|
XR AC JOINTS W WO WEIGHTS
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
XR ANKLE 2 VIEWS BILATERAL
|
Facility
IP
|
$234.00
|
|
|
Service Code
|
CPT 73600 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: AETNA Commercial |
$222.30
|
| Rate for Payer: AETNA Medicare |
$210.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$222.30
|
| Rate for Payer: BCBS Healthlink |
$210.60
|
| Rate for Payer: BCBS HMK CHIP |
$210.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$210.60
|
| Rate for Payer: BCBS POS |
$222.30
|
| Rate for Payer: BCBS Traditional |
$234.00
|
| Rate for Payer: CASH_PRICE |
$187.20
|
| Rate for Payer: CIGNA Commercial |
$222.30
|
| Rate for Payer: CIGNA Medicare |
$210.60
|
| Rate for Payer: HUMANA Commercial |
$210.60
|
| Rate for Payer: MEDICAID Medicaid |
$215.28
|
| Rate for Payer: MEDICARE Medicare |
$163.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$222.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$222.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$222.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$187.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$187.20
|
|
|
XR ANKLE 2 VIEWS BILATERAL
|
Facility
OP
|
$234.00
|
|
|
Service Code
|
CPT 73600 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: AETNA Commercial |
$222.30
|
| Rate for Payer: AETNA Medicare |
$210.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$222.30
|
| Rate for Payer: BCBS Healthlink |
$210.60
|
| Rate for Payer: BCBS HMK CHIP |
$210.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$210.60
|
| Rate for Payer: BCBS POS |
$222.30
|
| Rate for Payer: BCBS Traditional |
$234.00
|
| Rate for Payer: CASH_PRICE |
$187.20
|
| Rate for Payer: CIGNA Commercial |
$222.30
|
| Rate for Payer: CIGNA Medicare |
$210.60
|
| Rate for Payer: HUMANA Commercial |
$210.60
|
| Rate for Payer: MEDICAID Medicaid |
$215.28
|
| Rate for Payer: MEDICARE Medicare |
$163.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$222.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$222.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$222.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$187.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$187.20
|
|
|
XR ANKLE 3 VIEWS BILATERAL
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
CPT 73610 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
XR ANKLE 3 VIEWS BILATERAL
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
CPT 73610 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
XR ANKLE LT 1 VIEW
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE LT 1 VIEW
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE LT 2 VIEWS
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE LT 2 VIEWS
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE LT 3 VIEWS
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 73610 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
XR ANKLE LT 3 VIEWS
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 73610 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
XR ANKLE RT 1 VIEW
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE RT 1 VIEW
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE RT 2 VIEWS
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE RT 2 VIEWS
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR ANKLE RT 3 VIEWS
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 73610 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
XR ANKLE RT 3 VIEWS
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 73610 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
XR BALL CATCHERS
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR BALL CATCHERS
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR BONE AGE STUDY
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
XR BONE AGE STUDY
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
XR BONE LENGTH STUDY
|
Facility
IP
|
$293.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: AETNA Commercial |
$278.35
|
| Rate for Payer: AETNA Medicare |
$263.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$278.35
|
| Rate for Payer: BCBS Healthlink |
$263.70
|
| Rate for Payer: BCBS HMK CHIP |
$263.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$263.70
|
| Rate for Payer: BCBS POS |
$278.35
|
| Rate for Payer: BCBS Traditional |
$293.00
|
| Rate for Payer: CASH_PRICE |
$234.40
|
| Rate for Payer: CIGNA Commercial |
$278.35
|
| Rate for Payer: CIGNA Medicare |
$263.70
|
| Rate for Payer: HUMANA Commercial |
$263.70
|
| Rate for Payer: MEDICAID Medicaid |
$269.56
|
| Rate for Payer: MEDICARE Medicare |
$205.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$278.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$284.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$278.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$278.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$249.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$234.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$234.40
|
|
|
XR BONE LENGTH STUDY
|
Facility
OP
|
$293.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: AETNA Commercial |
$278.35
|
| Rate for Payer: AETNA Medicare |
$263.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$278.35
|
| Rate for Payer: BCBS Healthlink |
$263.70
|
| Rate for Payer: BCBS HMK CHIP |
$263.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$263.70
|
| Rate for Payer: BCBS POS |
$278.35
|
| Rate for Payer: BCBS Traditional |
$293.00
|
| Rate for Payer: CASH_PRICE |
$234.40
|
| Rate for Payer: CIGNA Commercial |
$278.35
|
| Rate for Payer: CIGNA Medicare |
$263.70
|
| Rate for Payer: HUMANA Commercial |
$263.70
|
| Rate for Payer: MEDICAID Medicaid |
$269.56
|
| Rate for Payer: MEDICARE Medicare |
$205.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$278.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$284.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$278.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$278.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$249.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$234.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$234.40
|
|
|
XR CALCANEUS BILATERAL 2 VIEWS
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 73650 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
XR CALCANEUS BILATERAL 2 VIEWS
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 73650 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
