payer: CIGNA Commercial |
$622.25
|
| Rate for Payer: CIGNA Medicare |
$589.50
|
| Rate for Payer: HUMANA Commercial |
$589.50
|
| Rate for Payer: MEDICAID Medicaid |
$602.60
|
| Rate for Payer: MEDICARE Medicare |
$458.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$622.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$635.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$622.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$622.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$556.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$524.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$524.00
|
|
|
US CAROTID UNILATERAL
|
Facility
IP
|
$387.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: AETNA Commercial |
$367.65
|
| Rate for Payer: AETNA Medicare |
$348.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$367.65
|
| Rate for Payer: BCBS Healthlink |
$348.30
|
| Rate for Payer: BCBS HMK CHIP |
$348.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$348.30
|
| Rate for Payer: BCBS POS |
$367.65
|
| Rate for Payer: BCBS Traditional |
$387.00
|
| Rate for Payer: CASH_PRICE |
$309.60
|
| Rate for Payer: CIGNA Commercial |
$367.65
|
| Rate for Payer: CIGNA Medicare |
$348.30
|
| Rate for Payer: HUMANA Commercial |
$348.30
|
| Rate for Payer: MEDICAID Medicaid |
$356.04
|
| Rate for Payer: MEDICARE Medicare |
$270.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$367.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$375.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$367.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$367.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$309.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$309.60
|
|
|
US CAROTID UNILATERAL
|
Facility
OP
|
$387.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: AETNA Commercial |
$367.65
|
| Rate for Payer: AETNA Medicare |
$348.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$367.65
|
| Rate for Payer: BCBS Healthlink |
$348.30
|
| Rate for Payer: BCBS HMK CHIP |
$348.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$348.30
|
| Rate for Payer: BCBS POS |
$367.65
|
| Rate for Payer: BCBS Traditional |
$387.00
|
| Rate for Payer: CASH_PRICE |
$309.60
|
| Rate for Payer: CIGNA Commercial |
$367.65
|
| Rate for Payer: CIGNA Medicare |
$348.30
|
| Rate for Payer: HUMANA Commercial |
$348.30
|
| Rate for Payer: MEDICAID Medicaid |
$356.04
|
| Rate for Payer: MEDICARE Medicare |
$270.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$367.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$375.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$367.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$367.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$309.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$309.60
|
|
|
US COMPLETE TTHRC ECHO CONGENI CARDIAC A
|
Facility
OP
|
$595.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: AETNA Commercial |
$565.25
|
| Rate for Payer: AETNA Medicare |
$535.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$565.25
|
| Rate for Payer: BCBS Healthlink |
$535.50
|
| Rate for Payer: BCBS HMK CHIP |
$535.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$535.50
|
| Rate for Payer: BCBS POS |
$565.25
|
| Rate for Payer: BCBS Traditional |
$595.00
|
| Rate for Payer: CASH_PRICE |
$476.00
|
| Rate for Payer: CIGNA Commercial |
$565.25
|
| Rate for Payer: CIGNA Medicare |
$535.50
|
| Rate for Payer: HUMANA Commercial |
$535.50
|
| Rate for Payer: MEDICAID Medicaid |
$547.40
|
| Rate for Payer: MEDICARE Medicare |
$416.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$565.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$577.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$565.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$565.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$505.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$476.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$476.00
|
|
|
US COMPLETE TTHRC ECHO CONGENI CARDIAC A
|
Facility
IP
|
$595.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: AETNA Commercial |
$565.25
|
| Rate for Payer: AETNA Medicare |
$535.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$565.25
|
| Rate for Payer: BCBS Healthlink |
$535.50
|
| Rate for Payer: BCBS HMK CHIP |
$535.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$535.50
|
| Rate for Payer: BCBS POS |
$565.25
|
| Rate for Payer: BCBS Traditional |
$595.00
|
| Rate for Payer: CASH_PRICE |
$476.00
|
| Rate for Payer: CIGNA Commercial |
$565.25
|
| Rate for Payer: CIGNA Medicare |
$535.50
|
| Rate for Payer: HUMANA Commercial |
$535.50
|
| Rate for Payer: MEDICAID Medicaid |
$547.40
|
| Rate for Payer: MEDICARE Medicare |
$416.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$565.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$577.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$565.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$565.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$505.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$476.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$476.00
|
|
|
US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 76881 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: AETNA Commercial |
$336.30
|
| Rate for Payer: AETNA Medicare |
$318.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$336.30
|
| Rate for Payer: BCBS Healthlink |
$318.60
|
| Rate for Payer: BCBS HMK CHIP |
$318.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$318.60
|
| Rate for Payer: BCBS POS |
$336.30
|
| Rate for Payer: BCBS Traditional |
$354.00
|
| Rate for Payer: CASH_PRICE |
$283.20
|
| Rate for Payer: CIGNA Commercial |
$336.30
|
| Rate for Payer: CIGNA Medicare |
$318.60
|
| Rate for Payer: HUMANA Commercial |
$318.60
|
| Rate for Payer: MEDICAID Medicaid |
$325.68
|
| Rate for Payer: MEDICARE Medicare |
$247.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$336.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$343.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$336.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$336.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$283.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$283.20
|
|
|
US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 76881 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: AETNA Commercial |
$336.30
|
| Rate for Payer: AETNA Medicare |
$318.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$336.30
|
| Rate for Payer: BCBS Healthlink |
$318.60
|
| Rate for Payer: BCBS HMK CHIP |
$318.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$318.60
|
| Rate for Payer: BCBS POS |
$336.30
|
| Rate for Payer: BCBS Traditional |
$354.00
|
| Rate for Payer: CASH_PRICE |
$283.20
|
| Rate for Payer: CIGNA Commercial |
$336.30
|
| Rate for Payer: CIGNA Medicare |
$318.60
|
| Rate for Payer: HUMANA Commercial |
$318.60
|
| Rate for Payer: MEDICAID Medicaid |
$325.68
|
| Rate for Payer: MEDICARE Medicare |
$247.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$336.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$343.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$336.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$336.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$283.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$283.20
|
|
|
US DOP ECHOCARD PULSE WAVE W/SPECT F-UP/
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
US DOP ECHOCARD PULSE WAVE W/SPECT F-UP/
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
US DOPPLER COLOR FLOW ADD-ON
|
Facility
OP
|
$941.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$658.70 |
| Max. Negotiated Rate |
$941.00 |
| Rate for Payer: AETNA Commercial |
$893.95
|
| Rate for Payer: AETNA Medicare |
$846.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$893.95
|
| Rate for Payer: BCBS Healthlink |
$846.90
|
| Rate for Payer: BCBS HMK CHIP |
$846.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$846.90
|
| Rate for Payer: BCBS POS |
$893.95
|
| Rate for Payer: BCBS Traditional |
$941.00
|
| Rate for Payer: CASH_PRICE |
$752.80
|
| Rate for Payer: CIGNA Commercial |
$893.95
|
| Rate for Payer: CIGNA Medicare |
$846.90
|
| Rate for Payer: HUMANA Commercial |
$846.90
|
| Rate for Payer: MEDICAID Medicaid |
$865.72
|
| Rate for Payer: MEDICARE Medicare |
$658.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$893.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$912.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$893.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$893.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$799.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$752.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$752.80
|
|
|
US DOPPLER COLOR FLOW ADD-ON
|
Facility
IP
|
$941.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$658.70 |
| Max. Negotiated Rate |
$941.00 |
| Rate for Payer: AETNA Commercial |
$893.95
|
| Rate for Payer: AETNA Medicare |
$846.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$893.95
|
| Rate for Payer: BCBS Healthlink |
$846.90
|
| Rate for Payer: BCBS HMK CHIP |
$846.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$846.90
|
| Rate for Payer: BCBS POS |
$893.95
|
| Rate for Payer: BCBS Traditional |
$941.00
|
| Rate for Payer: CASH_PRICE |
$752.80
|
| Rate for Payer: CIGNA Commercial |
$893.95
|
| Rate for Payer: CIGNA Medicare |
$846.90
|
| Rate for Payer: HUMANA Commercial |
$846.90
|
| Rate for Payer: MEDICAID Medicaid |
$865.72
|
| Rate for Payer: MEDICARE Medicare |
$658.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$893.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$912.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$893.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$893.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$799.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$752.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$752.80
|
|
|
US DUP-SCAN ARTL FLO ABD/PEL/SCRO/RPR OR
|
Facility
IP
|
$668.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$668.00 |
| Rate for Payer: AETNA Commercial |
$634.60
|
| Rate for Payer: AETNA Medicare |
$601.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$634.60
|
| Rate for Payer: BCBS Healthlink |
$601.20
|
| Rate for Payer: BCBS HMK CHIP |
$601.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$601.20
|
| Rate for Payer: BCBS POS |
$634.60
|
| Rate for Payer: BCBS Traditional |
$668.00
|
| Rate for Payer: CASH_PRICE |
$534.40
|
| Rate for Payer: CIGNA Commercial |
$634.60
|
| Rate for Payer: CIGNA Medicare |
$601.20
|
| Rate for Payer: HUMANA Commercial |
$601.20
|
| Rate for Payer: MEDICAID Medicaid |
$614.56
|
| Rate for Payer: MEDICARE Medicare |
$467.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$634.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$647.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$634.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$634.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$567.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$534.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$534.40
|
|
|
US DUP-SCAN ARTL FLO ABD/PEL/SCRO/RPR OR
|
Facility
OP
|
$668.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$668.00 |
| Rate for Payer: AETNA Commercial |
$634.60
|
| Rate for Payer: AETNA Medicare |
$601.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$634.60
|
| Rate for Payer: BCBS Healthlink |
$601.20
|
| Rate for Payer: BCBS HMK CHIP |
$601.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$601.20
|
| Rate for Payer: BCBS POS |
$634.60
|
| Rate for Payer: BCBS Traditional |
$668.00
|
| Rate for Payer: CASH_PRICE |
$534.40
|
| Rate for Payer: CIGNA Commercial |
$634.60
|
| Rate for Payer: CIGNA Medicare |
$601.20
|
| Rate for Payer: HUMANA Commercial |
$601.20
|
| Rate for Payer: MEDICAID Medicaid |
$614.56
|
| Rate for Payer: MEDICARE Medicare |
$467.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$634.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$647.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$634.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$634.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$567.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$534.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$534.40
|
|
|
US ECHO BUBBLE STUDY
|
Facility
OP
|
$1,798.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,258.60 |
| Max. Negotiated Rate |
$1,798.00 |
| Rate for Payer: AETNA Commercial |
$1,708.10
|
| Rate for Payer: AETNA Medicare |
$1,618.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,708.10
|
| Rate for Payer: BCBS Healthlink |
$1,618.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,618.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,618.20
|
| Rate for Payer: BCBS POS |
$1,708.10
|
| Rate for Payer: BCBS Traditional |
$1,798.00
|
| Rate for Payer: CASH_PRICE |
$1,438.40
|
| Rate for Payer: CIGNA Commercial |
$1,708.10
|
| Rate for Payer: CIGNA Medicare |
$1,618.20
|
| Rate for Payer: HUMANA Commercial |
$1,618.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,654.16
|
| Rate for Payer: MEDICARE Medicare |
$1,258.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,744.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,708.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,528.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,438.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,438.40
|
|
|
US ECHO BUBBLE STUDY
|
Facility
IP
|
$1,798.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,258.60 |
| Max. Negotiated Rate |
$1,798.00 |
| Rate for Payer: AETNA Commercial |
$1,708.10
|
| Rate for Payer: AETNA Medicare |
$1,618.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,708.10
|
| Rate for Payer: BCBS Healthlink |
$1,618.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,618.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,618.20
|
| Rate for Payer: BCBS POS |
$1,708.10
|
| Rate for Payer: BCBS Traditional |
$1,798.00
|
| Rate for Payer: CASH_PRICE |
$1,438.40
|
| Rate for Payer: CIGNA Commercial |
$1,708.10
|
| Rate for Payer: CIGNA Medicare |
$1,618.20
|
| Rate for Payer: HUMANA Commercial |
$1,618.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,654.16
|
| Rate for Payer: MEDICARE Medicare |
$1,258.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,744.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,708.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,528.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,438.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,438.40
|
|
|
US ECHO COMPLETE
|
Facility
IP
|
$1,798.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,258.60 |
| Max. Negotiated Rate |
$1,798.00 |
| Rate for Payer: AETNA Commercial |
$1,708.10
|
| Rate for Payer: AETNA Medicare |
$1,618.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,708.10
|
| Rate for Payer: BCBS Healthlink |
$1,618.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,618.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,618.20
|
| Rate for Payer: BCBS POS |
$1,708.10
|
| Rate for Payer: BCBS Traditional |
$1,798.00
|
| Rate for Payer: CASH_PRICE |
$1,438.40
|
| Rate for Payer: CIGNA Commercial |
$1,708.10
|
| Rate for Payer: CIGNA Medicare |
$1,618.20
|
| Rate for Payer: HUMANA Commercial |
$1,618.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,654.16
|
| Rate for Payer: MEDICARE Medicare |
$1,258.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,744.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,708.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,528.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,438.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,438.40
|
|
|
US ECHO COMPLETE
|
Facility
OP
|
$1,798.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,258.60 |
| Max. Negotiated Rate |
$1,798.00 |
| Rate for Payer: AETNA Commercial |
$1,708.10
|
| Rate for Payer: AETNA Medicare |
$1,618.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,708.10
|
| Rate for Payer: BCBS Healthlink |
$1,618.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,618.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,618.20
|
| Rate for Payer: BCBS POS |
$1,708.10
|
| Rate for Payer: BCBS Traditional |
$1,798.00
|
| Rate for Payer: CASH_PRICE |
$1,438.40
|
| Rate for Payer: CIGNA Commercial |
$1,708.10
|
| Rate for Payer: CIGNA Medicare |
$1,618.20
|
| Rate for Payer: HUMANA Commercial |
$1,618.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,654.16
|
| Rate for Payer: MEDICARE Medicare |
$1,258.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,744.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,708.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,708.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,528.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,438.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,438.40
|
|
|
US ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
CPT 76506 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: AETNA Commercial |
$598.50
|
| Rate for Payer: AETNA Medicare |
$567.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$598.50
|
| Rate for Payer: BCBS Healthlink |
$567.00
|
| Rate for Payer: BCBS HMK CHIP |
$567.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$567.00
|
| Rate for Payer: BCBS POS |
$598.50
|
| Rate for Payer: BCBS Traditional |
$630.00
|
| Rate for Payer: CASH_PRICE |
$504.00
|
| Rate for Payer: CIGNA Commercial |
$598.50
|
| Rate for Payer: CIGNA Medicare |
$567.00
|
| Rate for Payer: HUMANA Commercial |
$567.00
|
| Rate for Payer: MEDICAID Medicaid |
$579.60
|
| Rate for Payer: MEDICARE Medicare |
$441.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$598.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$611.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$598.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$598.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$535.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$504.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$504.00
|
|
|
US ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Facility
OP
|
$630.00
|
|
|
Service Code
|
CPT 76506 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: AETNA Commercial |
$598.50
|
| Rate for Payer: AETNA Medicare |
$567.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$598.50
|
| Rate for Payer: BCBS Healthlink |
$567.00
|
| Rate for Payer: BCBS HMK CHIP |
$567.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$567.00
|
| Rate for Payer: BCBS POS |
$598.50
|
| Rate for Payer: BCBS Traditional |
$630.00
|
| Rate for Payer: CASH_PRICE |
$504.00
|
| Rate for Payer: CIGNA Commercial |
$598.50
|
| Rate for Payer: CIGNA Medicare |
$567.00
|
| Rate for Payer: HUMANA Commercial |
$567.00
|
| Rate for Payer: MEDICAID Medicaid |
$579.60
|
| Rate for Payer: MEDICARE Medicare |
$441.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$598.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$611.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$598.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$598.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$535.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$504.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$504.00
|
|
|
US ECHO EXAM OF FETAL HEART
|
Facility
OP
|
$1,369.00
|
|
|
Service Code
|
CPT 76825 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$958.30 |
| Max. Negotiated Rate |
$1,369.00 |
| Rate for Payer: AETNA Commercial |
$1,300.55
|
| Rate for Payer: AETNA Medicare |
$1,232.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,300.55
|
| Rate for Payer: BCBS Healthlink |
$1,232.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,232.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,232.10
|
| Rate for Payer: BCBS POS |
$1,300.55
|
| Rate for Payer: BCBS Traditional |
$1,369.00
|
| Rate for Payer: CASH_PRICE |
$1,095.20
|
| Rate for Payer: CIGNA Commercial |
$1,300.55
|
| Rate for Payer: CIGNA Medicare |
$1,232.10
|
| Rate for Payer: HUMANA Commercial |
$1,232.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,259.48
|
| Rate for Payer: MEDICARE Medicare |
$958.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,300.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,327.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,300.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,300.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,163.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,095.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,095.20
|
|
|
US ECHO EXAM OF FETAL HEART
|
Facility
IP
|
$1,369.00
|
|
|
Service Code
|
CPT 76825 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$958.30 |
| Max. Negotiated Rate |
$1,369.00 |
| Rate for Payer: AETNA Commercial |
$1,300.55
|
| Rate for Payer: AETNA Medicare |
$1,232.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,300.55
|
| Rate for Payer: BCBS Healthlink |
$1,232.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,232.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,232.10
|
| Rate for Payer: BCBS POS |
$1,300.55
|
| Rate for Payer: BCBS Traditional |
$1,369.00
|
| Rate for Payer: CASH_PRICE |
$1,095.20
|
| Rate for Payer: CIGNA Commercial |
$1,300.55
|
| Rate for Payer: CIGNA Medicare |
$1,232.10
|
| Rate for Payer: HUMANA Commercial |
$1,232.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,259.48
|
| Rate for Payer: MEDICARE Medicare |
$958.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,300.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,327.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,300.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,300.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,163.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,095.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,095.20
|
|
|
US ECHO EXAM UTERUS
|
Facility
OP
|
$546.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: AETNA Commercial |
$518.70
|
| Rate for Payer: AETNA Medicare |
$491.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$518.70
|
| Rate for Payer: BCBS Healthlink |
$491.40
|
| Rate for Payer: BCBS HMK CHIP |
$491.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$491.40
|
| Rate for Payer: BCBS POS |
$518.70
|
| Rate for Payer: BCBS Traditional |
$546.00
|
| Rate for Payer: CASH_PRICE |
$436.80
|
| Rate for Payer: CIGNA Commercial |
$518.70
|
| Rate for Payer: CIGNA Medicare |
$491.40
|
| Rate for Payer: HUMANA Commercial |
$491.40
|
| Rate for Payer: MEDICAID Medicaid |
$502.32
|
| Rate for Payer: MEDICARE Medicare |
$382.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$518.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$529.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$518.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$518.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$464.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$436.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$436.80
|
|
|
US ECHO EXAM UTERUS
|
Facility
IP
|
$546.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: AETNA Commercial |
$518.70
|
| Rate for Payer: AETNA Medicare |
$491.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$518.70
|
| Rate for Payer: BCBS Healthlink |
$491.40
|
| Rate for Payer: BCBS HMK CHIP |
$491.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$491.40
|
| Rate for Payer: BCBS POS |
$518.70
|
| Rate for Payer: BCBS Traditional |
$546.00
|
| Rate for Payer: CASH_PRICE |
$436.80
|
| Rate for Payer: CIGNA Commercial |
$518.70
|
| Rate for Payer: CIGNA Medicare |
$491.40
|
| Rate for Payer: HUMANA Commercial |
$491.40
|
| Rate for Payer: MEDICAID Medicaid |
$502.32
|
| Rate for Payer: MEDICARE Medicare |
$382.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$518.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$529.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$518.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$518.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$464.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$436.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$436.80
|
|
