|
XR CALCANEUS LT 2 VIEWS
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
XR CALCANEUS LT 2 VIEWS
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 73650 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
XR CALCANEUS RT 2 VIEWS
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
XR CALCANEUS RT 2 VIEWS
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 73650 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
XR CERVICAL SPINE 2 TO 3 VIEWS
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
XR CERVICAL SPINE 2 TO 3 VIEWS
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
XR CERVICAL SPINE COMPLETE
|
Facility
IP
|
$437.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: AETNA Commercial |
$415.15
|
| Rate for Payer: AETNA Medicare |
$393.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$415.15
|
| Rate for Payer: BCBS Healthlink |
$393.30
|
| Rate for Payer: BCBS HMK CHIP |
$393.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$393.30
|
| Rate for Payer: BCBS POS |
$415.15
|
| Rate for Payer: BCBS Traditional |
$437.00
|
| Rate for Payer: CASH_PRICE |
$349.60
|
| Rate for Payer: CIGNA Commercial |
$415.15
|
| Rate for Payer: CIGNA Medicare |
$393.30
|
| Rate for Payer: HUMANA Commercial |
$393.30
|
| Rate for Payer: MEDICAID Medicaid |
$402.04
|
| Rate for Payer: MEDICARE Medicare |
$305.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$415.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$423.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$415.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$415.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$371.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$349.60
|
|
|
XR CERVICAL SPINE COMPLETE
|
Facility
OP
|
$437.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.90 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: AETNA Commercial |
$415.15
|
| Rate for Payer: AETNA Medicare |
$393.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$415.15
|
| Rate for Payer: BCBS Healthlink |
$393.30
|
| Rate for Payer: BCBS HMK CHIP |
$393.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$393.30
|
| Rate for Payer: BCBS POS |
$415.15
|
| Rate for Payer: BCBS Traditional |
$437.00
|
| Rate for Payer: CASH_PRICE |
$349.60
|
| Rate for Payer: CIGNA Commercial |
$415.15
|
| Rate for Payer: CIGNA Medicare |
$393.30
|
| Rate for Payer: HUMANA Commercial |
$393.30
|
| Rate for Payer: MEDICAID Medicaid |
$402.04
|
| Rate for Payer: MEDICARE Medicare |
$305.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$415.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$423.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$415.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$415.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$371.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$349.60
|
|
|
XR CERVICAL SPINE COMPLETE W/ FLEX/EXT
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$343.70 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: AETNA Commercial |
$466.45
|
| Rate for Payer: AETNA Medicare |
$441.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$466.45
|
| Rate for Payer: BCBS Healthlink |
$441.90
|
| Rate for Payer: BCBS HMK CHIP |
$441.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$441.90
|
| Rate for Payer: BCBS POS |
$466.45
|
| Rate for Payer: BCBS Traditional |
$491.00
|
| Rate for Payer: CASH_PRICE |
$392.80
|
| Rate for Payer: CIGNA Commercial |
$466.45
|
| Rate for Payer: CIGNA Medicare |
$441.90
|
| Rate for Payer: HUMANA Commercial |
$441.90
|
| Rate for Payer: MEDICAID Medicaid |
$451.72
|
| Rate for Payer: MEDICARE Medicare |
$343.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$466.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$476.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$466.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$466.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$417.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$392.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$392.80
|
|
|
XR CERVICAL SPINE COMPLETE W/ FLEX/EXT
|
Facility
OP
|
$491.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$343.70 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: AETNA Commercial |
$466.45
|
| Rate for Payer: AETNA Medicare |
$441.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$466.45
|
| Rate for Payer: BCBS Healthlink |
$441.90
|
| Rate for Payer: BCBS HMK CHIP |
$441.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$441.90
|
| Rate for Payer: BCBS POS |
$466.45
|
| Rate for Payer: BCBS Traditional |
$491.00
|
| Rate for Payer: CASH_PRICE |
$392.80
|
| Rate for Payer: CIGNA Commercial |
$466.45
|
| Rate for Payer: CIGNA Medicare |
$441.90
|
| Rate for Payer: HUMANA Commercial |
$441.90
|
| Rate for Payer: MEDICAID Medicaid |
$451.72
|
| Rate for Payer: MEDICARE Medicare |
$343.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$466.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$476.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$466.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$466.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$417.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$392.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$392.80
|
|
|
XR CHEST 1 VIEW
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR CHEST 1 VIEW
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR CHEST 2 VIEWS
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
XR CHEST 2 VIEWS
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
XR CHEST CHILD 1 VIEW
|
Facility
OP
|
$196.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
XR CHEST CHILD 1 VIEW
|
Facility
IP
|
$196.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
XR CHEST/RIBS 4/> VIEWS
|
Facility
OP
|
$464.00
|
|
|
Service Code
|
CPT 71111 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: AETNA Commercial |
$440.80
|
| Rate for Payer: AETNA Medicare |
$417.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$440.80
|
| Rate for Payer: BCBS Healthlink |
$417.60
|
| Rate for Payer: BCBS HMK CHIP |
$417.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$417.60
|
| Rate for Payer: BCBS POS |
$440.80
|
| Rate for Payer: BCBS Traditional |
$464.00
|
| Rate for Payer: CASH_PRICE |
$371.20
|
| Rate for Payer: CIGNA Commercial |
$440.80
|
| Rate for Payer: CIGNA Medicare |
$417.60
|
| Rate for Payer: HUMANA Commercial |
$417.60
|
| Rate for Payer: MEDICAID Medicaid |
$426.88
|
| Rate for Payer: MEDICARE Medicare |
$324.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$440.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$450.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$440.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$440.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$394.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$371.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$371.20
|
|
|
XR CHEST/RIBS 4/> VIEWS
|
Facility
IP
|
$464.00
|
|
|
Service Code
|
CPT 71111 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: AETNA Commercial |
$440.80
|
| Rate for Payer: AETNA Medicare |
$417.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$440.80
|
| Rate for Payer: BCBS Healthlink |
$417.60
|
| Rate for Payer: BCBS HMK CHIP |
$417.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$417.60
|
| Rate for Payer: BCBS POS |
$440.80
|
| Rate for Payer: BCBS Traditional |
$464.00
|
| Rate for Payer: CASH_PRICE |
$371.20
|
| Rate for Payer: CIGNA Commercial |
$440.80
|
| Rate for Payer: CIGNA Medicare |
$417.60
|
| Rate for Payer: HUMANA Commercial |
$417.60
|
| Rate for Payer: MEDICAID Medicaid |
$426.88
|
| Rate for Payer: MEDICARE Medicare |
$324.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$440.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$450.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$440.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$440.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$394.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$371.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$371.20
|
|
|
XR CHEST SINGLE VIEW
|
Facility
OP
|
$234.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
20221105
|
|
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 CHEST SINGLE VIEW
|
Facility
IP
|
$234.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
20221105
|
|
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 CINE/VIDEO THROAT/ESOPH
|
Facility
OP
|
$637.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.90 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: AETNA Commercial |
$605.15
|
| Rate for Payer: AETNA Medicare |
$573.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$605.15
|
| Rate for Payer: BCBS Healthlink |
$573.30
|
| Rate for Payer: BCBS HMK CHIP |
$573.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$573.30
|
| Rate for Payer: BCBS POS |
$605.15
|
| Rate for Payer: BCBS Traditional |
$637.00
|
| Rate for Payer: CASH_PRICE |
$509.60
|
| Rate for Payer: CIGNA Commercial |
$605.15
|
| Rate for Payer: CIGNA Medicare |
$573.30
|
| Rate for Payer: HUMANA Commercial |
$573.30
|
| Rate for Payer: MEDICAID Medicaid |
$586.04
|
| Rate for Payer: MEDICARE Medicare |
$445.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$605.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$617.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$605.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$605.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$541.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$509.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$509.60
|
|
|
XR CINE/VIDEO THROAT/ESOPH
|
Facility
IP
|
$637.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.90 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: AETNA Commercial |
$605.15
|
| Rate for Payer: AETNA Medicare |
$573.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$605.15
|
| Rate for Payer: BCBS Healthlink |
$573.30
|
| Rate for Payer: BCBS HMK CHIP |
$573.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$573.30
|
| Rate for Payer: BCBS POS |
$605.15
|
| Rate for Payer: BCBS Traditional |
$637.00
|
| Rate for Payer: CASH_PRICE |
$509.60
|
| Rate for Payer: CIGNA Commercial |
$605.15
|
| Rate for Payer: CIGNA Medicare |
$573.30
|
| Rate for Payer: HUMANA Commercial |
$573.30
|
| Rate for Payer: MEDICAID Medicaid |
$586.04
|
| Rate for Payer: MEDICARE Medicare |
$445.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$605.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$617.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$605.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$605.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$541.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$509.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$509.60
|
|
|
XR CLAVICLE BILATERAL COMPLETE
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT 73000 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: AETNA Commercial |
$237.50
|
| Rate for Payer: AETNA Medicare |
$225.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$237.50
|
| Rate for Payer: BCBS Healthlink |
$225.00
|
| Rate for Payer: BCBS HMK CHIP |
$225.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.00
|
| Rate for Payer: BCBS POS |
$237.50
|
| Rate for Payer: BCBS Traditional |
$250.00
|
| Rate for Payer: CASH_PRICE |
$200.00
|
| Rate for Payer: CIGNA Commercial |
$237.50
|
| Rate for Payer: CIGNA Medicare |
$225.00
|
| Rate for Payer: HUMANA Commercial |
$225.00
|
| Rate for Payer: MEDICAID Medicaid |
$230.00
|
| Rate for Payer: MEDICARE Medicare |
$175.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$237.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$242.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$237.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$237.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$212.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.00
|
|
|
XR CLAVICLE BILATERAL COMPLETE
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 73000 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: AETNA Commercial |
$237.50
|
| Rate for Payer: AETNA Medicare |
$225.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$237.50
|
| Rate for Payer: BCBS Healthlink |
$225.00
|
| Rate for Payer: BCBS HMK CHIP |
$225.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.00
|
| Rate for Payer: BCBS POS |
$237.50
|
| Rate for Payer: BCBS Traditional |
$250.00
|
| Rate for Payer: CASH_PRICE |
$200.00
|
| Rate for Payer: CIGNA Commercial |
$237.50
|
| Rate for Payer: CIGNA Medicare |
$225.00
|
| Rate for Payer: HUMANA Commercial |
$225.00
|
| Rate for Payer: MEDICAID Medicaid |
$230.00
|
| Rate for Payer: MEDICARE Medicare |
$175.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$237.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$242.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$237.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$237.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$212.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.00
|
|
|
XR CLAVICLE LT COMPLETE
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
