|
US POST VOID RESIDUAL
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 51798 TC
|
| 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 POST VOID RESIDUAL
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 51798 TC
|
| 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 RADIOLOGL GUIDANCE PRQ DRG W/PLMT CAT
|
Facility
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$1,578.00 |
| Rate for Payer: AETNA Commercial |
$1,499.10
|
| Rate for Payer: AETNA Medicare |
$1,420.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,499.10
|
| Rate for Payer: BCBS Healthlink |
$1,420.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,420.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,420.20
|
| Rate for Payer: BCBS POS |
$1,499.10
|
| Rate for Payer: BCBS Traditional |
$1,578.00
|
| Rate for Payer: CASH_PRICE |
$1,262.40
|
| Rate for Payer: CIGNA Commercial |
$1,499.10
|
| Rate for Payer: CIGNA Medicare |
$1,420.20
|
| Rate for Payer: HUMANA Commercial |
$1,420.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,451.76
|
| Rate for Payer: MEDICARE Medicare |
$1,104.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,499.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,530.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,499.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,499.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,341.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,262.40
|
|
|
US RADIOLOGL GUIDANCE PRQ DRG W/PLMT CAT
|
Facility
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$1,578.00 |
| Rate for Payer: AETNA Commercial |
$1,499.10
|
| Rate for Payer: AETNA Medicare |
$1,420.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,499.10
|
| Rate for Payer: BCBS Healthlink |
$1,420.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,420.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,420.20
|
| Rate for Payer: BCBS POS |
$1,499.10
|
| Rate for Payer: BCBS Traditional |
$1,578.00
|
| Rate for Payer: CASH_PRICE |
$1,262.40
|
| Rate for Payer: CIGNA Commercial |
$1,499.10
|
| Rate for Payer: CIGNA Medicare |
$1,420.20
|
| Rate for Payer: HUMANA Commercial |
$1,420.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,451.76
|
| Rate for Payer: MEDICARE Medicare |
$1,104.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,499.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,530.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,499.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,499.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,341.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,262.40
|
|
|
US RETROPERITONEAL COMP RENALS
|
Facility
OP
|
$519.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$363.30 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: AETNA Commercial |
$493.05
|
| Rate for Payer: AETNA Medicare |
$467.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$493.05
|
| Rate for Payer: BCBS Healthlink |
$467.10
|
| Rate for Payer: BCBS HMK CHIP |
$467.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$467.10
|
| Rate for Payer: BCBS POS |
$493.05
|
| Rate for Payer: BCBS Traditional |
$519.00
|
| Rate for Payer: CASH_PRICE |
$415.20
|
| Rate for Payer: CIGNA Commercial |
$493.05
|
| Rate for Payer: CIGNA Medicare |
$467.10
|
| Rate for Payer: HUMANA Commercial |
$467.10
|
| Rate for Payer: MEDICAID Medicaid |
$477.48
|
| Rate for Payer: MEDICARE Medicare |
$363.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$493.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$503.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$493.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$493.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$441.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$415.20
|
|
|
US RETROPERITONEAL COMP RENALS
|
Facility
IP
|
$519.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$363.30 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$441.15
|
| Rate for Payer: AETNA Commercial |
$493.05
|
| Rate for Payer: AETNA Medicare |
$467.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$493.05
|
| Rate for Payer: BCBS Healthlink |
$467.10
|
| Rate for Payer: BCBS HMK CHIP |
$467.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$467.10
|
| Rate for Payer: BCBS POS |
$493.05
|
| Rate for Payer: BCBS Traditional |
$519.00
|
| Rate for Payer: CASH_PRICE |
$415.20
|
| Rate for Payer: CIGNA Commercial |
$493.05
|
| Rate for Payer: CIGNA Medicare |
$467.10
|
| Rate for Payer: HUMANA Commercial |
$467.10
|
| Rate for Payer: MEDICAID Medicaid |
$477.48
|
| Rate for Payer: MEDICARE Medicare |
$363.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$493.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$503.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$493.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$493.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$415.20
|
|
|
US RETROPERITONEAL LMT AORTA
|
Facility
OP
|
$371.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$259.70 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: AETNA Commercial |
$352.45
|
| Rate for Payer: AETNA Medicare |
$333.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$352.45
|
| Rate for Payer: BCBS Healthlink |
$333.90
|
| Rate for Payer: BCBS HMK CHIP |
$333.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$333.90
|
| Rate for Payer: BCBS POS |
$352.45
|
| Rate for Payer: BCBS Traditional |
$371.00
|
| Rate for Payer: CASH_PRICE |
$296.80
|
| Rate for Payer: CIGNA Commercial |
$352.45
|
| Rate for Payer: CIGNA Medicare |
$333.90
|
| Rate for Payer: HUMANA Commercial |
$333.90
|
| Rate for Payer: MEDICAID Medicaid |
$341.32
|
| Rate for Payer: MEDICARE Medicare |
$259.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$352.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$359.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$352.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$352.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$315.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$296.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$296.80
|
|
|
US RETROPERITONEAL LMT AORTA
|
Facility
IP
|
$371.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$259.70 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: AETNA Commercial |
$352.45
|
| Rate for Payer: AETNA Medicare |
$333.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$352.45
|
| Rate for Payer: BCBS Healthlink |
$333.90
|
| Rate for Payer: BCBS HMK CHIP |
$333.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$333.90
|
| Rate for Payer: BCBS POS |
$352.45
|
| Rate for Payer: BCBS Traditional |
$371.00
|
| Rate for Payer: CASH_PRICE |
$296.80
|
| Rate for Payer: CIGNA Commercial |
$352.45
|
| Rate for Payer: CIGNA Medicare |
$333.90
|
| Rate for Payer: HUMANA Commercial |
$333.90
|
| Rate for Payer: MEDICAID Medicaid |
$341.32
|
| Rate for Payer: MEDICARE Medicare |
$259.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$352.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$359.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$352.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$352.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$315.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$296.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$296.80
|
|
|
US SOFT TISSUE ABDOMEN
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
US SOFT TISSUE ABDOMEN
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
US SOFT TISSUE CHEST
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
US SOFT TISSUE CHEST
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
US SOFT TISSUE EXTREMITY LMT
|
Facility
IP
|
$509.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$356.30 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: AETNA Commercial |
$483.55
|
| Rate for Payer: AETNA Medicare |
$458.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$483.55
|
| Rate for Payer: BCBS Healthlink |
$458.10
|
| Rate for Payer: BCBS HMK CHIP |
$458.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$458.10
|
| Rate for Payer: BCBS POS |
$483.55
|
| Rate for Payer: BCBS Traditional |
$509.00
|
| Rate for Payer: CASH_PRICE |
$407.20
|
| Rate for Payer: CIGNA Commercial |
$483.55
|
| Rate for Payer: CIGNA Medicare |
$458.10
|
| Rate for Payer: HUMANA Commercial |
$458.10
|
| Rate for Payer: MEDICAID Medicaid |
$468.28
|
| Rate for Payer: MEDICARE Medicare |
$356.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$483.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$493.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$483.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$483.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$432.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$407.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$407.20
|
|
|
US SOFT TISSUE EXTREMITY LMT
|
Facility
OP
|
$509.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$356.30 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: AETNA Commercial |
$483.55
|
| Rate for Payer: AETNA Medicare |
$458.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$483.55
|
| Rate for Payer: BCBS Healthlink |
$458.10
|
| Rate for Payer: BCBS HMK CHIP |
$458.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$458.10
|
| Rate for Payer: BCBS POS |
$483.55
|
| Rate for Payer: BCBS Traditional |
$509.00
|
| Rate for Payer: CASH_PRICE |
$407.20
|
| Rate for Payer: CIGNA Commercial |
$483.55
|
| Rate for Payer: CIGNA Medicare |
$458.10
|
| Rate for Payer: HUMANA Commercial |
$458.10
|
| Rate for Payer: MEDICAID Medicaid |
$468.28
|
| Rate for Payer: MEDICARE Medicare |
$356.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$483.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$493.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$483.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$483.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$432.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$407.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$407.20
|
|
|
US SOFT TISSUE HEAD OR NECK
|
Facility
IP
|
$397.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$277.90 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: AETNA Commercial |
$377.15
|
| Rate for Payer: AETNA Medicare |
$357.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$377.15
|
| Rate for Payer: BCBS Healthlink |
$357.30
|
| Rate for Payer: BCBS HMK CHIP |
$357.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$357.30
|
| Rate for Payer: BCBS POS |
$377.15
|
| Rate for Payer: BCBS Traditional |
$397.00
|
| Rate for Payer: CASH_PRICE |
$317.60
|
| Rate for Payer: CIGNA Commercial |
$377.15
|
| Rate for Payer: CIGNA Medicare |
$357.30
|
| Rate for Payer: HUMANA Commercial |
$357.30
|
| Rate for Payer: MEDICAID Medicaid |
$365.24
|
| Rate for Payer: MEDICARE Medicare |
$277.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$377.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$385.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$377.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$377.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$337.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$317.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$317.60
|
|
|
US SOFT TISSUE HEAD OR NECK
|
Facility
OP
|
$397.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$277.90 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: AETNA Commercial |
$377.15
|
| Rate for Payer: AETNA Medicare |
$357.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$377.15
|
| Rate for Payer: BCBS Healthlink |
$357.30
|
| Rate for Payer: BCBS HMK CHIP |
$357.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$357.30
|
| Rate for Payer: BCBS POS |
$377.15
|
| Rate for Payer: BCBS Traditional |
$397.00
|
| Rate for Payer: CASH_PRICE |
$317.60
|
| Rate for Payer: CIGNA Commercial |
$377.15
|
| Rate for Payer: CIGNA Medicare |
$357.30
|
| Rate for Payer: HUMANA Commercial |
$357.30
|
| Rate for Payer: MEDICAID Medicaid |
$365.24
|
| Rate for Payer: MEDICARE Medicare |
$277.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$377.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$385.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$377.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$377.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$337.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$317.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$317.60
|
|
|
US SOFT TISSUE PELVIS
|
Facility
IP
|
$318.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
US SOFT TISSUE PELVIS
|
Facility
OP
|
$318.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: AETNA Commercial |
$302.10
|
| Rate for Payer: AETNA Medicare |
$286.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$302.10
|
| Rate for Payer: BCBS Healthlink |
$286.20
|
| Rate for Payer: BCBS HMK CHIP |
$286.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$286.20
|
| Rate for Payer: BCBS POS |
$302.10
|
| Rate for Payer: BCBS Traditional |
$318.00
|
| Rate for Payer: CASH_PRICE |
$254.40
|
| Rate for Payer: CIGNA Commercial |
$302.10
|
| Rate for Payer: CIGNA Medicare |
$286.20
|
| Rate for Payer: HUMANA Commercial |
$286.20
|
| Rate for Payer: MEDICAID Medicaid |
$292.56
|
| Rate for Payer: MEDICARE Medicare |
$222.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$302.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$308.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$302.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$302.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$270.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$254.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$254.40
|
|
|
US STRESS ECHO DOBUTAMINE
|
Facility
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,428.70 |
| Max. Negotiated Rate |
$2,041.00 |
| Rate for Payer: AETNA Commercial |
$1,938.95
|
| Rate for Payer: AETNA Medicare |
$1,836.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,938.95
|
| Rate for Payer: BCBS Healthlink |
$1,836.90
|
| Rate for Payer: BCBS HMK CHIP |
$1,836.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,836.90
|
| Rate for Payer: BCBS POS |
$1,938.95
|
| Rate for Payer: BCBS Traditional |
$2,041.00
|
| Rate for Payer: CASH_PRICE |
$1,632.80
|
| Rate for Payer: CIGNA Commercial |
$1,938.95
|
| Rate for Payer: CIGNA Medicare |
$1,836.90
|
| Rate for Payer: HUMANA Commercial |
$1,836.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,877.72
|
| Rate for Payer: MEDICARE Medicare |
$1,428.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,979.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,938.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,734.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,632.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,632.80
|
|
|
US STRESS ECHO DOBUTAMINE
|
Facility
IP
|
$2,041.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,428.70 |
| Max. Negotiated Rate |
$2,041.00 |
| Rate for Payer: AETNA Commercial |
$1,938.95
|
| Rate for Payer: AETNA Medicare |
$1,836.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,938.95
|
| Rate for Payer: BCBS Healthlink |
$1,836.90
|
| Rate for Payer: BCBS HMK CHIP |
$1,836.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,836.90
|
| Rate for Payer: BCBS POS |
$1,938.95
|
| Rate for Payer: BCBS Traditional |
$2,041.00
|
| Rate for Payer: CASH_PRICE |
$1,632.80
|
| Rate for Payer: CIGNA Commercial |
$1,938.95
|
| Rate for Payer: CIGNA Medicare |
$1,836.90
|
| Rate for Payer: HUMANA Commercial |
$1,836.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,877.72
|
| Rate for Payer: MEDICARE Medicare |
$1,428.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,979.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,938.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,734.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,632.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,632.80
|
|
|
US STRESS ECHO TREADMILL
|
Facility
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,428.70 |
| Max. Negotiated Rate |
$2,041.00 |
| Rate for Payer: AETNA Commercial |
$1,938.95
|
| Rate for Payer: AETNA Medicare |
$1,836.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,938.95
|
| Rate for Payer: BCBS Healthlink |
$1,836.90
|
| Rate for Payer: BCBS HMK CHIP |
$1,836.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,836.90
|
| Rate for Payer: BCBS POS |
$1,938.95
|
| Rate for Payer: BCBS Traditional |
$2,041.00
|
| Rate for Payer: CASH_PRICE |
$1,632.80
|
| Rate for Payer: CIGNA Commercial |
$1,938.95
|
| Rate for Payer: CIGNA Medicare |
$1,836.90
|
| Rate for Payer: HUMANA Commercial |
$1,836.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,877.72
|
| Rate for Payer: MEDICARE Medicare |
$1,428.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,979.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,938.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,734.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,632.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,632.80
|
|
|
US STRESS ECHO TREADMILL
|
Facility
IP
|
$2,041.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,428.70 |
| Max. Negotiated Rate |
$2,041.00 |
| Rate for Payer: AETNA Commercial |
$1,938.95
|
| Rate for Payer: AETNA Medicare |
$1,836.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,938.95
|
| Rate for Payer: BCBS Healthlink |
$1,836.90
|
| Rate for Payer: BCBS HMK CHIP |
$1,836.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,836.90
|
| Rate for Payer: BCBS POS |
$1,938.95
|
| Rate for Payer: BCBS Traditional |
$2,041.00
|
| Rate for Payer: CASH_PRICE |
$1,632.80
|
| Rate for Payer: CIGNA Commercial |
$1,938.95
|
| Rate for Payer: CIGNA Medicare |
$1,836.90
|
| Rate for Payer: HUMANA Commercial |
$1,836.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,877.72
|
| Rate for Payer: MEDICARE Medicare |
$1,428.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,979.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,938.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,938.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,734.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,632.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,632.80
|
|
|
US TESTICULAR SCROTUM
|
Facility
OP
|
$425.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: AETNA Commercial |
$403.75
|
| Rate for Payer: AETNA Medicare |
$382.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$403.75
|
| Rate for Payer: BCBS Healthlink |
$382.50
|
| Rate for Payer: BCBS HMK CHIP |
$382.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$382.50
|
| Rate for Payer: BCBS POS |
$403.75
|
| Rate for Payer: BCBS Traditional |
$425.00
|
| Rate for Payer: CASH_PRICE |
$340.00
|
| Rate for Payer: CIGNA Commercial |
$403.75
|
| Rate for Payer: CIGNA Medicare |
$382.50
|
| Rate for Payer: HUMANA Commercial |
$382.50
|
| Rate for Payer: MEDICAID Medicaid |
$391.00
|
| Rate for Payer: MEDICARE Medicare |
$297.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$403.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$412.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$403.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$361.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.00
|
|
|
US TESTICULAR SCROTUM
|
Facility
IP
|
$425.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: AETNA Commercial |
$403.75
|
| Rate for Payer: AETNA Medicare |
$382.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$403.75
|
| Rate for Payer: BCBS Healthlink |
$382.50
|
| Rate for Payer: BCBS HMK CHIP |
$382.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$382.50
|
| Rate for Payer: BCBS POS |
$403.75
|
| Rate for Payer: BCBS Traditional |
$425.00
|
| Rate for Payer: CASH_PRICE |
$340.00
|
| Rate for Payer: CIGNA Commercial |
$403.75
|
| Rate for Payer: CIGNA Medicare |
$382.50
|
| Rate for Payer: HUMANA Commercial |
$382.50
|
| Rate for Payer: MEDICAID Medicaid |
$391.00
|
| Rate for Payer: MEDICARE Medicare |
$297.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$403.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$412.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$403.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$361.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.00
|
|
|
US THYROID
|
Facility
IP
|
$397.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$277.90 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: AETNA Commercial |
$377.15
|
| Rate for Payer: AETNA Medicare |
$357.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$377.15
|
| Rate for Payer: BCBS Healthlink |
$357.30
|
| Rate for Payer: BCBS HMK CHIP |
$357.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$357.30
|
| Rate for Payer: BCBS POS |
$377.15
|
| Rate for Payer: BCBS Traditional |
$397.00
|
| Rate for Payer: CASH_PRICE |
$317.60
|
| Rate for Payer: CIGNA Commercial |
$377.15
|
| Rate for Payer: CIGNA Medicare |
$357.30
|
| Rate for Payer: HUMANA Commercial |
$357.30
|
| Rate for Payer: MEDICAID Medicaid |
$365.24
|
| Rate for Payer: MEDICARE Medicare |
$277.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$377.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$385.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$377.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$377.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$337.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$317.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$317.60
|
|
