|
US ECHO LIMITED
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$517.30 |
| Max. Negotiated Rate |
$739.00 |
| Rate for Payer: AETNA Commercial |
$702.05
|
| Rate for Payer: AETNA Medicare |
$665.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$702.05
|
| Rate for Payer: BCBS Healthlink |
$665.10
|
| Rate for Payer: BCBS HMK CHIP |
$665.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$665.10
|
| Rate for Payer: BCBS POS |
$702.05
|
| Rate for Payer: BCBS Traditional |
$739.00
|
| Rate for Payer: CASH_PRICE |
$591.20
|
| Rate for Payer: CIGNA Commercial |
$702.05
|
| Rate for Payer: CIGNA Medicare |
$665.10
|
| Rate for Payer: HUMANA Commercial |
$665.10
|
| Rate for Payer: MEDICAID Medicaid |
$679.88
|
| Rate for Payer: MEDICARE Medicare |
$517.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$702.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$716.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$702.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$702.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$628.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$591.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$591.20
|
|
|
US ECHO LIMITED
|
Facility
IP
|
$739.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$517.30 |
| Max. Negotiated Rate |
$739.00 |
| Rate for Payer: AETNA Commercial |
$702.05
|
| Rate for Payer: AETNA Medicare |
$665.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$702.05
|
| Rate for Payer: BCBS Healthlink |
$665.10
|
| Rate for Payer: BCBS HMK CHIP |
$665.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$665.10
|
| Rate for Payer: BCBS POS |
$702.05
|
| Rate for Payer: BCBS Traditional |
$739.00
|
| Rate for Payer: CASH_PRICE |
$591.20
|
| Rate for Payer: CIGNA Commercial |
$702.05
|
| Rate for Payer: CIGNA Medicare |
$665.10
|
| Rate for Payer: HUMANA Commercial |
$665.10
|
| Rate for Payer: MEDICAID Medicaid |
$679.88
|
| Rate for Payer: MEDICARE Medicare |
$517.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$702.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$716.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$702.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$702.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$628.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$591.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$591.20
|
|
|
US ELASTOGRAPHY EA ADDL TAGET LE
|
Facility
OP
|
$259.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$259.00 |
| Rate for Payer: AETNA Commercial |
$246.05
|
| Rate for Payer: AETNA Medicare |
$233.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$246.05
|
| Rate for Payer: BCBS Healthlink |
$233.10
|
| Rate for Payer: BCBS HMK CHIP |
$233.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$233.10
|
| Rate for Payer: BCBS POS |
$246.05
|
| Rate for Payer: BCBS Traditional |
$259.00
|
| Rate for Payer: CASH_PRICE |
$207.20
|
| Rate for Payer: CIGNA Commercial |
$246.05
|
| Rate for Payer: CIGNA Medicare |
$233.10
|
| Rate for Payer: HUMANA Commercial |
$233.10
|
| Rate for Payer: MEDICAID Medicaid |
$238.28
|
| Rate for Payer: MEDICARE Medicare |
$181.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$246.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$251.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$246.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$246.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$220.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$207.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$207.20
|
|
|
US ELASTOGRAPHY EA ADDL TAGET LE
|
Facility
IP
|
$259.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$259.00 |
| Rate for Payer: AETNA Commercial |
$246.05
|
| Rate for Payer: AETNA Medicare |
$233.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$246.05
|
| Rate for Payer: BCBS Healthlink |
$233.10
|
| Rate for Payer: BCBS HMK CHIP |
$233.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$233.10
|
| Rate for Payer: BCBS POS |
$246.05
|
| Rate for Payer: BCBS Traditional |
$259.00
|
| Rate for Payer: CASH_PRICE |
$207.20
|
| Rate for Payer: CIGNA Commercial |
$246.05
|
| Rate for Payer: CIGNA Medicare |
$233.10
|
| Rate for Payer: HUMANA Commercial |
$233.10
|
| Rate for Payer: MEDICAID Medicaid |
$238.28
|
| Rate for Payer: MEDICARE Medicare |
$181.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$246.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$251.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$246.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$246.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$220.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$207.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$207.20
|
|
|
US ELASTOGRAPHY FIRST TARGET LESION
|
Facility
IP
|
$341.00
|
|
|
Service Code
|
CPT 76982 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.70 |
| Max. Negotiated Rate |
$341.00 |
| Rate for Payer: AETNA Commercial |
$323.95
|
| Rate for Payer: AETNA Medicare |
$306.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$323.95
|
| Rate for Payer: BCBS Healthlink |
$306.90
|
| Rate for Payer: BCBS HMK CHIP |
$306.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$306.90
|
| Rate for Payer: BCBS POS |
$323.95
|
| Rate for Payer: BCBS Traditional |
$341.00
|
| Rate for Payer: CASH_PRICE |
$272.80
|
| Rate for Payer: CIGNA Commercial |
$323.95
|
| Rate for Payer: CIGNA Medicare |
$306.90
|
| Rate for Payer: HUMANA Commercial |
$306.90
|
| Rate for Payer: MEDICAID Medicaid |
$313.72
|
| Rate for Payer: MEDICARE Medicare |
$238.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$323.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$330.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$323.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$323.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$289.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$272.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$272.80
|
|
|
US ELASTOGRAPHY FIRST TARGET LESION
|
Facility
OP
|
$341.00
|
|
|
Service Code
|
CPT 76982 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.70 |
| Max. Negotiated Rate |
$341.00 |
| Rate for Payer: AETNA Commercial |
$323.95
|
| Rate for Payer: AETNA Medicare |
$306.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$323.95
|
| Rate for Payer: BCBS Healthlink |
$306.90
|
| Rate for Payer: BCBS HMK CHIP |
$306.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$306.90
|
| Rate for Payer: BCBS POS |
$323.95
|
| Rate for Payer: BCBS Traditional |
$341.00
|
| Rate for Payer: CASH_PRICE |
$272.80
|
| Rate for Payer: CIGNA Commercial |
$323.95
|
| Rate for Payer: CIGNA Medicare |
$306.90
|
| Rate for Payer: HUMANA Commercial |
$306.90
|
| Rate for Payer: MEDICAID Medicaid |
$313.72
|
| Rate for Payer: MEDICARE Medicare |
$238.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$323.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$330.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$323.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$323.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$289.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$272.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$272.80
|
|
|
US ELASTOGRAPHY OF ORGAN TISSUE
|
Facility
OP
|
$403.00
|
|
|
Service Code
|
CPT 76981 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: AETNA Commercial |
$382.85
|
| Rate for Payer: AETNA Medicare |
$362.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$382.85
|
| Rate for Payer: BCBS Healthlink |
$362.70
|
| Rate for Payer: BCBS HMK CHIP |
$362.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$362.70
|
| Rate for Payer: BCBS POS |
$382.85
|
| Rate for Payer: BCBS Traditional |
$403.00
|
| Rate for Payer: CASH_PRICE |
$322.40
|
| Rate for Payer: CIGNA Commercial |
$382.85
|
| Rate for Payer: CIGNA Medicare |
$362.70
|
| Rate for Payer: HUMANA Commercial |
$362.70
|
| Rate for Payer: MEDICAID Medicaid |
$370.76
|
| Rate for Payer: MEDICARE Medicare |
$282.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$382.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$390.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$382.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$382.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$342.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$322.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$322.40
|
|
|
US ELASTOGRAPHY OF ORGAN TISSUE
|
Facility
IP
|
$403.00
|
|
|
Service Code
|
CPT 76981 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: AETNA Commercial |
$382.85
|
| Rate for Payer: AETNA Medicare |
$362.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$382.85
|
| Rate for Payer: BCBS Healthlink |
$362.70
|
| Rate for Payer: BCBS HMK CHIP |
$362.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$362.70
|
| Rate for Payer: BCBS POS |
$382.85
|
| Rate for Payer: BCBS Traditional |
$403.00
|
| Rate for Payer: CASH_PRICE |
$322.40
|
| Rate for Payer: CIGNA Commercial |
$382.85
|
| Rate for Payer: CIGNA Medicare |
$362.70
|
| Rate for Payer: HUMANA Commercial |
$362.70
|
| Rate for Payer: MEDICAID Medicaid |
$370.76
|
| Rate for Payer: MEDICARE Medicare |
$282.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$382.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$390.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$382.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$382.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$342.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$322.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$322.40
|
|
|
US FETAL BIOPHYS PROF W/O NON STRESS TES
|
Facility
IP
|
$635.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$444.50 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: AETNA Commercial |
$603.25
|
| Rate for Payer: AETNA Medicare |
$571.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$603.25
|
| Rate for Payer: BCBS Healthlink |
$571.50
|
| Rate for Payer: BCBS HMK CHIP |
$571.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$571.50
|
| Rate for Payer: BCBS POS |
$603.25
|
| Rate for Payer: BCBS Traditional |
$635.00
|
| Rate for Payer: CASH_PRICE |
$508.00
|
| Rate for Payer: CIGNA Commercial |
$603.25
|
| Rate for Payer: CIGNA Medicare |
$571.50
|
| Rate for Payer: HUMANA Commercial |
$571.50
|
| Rate for Payer: MEDICAID Medicaid |
$584.20
|
| Rate for Payer: MEDICARE Medicare |
$444.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$603.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$615.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$603.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$603.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$539.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$508.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$508.00
|
|
|
US FETAL BIOPHYS PROF W/O NON STRESS TES
|
Facility
OP
|
$635.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$444.50 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: AETNA Commercial |
$603.25
|
| Rate for Payer: AETNA Medicare |
$571.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$603.25
|
| Rate for Payer: BCBS Healthlink |
$571.50
|
| Rate for Payer: BCBS HMK CHIP |
$571.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$571.50
|
| Rate for Payer: BCBS POS |
$603.25
|
| Rate for Payer: BCBS Traditional |
$635.00
|
| Rate for Payer: CASH_PRICE |
$508.00
|
| Rate for Payer: CIGNA Commercial |
$603.25
|
| Rate for Payer: CIGNA Medicare |
$571.50
|
| Rate for Payer: HUMANA Commercial |
$571.50
|
| Rate for Payer: MEDICAID Medicaid |
$584.20
|
| Rate for Payer: MEDICARE Medicare |
$444.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$603.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$615.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$603.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$603.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$539.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$508.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$508.00
|
|
|
US FETAL UMBILICAL CORD OCCLUSION W/US
|
Facility
IP
|
$289.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: AETNA Commercial |
$274.55
|
| Rate for Payer: AETNA Medicare |
$260.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$274.55
|
| Rate for Payer: BCBS Healthlink |
$260.10
|
| Rate for Payer: BCBS HMK CHIP |
$260.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$260.10
|
| Rate for Payer: BCBS POS |
$274.55
|
| Rate for Payer: BCBS Traditional |
$289.00
|
| Rate for Payer: CASH_PRICE |
$231.20
|
| Rate for Payer: CIGNA Commercial |
$274.55
|
| Rate for Payer: CIGNA Medicare |
$260.10
|
| Rate for Payer: HUMANA Commercial |
$260.10
|
| Rate for Payer: MEDICAID Medicaid |
$265.88
|
| Rate for Payer: MEDICARE Medicare |
$202.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$274.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$280.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$274.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$274.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$245.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$231.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$231.20
|
|
|
US FETAL UMBILICAL CORD OCCLUSION W/US
|
Facility
OP
|
$289.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: AETNA Commercial |
$274.55
|
| Rate for Payer: AETNA Medicare |
$260.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$274.55
|
| Rate for Payer: BCBS Healthlink |
$260.10
|
| Rate for Payer: BCBS HMK CHIP |
$260.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$260.10
|
| Rate for Payer: BCBS POS |
$274.55
|
| Rate for Payer: BCBS Traditional |
$289.00
|
| Rate for Payer: CASH_PRICE |
$231.20
|
| Rate for Payer: CIGNA Commercial |
$274.55
|
| Rate for Payer: CIGNA Medicare |
$260.10
|
| Rate for Payer: HUMANA Commercial |
$260.10
|
| Rate for Payer: MEDICAID Medicaid |
$265.88
|
| Rate for Payer: MEDICARE Medicare |
$202.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$274.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$280.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$274.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$274.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$245.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$231.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$231.20
|
|
|
US GASTRO/INTEST SUPERVISION AND INTERPR
|
Facility
OP
|
$247.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: AETNA Commercial |
$234.65
|
| Rate for Payer: AETNA Medicare |
$222.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$234.65
|
| Rate for Payer: BCBS Healthlink |
$222.30
|
| Rate for Payer: BCBS HMK CHIP |
$222.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$222.30
|
| Rate for Payer: BCBS POS |
$234.65
|
| Rate for Payer: BCBS Traditional |
$247.00
|
| Rate for Payer: CASH_PRICE |
$197.60
|
| Rate for Payer: CIGNA Commercial |
$234.65
|
| Rate for Payer: CIGNA Medicare |
$222.30
|
| Rate for Payer: HUMANA Commercial |
$222.30
|
| Rate for Payer: MEDICAID Medicaid |
$227.24
|
| Rate for Payer: MEDICARE Medicare |
$172.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$234.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$239.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$234.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$234.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$197.60
|
|
|
US GASTRO/INTEST SUPERVISION AND INTERPR
|
Facility
IP
|
$247.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: AETNA Commercial |
$234.65
|
| Rate for Payer: AETNA Medicare |
$222.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$234.65
|
| Rate for Payer: BCBS Healthlink |
$222.30
|
| Rate for Payer: BCBS HMK CHIP |
$222.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$222.30
|
| Rate for Payer: BCBS POS |
$234.65
|
| Rate for Payer: BCBS Traditional |
$247.00
|
| Rate for Payer: CASH_PRICE |
$197.60
|
| Rate for Payer: CIGNA Commercial |
$234.65
|
| Rate for Payer: CIGNA Medicare |
$222.30
|
| Rate for Payer: HUMANA Commercial |
$222.30
|
| Rate for Payer: MEDICAID Medicaid |
$227.24
|
| Rate for Payer: MEDICARE Medicare |
$172.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$234.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$239.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$234.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$234.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$197.60
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: AETNA Commercial |
$156.75
|
| Rate for Payer: AETNA Medicare |
$148.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$156.75
|
| Rate for Payer: BCBS Healthlink |
$148.50
|
| Rate for Payer: BCBS HMK CHIP |
$148.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$148.50
|
| Rate for Payer: BCBS POS |
$156.75
|
| Rate for Payer: BCBS Traditional |
$165.00
|
| Rate for Payer: CASH_PRICE |
$132.00
|
| Rate for Payer: CIGNA Commercial |
$156.75
|
| Rate for Payer: CIGNA Medicare |
$148.50
|
| Rate for Payer: HUMANA Commercial |
$148.50
|
| Rate for Payer: MEDICAID Medicaid |
$151.80
|
| Rate for Payer: MEDICARE Medicare |
$115.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$156.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$160.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$156.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$156.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$140.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$132.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$132.00
|
|
|
US GUIDE VASCULAR ACCESS
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: AETNA Commercial |
$156.75
|
| Rate for Payer: AETNA Medicare |
$148.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$156.75
|
| Rate for Payer: BCBS Healthlink |
$148.50
|
| Rate for Payer: BCBS HMK CHIP |
$148.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$148.50
|
| Rate for Payer: BCBS POS |
$156.75
|
| Rate for Payer: BCBS Traditional |
$165.00
|
| Rate for Payer: CASH_PRICE |
$132.00
|
| Rate for Payer: CIGNA Commercial |
$156.75
|
| Rate for Payer: CIGNA Medicare |
$148.50
|
| Rate for Payer: HUMANA Commercial |
$148.50
|
| Rate for Payer: MEDICAID Medicaid |
$151.80
|
| Rate for Payer: MEDICARE Medicare |
$115.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$156.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$160.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$156.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$156.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$140.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$132.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$132.00
|
|
|
US LOWER EXTREMITY STUDY BILATERAL
|
Facility
OP
|
$630.00
|
|
|
Service Code
|
CPT 93925
|
| 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 LOWER EXTREMITY STUDY BILATERAL
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
CPT 93925
|
| 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 LOWER EXTREMITY STUDY UNILATERAL
|
Facility
IP
|
$453.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: AETNA Commercial |
$430.35
|
| Rate for Payer: AETNA Medicare |
$407.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$430.35
|
| Rate for Payer: BCBS Healthlink |
$407.70
|
| Rate for Payer: BCBS HMK CHIP |
$407.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$407.70
|
| Rate for Payer: BCBS POS |
$430.35
|
| Rate for Payer: BCBS Traditional |
$453.00
|
| Rate for Payer: CASH_PRICE |
$362.40
|
| Rate for Payer: CIGNA Commercial |
$430.35
|
| Rate for Payer: CIGNA Medicare |
$407.70
|
| Rate for Payer: HUMANA Commercial |
$407.70
|
| Rate for Payer: MEDICAID Medicaid |
$416.76
|
| Rate for Payer: MEDICARE Medicare |
$317.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$430.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$439.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$430.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$430.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$385.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$362.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$362.40
|
|
|
US LOWER EXTREMITY STUDY UNILATERAL
|
Facility
OP
|
$453.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: AETNA Commercial |
$430.35
|
| Rate for Payer: AETNA Medicare |
$407.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$430.35
|
| Rate for Payer: BCBS Healthlink |
$407.70
|
| Rate for Payer: BCBS HMK CHIP |
$407.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$407.70
|
| Rate for Payer: BCBS POS |
$430.35
|
| Rate for Payer: BCBS Traditional |
$453.00
|
| Rate for Payer: CASH_PRICE |
$362.40
|
| Rate for Payer: CIGNA Commercial |
$430.35
|
| Rate for Payer: CIGNA Medicare |
$407.70
|
| Rate for Payer: HUMANA Commercial |
$407.70
|
| Rate for Payer: MEDICAID Medicaid |
$416.76
|
| Rate for Payer: MEDICARE Medicare |
$317.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$430.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$439.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$430.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$430.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$385.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$362.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$362.40
|
|
|
US/MONITORING OF HEART OF FETUS BIOPHYPR
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: AETNA Commercial |
$330.60
|
| Rate for Payer: AETNA Medicare |
$313.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$330.60
|
| Rate for Payer: BCBS Healthlink |
$313.20
|
| Rate for Payer: BCBS HMK CHIP |
$313.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$313.20
|
| Rate for Payer: BCBS POS |
$330.60
|
| Rate for Payer: BCBS Traditional |
$348.00
|
| Rate for Payer: CASH_PRICE |
$278.40
|
| Rate for Payer: CIGNA Commercial |
$330.60
|
| Rate for Payer: CIGNA Medicare |
$313.20
|
| Rate for Payer: HUMANA Commercial |
$313.20
|
| Rate for Payer: MEDICAID Medicaid |
$320.16
|
| Rate for Payer: MEDICARE Medicare |
$243.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$330.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$337.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$330.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$330.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$295.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$278.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$278.40
|
|
|
US/MONITORING OF HEART OF FETUS BIOPHYPR
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: AETNA Commercial |
$330.60
|
| Rate for Payer: AETNA Medicare |
$313.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$330.60
|
| Rate for Payer: BCBS Healthlink |
$313.20
|
| Rate for Payer: BCBS HMK CHIP |
$313.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$313.20
|
| Rate for Payer: BCBS POS |
$330.60
|
| Rate for Payer: BCBS Traditional |
$348.00
|
| Rate for Payer: CASH_PRICE |
$278.40
|
| Rate for Payer: CIGNA Commercial |
$330.60
|
| Rate for Payer: CIGNA Medicare |
$313.20
|
| Rate for Payer: HUMANA Commercial |
$313.20
|
| Rate for Payer: MEDICAID Medicaid |
$320.16
|
| Rate for Payer: MEDICARE Medicare |
$243.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$330.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$337.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$330.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$330.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$295.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$278.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$278.40
|
|
|
US OF BONE DENSITY MEASUREMENT
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT 76977 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
US OF BONE DENSITY MEASUREMENT
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT 76977 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
US OF CORNEAL STRUCTURE AND MEASUREMENT
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 76514 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
