|
US OF CORNEAL STRUCTURE AND MEASUREMENT
|
Facility
IP
|
$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
|
|
|
US OF EYE DISEASE, GROWTH, OR STRUCTURE
|
Facility
OP
|
$447.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: AETNA Commercial |
$424.65
|
| Rate for Payer: AETNA Medicare |
$402.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$424.65
|
| Rate for Payer: BCBS Healthlink |
$402.30
|
| Rate for Payer: BCBS HMK CHIP |
$402.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$402.30
|
| Rate for Payer: BCBS POS |
$424.65
|
| Rate for Payer: BCBS Traditional |
$447.00
|
| Rate for Payer: CASH_PRICE |
$357.60
|
| Rate for Payer: CIGNA Commercial |
$424.65
|
| Rate for Payer: CIGNA Medicare |
$402.30
|
| Rate for Payer: HUMANA Commercial |
$402.30
|
| Rate for Payer: MEDICAID Medicaid |
$411.24
|
| Rate for Payer: MEDICARE Medicare |
$312.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$424.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$433.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$424.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$424.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$379.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$357.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$357.60
|
|
|
US OF EYE DISEASE, GROWTH, OR STRUCTURE
|
Facility
IP
|
$447.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: AETNA Commercial |
$424.65
|
| Rate for Payer: AETNA Medicare |
$402.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$424.65
|
| Rate for Payer: BCBS Healthlink |
$402.30
|
| Rate for Payer: BCBS HMK CHIP |
$402.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$402.30
|
| Rate for Payer: BCBS POS |
$424.65
|
| Rate for Payer: BCBS Traditional |
$447.00
|
| Rate for Payer: CASH_PRICE |
$357.60
|
| Rate for Payer: CIGNA Commercial |
$424.65
|
| Rate for Payer: CIGNA Medicare |
$402.30
|
| Rate for Payer: HUMANA Commercial |
$402.30
|
| Rate for Payer: MEDICAID Medicaid |
$411.24
|
| Rate for Payer: MEDICARE Medicare |
$312.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$424.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$433.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$424.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$424.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$379.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$357.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$357.60
|
|
|
US OF EYE DISEASE OR GROWTH
|
Facility
OP
|
$524.00
|
|
|
Service Code
|
CPT 76511 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: AETNA Commercial |
$497.80
|
| Rate for Payer: AETNA Medicare |
$471.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$497.80
|
| Rate for Payer: BCBS Healthlink |
$471.60
|
| Rate for Payer: BCBS HMK CHIP |
$471.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$471.60
|
| Rate for Payer: BCBS POS |
$497.80
|
| Rate for Payer: BCBS Traditional |
$524.00
|
| Rate for Payer: CASH_PRICE |
$419.20
|
| Rate for Payer: CIGNA Commercial |
$497.80
|
| Rate for Payer: CIGNA Medicare |
$471.60
|
| Rate for Payer: HUMANA Commercial |
$471.60
|
| Rate for Payer: MEDICAID Medicaid |
$482.08
|
| Rate for Payer: MEDICARE Medicare |
$366.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$497.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$508.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$497.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$497.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$445.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$419.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$419.20
|
|
|
US OF EYE DISEASE OR GROWTH
|
Facility
IP
|
$524.00
|
|
|
Service Code
|
CPT 76511 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: AETNA Commercial |
$497.80
|
| Rate for Payer: AETNA Medicare |
$471.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$497.80
|
| Rate for Payer: BCBS Healthlink |
$471.60
|
| Rate for Payer: BCBS HMK CHIP |
$471.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$471.60
|
| Rate for Payer: BCBS POS |
$497.80
|
| Rate for Payer: BCBS Traditional |
$524.00
|
| Rate for Payer: CASH_PRICE |
$419.20
|
| Rate for Payer: CIGNA Commercial |
$497.80
|
| Rate for Payer: CIGNA Medicare |
$471.60
|
| Rate for Payer: HUMANA Commercial |
$471.60
|
| Rate for Payer: MEDICAID Medicaid |
$482.08
|
| Rate for Payer: MEDICARE Medicare |
$366.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$497.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$508.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$497.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$497.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$445.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$419.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$419.20
|
|
|
US OF EYE FOR DETERMINATION LENS POWER
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: AETNA Commercial |
$393.30
|
| Rate for Payer: AETNA Medicare |
$372.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$393.30
|
| Rate for Payer: BCBS Healthlink |
$372.60
|
| Rate for Payer: BCBS HMK CHIP |
$372.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$372.60
|
| Rate for Payer: BCBS POS |
$393.30
|
| Rate for Payer: BCBS Traditional |
$414.00
|
| Rate for Payer: CASH_PRICE |
$331.20
|
| Rate for Payer: CIGNA Commercial |
$393.30
|
| Rate for Payer: CIGNA Medicare |
$372.60
|
| Rate for Payer: HUMANA Commercial |
$372.60
|
| Rate for Payer: MEDICAID Medicaid |
$380.88
|
| Rate for Payer: MEDICARE Medicare |
$289.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$393.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$401.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$393.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$393.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$351.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$331.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$331.20
|
|
|
US OF EYE FOR DETERMINATION LENS POWER
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.80 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: AETNA Commercial |
$393.30
|
| Rate for Payer: AETNA Medicare |
$372.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$393.30
|
| Rate for Payer: BCBS Healthlink |
$372.60
|
| Rate for Payer: BCBS HMK CHIP |
$372.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$372.60
|
| Rate for Payer: BCBS POS |
$393.30
|
| Rate for Payer: BCBS Traditional |
$414.00
|
| Rate for Payer: CASH_PRICE |
$331.20
|
| Rate for Payer: CIGNA Commercial |
$393.30
|
| Rate for Payer: CIGNA Medicare |
$372.60
|
| Rate for Payer: HUMANA Commercial |
$372.60
|
| Rate for Payer: MEDICAID Medicaid |
$380.88
|
| Rate for Payer: MEDICARE Medicare |
$289.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$393.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$401.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$393.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$393.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$351.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$331.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$331.20
|
|
|
US OF EYE FOREIGN BODY LOCALIZATION
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 76529 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
US OF EYE FOREIGN BODY LOCALIZATION
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 76529 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
US OF EYE TISSUE AND STRUCTURES
|
Facility
OP
|
$784.00
|
|
|
Service Code
|
CPT 76516 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$548.80 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: AETNA Commercial |
$744.80
|
| Rate for Payer: AETNA Medicare |
$705.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$744.80
|
| Rate for Payer: BCBS Healthlink |
$705.60
|
| Rate for Payer: BCBS HMK CHIP |
$705.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$705.60
|
| Rate for Payer: BCBS POS |
$744.80
|
| Rate for Payer: BCBS Traditional |
$784.00
|
| Rate for Payer: CASH_PRICE |
$627.20
|
| Rate for Payer: CIGNA Commercial |
$744.80
|
| Rate for Payer: CIGNA Medicare |
$705.60
|
| Rate for Payer: HUMANA Commercial |
$705.60
|
| Rate for Payer: MEDICAID Medicaid |
$721.28
|
| Rate for Payer: MEDICARE Medicare |
$548.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$744.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$760.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$744.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$744.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$666.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$627.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$627.20
|
|
|
US OF EYE TISSUE AND STRUCTURES
|
Facility
IP
|
$784.00
|
|
|
Service Code
|
CPT 76516 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$548.80 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: AETNA Commercial |
$744.80
|
| Rate for Payer: AETNA Medicare |
$705.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$744.80
|
| Rate for Payer: BCBS Healthlink |
$705.60
|
| Rate for Payer: BCBS HMK CHIP |
$705.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$705.60
|
| Rate for Payer: BCBS POS |
$744.80
|
| Rate for Payer: BCBS Traditional |
$784.00
|
| Rate for Payer: CASH_PRICE |
$627.20
|
| Rate for Payer: CIGNA Commercial |
$744.80
|
| Rate for Payer: CIGNA Medicare |
$705.60
|
| Rate for Payer: HUMANA Commercial |
$705.60
|
| Rate for Payer: MEDICAID Medicaid |
$721.28
|
| Rate for Payer: MEDICARE Medicare |
$548.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$744.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$760.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$744.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$744.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$666.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$627.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$627.20
|
|
|
US OF EYE USING WATER BATH METHOD
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
|
US OF EYE USING WATER BATH METHOD
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT 76513 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
|
US OF FETAL BRAIN ARTERY
|
Facility
OP
|
$426.00
|
|
|
Service Code
|
CPT 76821 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: AETNA Commercial |
$404.70
|
| Rate for Payer: AETNA Medicare |
$383.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$404.70
|
| Rate for Payer: BCBS Healthlink |
$383.40
|
| Rate for Payer: BCBS HMK CHIP |
$383.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$383.40
|
| Rate for Payer: BCBS POS |
$404.70
|
| Rate for Payer: BCBS Traditional |
$426.00
|
| Rate for Payer: CASH_PRICE |
$340.80
|
| Rate for Payer: CIGNA Commercial |
$404.70
|
| Rate for Payer: CIGNA Medicare |
$383.40
|
| Rate for Payer: HUMANA Commercial |
$383.40
|
| Rate for Payer: MEDICAID Medicaid |
$391.92
|
| Rate for Payer: MEDICARE Medicare |
$298.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$404.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$413.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$404.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$404.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$362.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.80
|
|
|
US OF FETAL BRAIN ARTERY
|
Facility
IP
|
$426.00
|
|
|
Service Code
|
CPT 76821 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: AETNA Commercial |
$404.70
|
| Rate for Payer: AETNA Medicare |
$383.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$404.70
|
| Rate for Payer: BCBS Healthlink |
$383.40
|
| Rate for Payer: BCBS HMK CHIP |
$383.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$383.40
|
| Rate for Payer: BCBS POS |
$404.70
|
| Rate for Payer: BCBS Traditional |
$426.00
|
| Rate for Payer: CASH_PRICE |
$340.80
|
| Rate for Payer: CIGNA Commercial |
$404.70
|
| Rate for Payer: CIGNA Medicare |
$383.40
|
| Rate for Payer: HUMANA Commercial |
$383.40
|
| Rate for Payer: MEDICAID Medicaid |
$391.92
|
| Rate for Payer: MEDICARE Medicare |
$298.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$404.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$413.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$404.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$404.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$362.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.80
|
|
|
US OF FETAL UMBILICAL ARTERY FLO
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: AETNA Commercial |
$386.65
|
| Rate for Payer: AETNA Medicare |
$366.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.65
|
| Rate for Payer: BCBS Healthlink |
$366.30
|
| Rate for Payer: BCBS HMK CHIP |
$366.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$366.30
|
| Rate for Payer: BCBS POS |
$386.65
|
| Rate for Payer: BCBS Traditional |
$407.00
|
| Rate for Payer: CASH_PRICE |
$325.60
|
| Rate for Payer: CIGNA Commercial |
$386.65
|
| Rate for Payer: CIGNA Medicare |
$366.30
|
| Rate for Payer: HUMANA Commercial |
$366.30
|
| Rate for Payer: MEDICAID Medicaid |
$374.44
|
| Rate for Payer: MEDICARE Medicare |
$284.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.60
|
|
|
US OF FETAL UMBILICAL ARTERY FLO
|
Facility
OP
|
$407.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: AETNA Commercial |
$386.65
|
| Rate for Payer: AETNA Medicare |
$366.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.65
|
| Rate for Payer: BCBS Healthlink |
$366.30
|
| Rate for Payer: BCBS HMK CHIP |
$366.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$366.30
|
| Rate for Payer: BCBS POS |
$386.65
|
| Rate for Payer: BCBS Traditional |
$407.00
|
| Rate for Payer: CASH_PRICE |
$325.60
|
| Rate for Payer: CIGNA Commercial |
$386.65
|
| Rate for Payer: CIGNA Medicare |
$366.30
|
| Rate for Payer: HUMANA Commercial |
$366.30
|
| Rate for Payer: MEDICAID Medicaid |
$374.44
|
| Rate for Payer: MEDICARE Medicare |
$284.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.60
|
|
|
US OF HIPS, INFANT
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
US OF HIPS, INFANT
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 76886
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
US PELVIC COMP NON OB
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
|
US PELVIC COMP NON OB
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
|
US PELVIC LMT NON OB
|
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 PELVIC LMT NON OB
|
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: 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 PELVIS BUNDLED
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
|
US PELVIS BUNDLED
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: AETNA Commercial |
$478.80
|
| Rate for Payer: AETNA Medicare |
$453.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$478.80
|
| Rate for Payer: BCBS Healthlink |
$453.60
|
| Rate for Payer: BCBS HMK CHIP |
$453.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$453.60
|
| Rate for Payer: BCBS POS |
$478.80
|
| Rate for Payer: BCBS Traditional |
$504.00
|
| Rate for Payer: CASH_PRICE |
$403.20
|
| Rate for Payer: CIGNA Commercial |
$478.80
|
| Rate for Payer: CIGNA Medicare |
$453.60
|
| Rate for Payer: HUMANA Commercial |
$453.60
|
| Rate for Payer: MEDICAID Medicaid |
$463.68
|
| Rate for Payer: MEDICARE Medicare |
$352.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$478.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$488.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$478.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$478.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$428.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$403.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$403.20
|
|
