|
US THYROID
|
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 TO DETERMINE LENGTH FROM CORN
|
Facility
IP
|
$332.00
|
|
|
Service Code
|
CPT 76516 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: AETNA Commercial |
$315.40
|
| Rate for Payer: AETNA Medicare |
$298.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$315.40
|
| Rate for Payer: BCBS Healthlink |
$298.80
|
| Rate for Payer: BCBS HMK CHIP |
$298.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$298.80
|
| Rate for Payer: BCBS POS |
$315.40
|
| Rate for Payer: BCBS Traditional |
$332.00
|
| Rate for Payer: CASH_PRICE |
$265.60
|
| Rate for Payer: CIGNA Commercial |
$315.40
|
| Rate for Payer: CIGNA Medicare |
$298.80
|
| Rate for Payer: HUMANA Commercial |
$298.80
|
| Rate for Payer: MEDICAID Medicaid |
$305.44
|
| Rate for Payer: MEDICARE Medicare |
$232.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$315.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$322.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$315.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$315.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$282.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$265.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$265.60
|
|
|
US TO DETERMINE LENGTH FROM CORN
|
Facility
OP
|
$332.00
|
|
|
Service Code
|
CPT 76516 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: AETNA Commercial |
$315.40
|
| Rate for Payer: AETNA Medicare |
$298.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$315.40
|
| Rate for Payer: BCBS Healthlink |
$298.80
|
| Rate for Payer: BCBS HMK CHIP |
$298.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$298.80
|
| Rate for Payer: BCBS POS |
$315.40
|
| Rate for Payer: BCBS Traditional |
$332.00
|
| Rate for Payer: CASH_PRICE |
$265.60
|
| Rate for Payer: CIGNA Commercial |
$315.40
|
| Rate for Payer: CIGNA Medicare |
$298.80
|
| Rate for Payer: HUMANA Commercial |
$298.80
|
| Rate for Payer: MEDICAID Medicaid |
$305.44
|
| Rate for Payer: MEDICARE Medicare |
$232.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$315.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$322.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$315.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$315.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$282.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$265.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$265.60
|
|
|
US TRANSCRAN DOPL INTRACRAN ART MICROBUB
|
Facility
OP
|
$669.00
|
|
|
Service Code
|
CPT 93893 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: AETNA Commercial |
$635.55
|
| Rate for Payer: AETNA Medicare |
$602.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$635.55
|
| Rate for Payer: BCBS Healthlink |
$602.10
|
| Rate for Payer: BCBS HMK CHIP |
$602.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$602.10
|
| Rate for Payer: BCBS POS |
$635.55
|
| Rate for Payer: BCBS Traditional |
$669.00
|
| Rate for Payer: CASH_PRICE |
$535.20
|
| Rate for Payer: CIGNA Commercial |
$635.55
|
| Rate for Payer: CIGNA Medicare |
$602.10
|
| Rate for Payer: HUMANA Commercial |
$602.10
|
| Rate for Payer: MEDICAID Medicaid |
$615.48
|
| Rate for Payer: MEDICARE Medicare |
$468.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$635.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$648.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$635.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$635.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$568.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$535.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$535.20
|
|
|
US TRANSCRAN DOPL INTRACRAN ART MICROBUB
|
Facility
IP
|
$669.00
|
|
|
Service Code
|
CPT 93893 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$669.00 |
| Rate for Payer: AETNA Commercial |
$635.55
|
| Rate for Payer: AETNA Medicare |
$602.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$635.55
|
| Rate for Payer: BCBS Healthlink |
$602.10
|
| Rate for Payer: BCBS HMK CHIP |
$602.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$602.10
|
| Rate for Payer: BCBS POS |
$635.55
|
| Rate for Payer: BCBS Traditional |
$669.00
|
| Rate for Payer: CASH_PRICE |
$535.20
|
| Rate for Payer: CIGNA Commercial |
$635.55
|
| Rate for Payer: CIGNA Medicare |
$602.10
|
| Rate for Payer: HUMANA Commercial |
$602.10
|
| Rate for Payer: MEDICAID Medicaid |
$615.48
|
| Rate for Payer: MEDICARE Medicare |
$468.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$635.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$648.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$635.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$635.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$568.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$535.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$535.20
|
|
|
US TRANSCRANIAL DOPPLER STDY INTRACRAN A
|
Facility
IP
|
$1,229.00
|
|
|
Service Code
|
CPT 93886 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$860.30 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,167.55
|
| Rate for Payer: AETNA Commercial |
$1,167.55
|
| Rate for Payer: AETNA Medicare |
$1,106.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,167.55
|
| Rate for Payer: BCBS Healthlink |
$1,106.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,106.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,106.10
|
| Rate for Payer: BCBS POS |
$1,167.55
|
| Rate for Payer: BCBS Traditional |
$1,229.00
|
| Rate for Payer: CASH_PRICE |
$983.20
|
| Rate for Payer: CIGNA Commercial |
$1,167.55
|
| Rate for Payer: CIGNA Medicare |
$1,106.10
|
| Rate for Payer: HUMANA Commercial |
$1,106.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,130.68
|
| Rate for Payer: MEDICARE Medicare |
$860.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,192.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,167.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,167.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,044.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$983.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$983.20
|
|
|
US TRANSCRANIAL DOPPLER STDY INTRACRAN A
|
Facility
OP
|
$1,229.00
|
|
|
Service Code
|
CPT 93886 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$860.30 |
| Max. Negotiated Rate |
$1,229.00 |
| Rate for Payer: AETNA Commercial |
$1,167.55
|
| Rate for Payer: AETNA Medicare |
$1,106.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,167.55
|
| Rate for Payer: BCBS Healthlink |
$1,106.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,106.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,106.10
|
| Rate for Payer: BCBS POS |
$1,167.55
|
| Rate for Payer: BCBS Traditional |
$1,229.00
|
| Rate for Payer: CASH_PRICE |
$983.20
|
| Rate for Payer: CIGNA Commercial |
$1,167.55
|
| Rate for Payer: CIGNA Medicare |
$1,106.10
|
| Rate for Payer: HUMANA Commercial |
$1,106.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,130.68
|
| Rate for Payer: MEDICARE Medicare |
$860.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,167.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,192.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,167.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,167.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,044.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$983.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$983.20
|
|
|
US TRANSCRANIAL DOPPLER STDY INTRACRANIL
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT 93888 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: AETNA Commercial |
$678.30
|
| Rate for Payer: AETNA Medicare |
$642.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$678.30
|
| Rate for Payer: BCBS Healthlink |
$642.60
|
| Rate for Payer: BCBS HMK CHIP |
$642.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$642.60
|
| Rate for Payer: BCBS POS |
$678.30
|
| Rate for Payer: BCBS Traditional |
$714.00
|
| Rate for Payer: CASH_PRICE |
$571.20
|
| Rate for Payer: CIGNA Commercial |
$678.30
|
| Rate for Payer: CIGNA Medicare |
$642.60
|
| Rate for Payer: HUMANA Commercial |
$642.60
|
| Rate for Payer: MEDICAID Medicaid |
$656.88
|
| Rate for Payer: MEDICARE Medicare |
$499.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$678.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$692.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$678.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$678.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$606.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$571.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$571.20
|
|
|
US TRANSCRANIAL DOPPLER STDY INTRACRANIL
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT 93888 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: AETNA Commercial |
$678.30
|
| Rate for Payer: AETNA Medicare |
$642.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$678.30
|
| Rate for Payer: BCBS Healthlink |
$642.60
|
| Rate for Payer: BCBS HMK CHIP |
$642.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$642.60
|
| Rate for Payer: BCBS POS |
$678.30
|
| Rate for Payer: BCBS Traditional |
$714.00
|
| Rate for Payer: CASH_PRICE |
$571.20
|
| Rate for Payer: CIGNA Commercial |
$678.30
|
| Rate for Payer: CIGNA Medicare |
$642.60
|
| Rate for Payer: HUMANA Commercial |
$642.60
|
| Rate for Payer: MEDICAID Medicaid |
$656.88
|
| Rate for Payer: MEDICARE Medicare |
$499.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$678.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$692.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$678.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$678.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$606.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$571.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$571.20
|
|
|
US TRANSCRANL DOPPLER INTRACRAN ART EMBO
|
Facility
IP
|
$737.00
|
|
|
Service Code
|
CPT 93892 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$515.90 |
| Max. Negotiated Rate |
$737.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$700.15
|
| Rate for Payer: AETNA Commercial |
$700.15
|
| Rate for Payer: AETNA Medicare |
$663.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$700.15
|
| Rate for Payer: BCBS Healthlink |
$663.30
|
| Rate for Payer: BCBS HMK CHIP |
$663.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$663.30
|
| Rate for Payer: BCBS POS |
$700.15
|
| Rate for Payer: BCBS Traditional |
$737.00
|
| Rate for Payer: CASH_PRICE |
$589.60
|
| Rate for Payer: CIGNA Commercial |
$700.15
|
| Rate for Payer: CIGNA Medicare |
$663.30
|
| Rate for Payer: HUMANA Commercial |
$663.30
|
| Rate for Payer: MEDICAID Medicaid |
$678.04
|
| Rate for Payer: MEDICARE Medicare |
$515.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$714.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$700.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$700.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$626.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$589.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$589.60
|
|
|
US TRANSCRANL DOPPLER INTRACRAN ART EMBO
|
Facility
OP
|
$737.00
|
|
|
Service Code
|
CPT 93892 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$515.90 |
| Max. Negotiated Rate |
$737.00 |
| Rate for Payer: AETNA Commercial |
$700.15
|
| Rate for Payer: AETNA Medicare |
$663.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$700.15
|
| Rate for Payer: BCBS Healthlink |
$663.30
|
| Rate for Payer: BCBS HMK CHIP |
$663.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$663.30
|
| Rate for Payer: BCBS POS |
$700.15
|
| Rate for Payer: BCBS Traditional |
$737.00
|
| Rate for Payer: CASH_PRICE |
$589.60
|
| Rate for Payer: CIGNA Commercial |
$700.15
|
| Rate for Payer: CIGNA Medicare |
$663.30
|
| Rate for Payer: HUMANA Commercial |
$663.30
|
| Rate for Payer: MEDICAID Medicaid |
$678.04
|
| Rate for Payer: MEDICARE Medicare |
$515.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$700.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$714.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$700.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$700.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$626.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$589.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$589.60
|
|
|
US TRANSVAGINAL US NON-OB
|
Facility
OP
|
$407.00
|
|
|
Service Code
|
CPT 76830
|
| 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 TRANSVAGINAL US NON-OB
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT 76830
|
| 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 TRANSVAGINAL US OBSTETRIC
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
US TRANSVAGINAL US OBSTETRIC
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
US TRANS VAG LMT
|
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: MONIDA - ALLEGIANCE Commercial |
$206.15
|
| Rate for Payer: AETNA Commercial |
$206.15
|
| Rate for Payer: AETNA Medicare |
$195.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$206.15
|
| Rate for Payer: BCBS Healthlink |
$195.30
|
| Rate for Payer: BCBS HMK CHIP |
$195.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$195.30
|
| Rate for Payer: BCBS POS |
$206.15
|
| Rate for Payer: BCBS Traditional |
$217.00
|
| Rate for Payer: CASH_PRICE |
$173.60
|
| Rate for Payer: CIGNA Commercial |
$206.15
|
| Rate for Payer: CIGNA Medicare |
$195.30
|
| Rate for Payer: HUMANA Commercial |
$195.30
|
| Rate for Payer: MEDICAID Medicaid |
$199.64
|
| Rate for Payer: MEDICARE Medicare |
$151.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$210.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$206.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$206.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$184.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$173.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$173.60
|
|
|
US TRANS VAG LMT
|
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 TRNSPLNT KIDNEY REAL TIME W/IMAGE DOC
|
Facility
IP
|
$847.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$592.90 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: AETNA Commercial |
$804.65
|
| Rate for Payer: AETNA Medicare |
$762.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$804.65
|
| Rate for Payer: BCBS Healthlink |
$762.30
|
| Rate for Payer: BCBS HMK CHIP |
$762.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$762.30
|
| Rate for Payer: BCBS POS |
$804.65
|
| Rate for Payer: BCBS Traditional |
$847.00
|
| Rate for Payer: CASH_PRICE |
$677.60
|
| Rate for Payer: CIGNA Commercial |
$804.65
|
| Rate for Payer: CIGNA Medicare |
$762.30
|
| Rate for Payer: HUMANA Commercial |
$762.30
|
| Rate for Payer: MEDICAID Medicaid |
$779.24
|
| Rate for Payer: MEDICARE Medicare |
$592.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$804.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$821.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$804.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$804.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$719.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$677.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$677.60
|
|
|
US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOC
|
Facility
OP
|
$847.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$592.90 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: AETNA Commercial |
$804.65
|
| Rate for Payer: AETNA Medicare |
$762.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$804.65
|
| Rate for Payer: BCBS Healthlink |
$762.30
|
| Rate for Payer: BCBS HMK CHIP |
$762.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$762.30
|
| Rate for Payer: BCBS POS |
$804.65
|
| Rate for Payer: BCBS Traditional |
$847.00
|
| Rate for Payer: CASH_PRICE |
$677.60
|
| Rate for Payer: CIGNA Commercial |
$804.65
|
| Rate for Payer: CIGNA Medicare |
$762.30
|
| Rate for Payer: HUMANA Commercial |
$762.30
|
| Rate for Payer: MEDICAID Medicaid |
$779.24
|
| Rate for Payer: MEDICARE Medicare |
$592.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$804.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$821.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$804.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$804.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$719.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$677.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$677.60
|
|
|
US VENOUS DOPP BILATERAL
|
Facility
IP
|
$693.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: AETNA Commercial |
$658.35
|
| Rate for Payer: AETNA Medicare |
$623.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$658.35
|
| Rate for Payer: BCBS Healthlink |
$623.70
|
| Rate for Payer: BCBS HMK CHIP |
$623.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$623.70
|
| Rate for Payer: BCBS POS |
$658.35
|
| Rate for Payer: BCBS Traditional |
$693.00
|
| Rate for Payer: CASH_PRICE |
$554.40
|
| Rate for Payer: CIGNA Commercial |
$658.35
|
| Rate for Payer: CIGNA Medicare |
$623.70
|
| Rate for Payer: HUMANA Commercial |
$623.70
|
| Rate for Payer: MEDICAID Medicaid |
$637.56
|
| Rate for Payer: MEDICARE Medicare |
$485.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$658.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$672.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$658.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$658.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$589.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$554.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$554.40
|
|
|
US VENOUS DOPP BILATERAL
|
Facility
OP
|
$693.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: AETNA Commercial |
$658.35
|
| Rate for Payer: AETNA Medicare |
$623.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$658.35
|
| Rate for Payer: BCBS Healthlink |
$623.70
|
| Rate for Payer: BCBS HMK CHIP |
$623.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$623.70
|
| Rate for Payer: BCBS POS |
$658.35
|
| Rate for Payer: BCBS Traditional |
$693.00
|
| Rate for Payer: CASH_PRICE |
$554.40
|
| Rate for Payer: CIGNA Commercial |
$658.35
|
| Rate for Payer: CIGNA Medicare |
$623.70
|
| Rate for Payer: HUMANA Commercial |
$623.70
|
| Rate for Payer: MEDICAID Medicaid |
$637.56
|
| Rate for Payer: MEDICARE Medicare |
$485.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$658.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$672.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$658.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$658.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$589.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$554.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$554.40
|
|
|
US VENOUS DOPP SINGLE
|
Facility
OP
|
$462.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$323.40 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: AETNA Commercial |
$438.90
|
| Rate for Payer: AETNA Medicare |
$415.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$438.90
|
| Rate for Payer: BCBS Healthlink |
$415.80
|
| Rate for Payer: BCBS HMK CHIP |
$415.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$415.80
|
| Rate for Payer: BCBS POS |
$438.90
|
| Rate for Payer: BCBS Traditional |
$462.00
|
| Rate for Payer: CASH_PRICE |
$369.60
|
| Rate for Payer: CIGNA Commercial |
$438.90
|
| Rate for Payer: CIGNA Medicare |
$415.80
|
| Rate for Payer: HUMANA Commercial |
$415.80
|
| Rate for Payer: MEDICAID Medicaid |
$425.04
|
| Rate for Payer: MEDICARE Medicare |
$323.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$438.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$448.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$438.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$438.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$392.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$369.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$369.60
|
|
|
US VENOUS DOPP SINGLE
|
Facility
IP
|
$462.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$323.40 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: AETNA Commercial |
$438.90
|
| Rate for Payer: AETNA Medicare |
$415.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$438.90
|
| Rate for Payer: BCBS Healthlink |
$415.80
|
| Rate for Payer: BCBS HMK CHIP |
$415.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$415.80
|
| Rate for Payer: BCBS POS |
$438.90
|
| Rate for Payer: BCBS Traditional |
$462.00
|
| Rate for Payer: CASH_PRICE |
$369.60
|
| Rate for Payer: CIGNA Commercial |
$438.90
|
| Rate for Payer: CIGNA Medicare |
$415.80
|
| Rate for Payer: HUMANA Commercial |
$415.80
|
| Rate for Payer: MEDICAID Medicaid |
$425.04
|
| Rate for Payer: MEDICARE Medicare |
$323.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$438.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$448.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$438.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$438.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$392.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$369.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$369.60
|
|
|
VAC - DTaP-Hepatitis B Recomb-IPV
|
Facility
IP
|
$353.00
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: AETNA Commercial |
$335.35
|
| Rate for Payer: AETNA Medicare |
$317.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$335.35
|
| Rate for Payer: BCBS Healthlink |
$317.70
|
| Rate for Payer: BCBS HMK CHIP |
$317.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$317.70
|
| Rate for Payer: BCBS POS |
$335.35
|
| Rate for Payer: BCBS Traditional |
$353.00
|
| Rate for Payer: CASH_PRICE |
$282.40
|
| Rate for Payer: CIGNA Commercial |
$335.35
|
| Rate for Payer: CIGNA Medicare |
$317.70
|
| Rate for Payer: HUMANA Commercial |
$317.70
|
| Rate for Payer: MEDICAID Medicaid |
$324.76
|
| Rate for Payer: MEDICARE Medicare |
$247.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$335.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$342.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$335.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$335.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$282.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$282.40
|
|
|
VAC - DTaP-Hepatitis B Recomb-IPV
|
Facility
OP
|
$353.00
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$247.10 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: AETNA Commercial |
$335.35
|
| Rate for Payer: AETNA Medicare |
$317.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$335.35
|
| Rate for Payer: BCBS Healthlink |
$317.70
|
| Rate for Payer: BCBS HMK CHIP |
$317.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$317.70
|
| Rate for Payer: BCBS POS |
$335.35
|
| Rate for Payer: BCBS Traditional |
$353.00
|
| Rate for Payer: CASH_PRICE |
$282.40
|
| Rate for Payer: CIGNA Commercial |
$335.35
|
| Rate for Payer: CIGNA Medicare |
$317.70
|
| Rate for Payer: HUMANA Commercial |
$317.70
|
| Rate for Payer: MEDICAID Medicaid |
$324.76
|
| Rate for Payer: MEDICARE Medicare |
$247.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$335.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$342.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$335.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$335.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$282.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$282.40
|
|
