|
XR CLAVICLE LT COMPLETE
|
Facility
OP
|
$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
|
|
|
XR CLAVICLE RT COMPLETE
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 73000 RT
|
| 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
|
|
|
XR CLAVICLE RT COMPLETE
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 73000 RT
|
| 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
|
|
|
XR CTA THORACIC AORTA W OR W/O CONTRAST
|
Facility
OP
|
$3,199.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,239.30 |
| Max. Negotiated Rate |
$3,199.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,719.15
|
| Rate for Payer: AETNA Commercial |
$3,039.05
|
| Rate for Payer: AETNA Medicare |
$2,879.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,039.05
|
| Rate for Payer: BCBS Healthlink |
$2,879.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,879.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,879.10
|
| Rate for Payer: BCBS POS |
$3,039.05
|
| Rate for Payer: BCBS Traditional |
$3,199.00
|
| Rate for Payer: CASH_PRICE |
$2,559.20
|
| Rate for Payer: CIGNA Commercial |
$3,039.05
|
| Rate for Payer: CIGNA Medicare |
$2,879.10
|
| Rate for Payer: HUMANA Commercial |
$2,879.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,943.08
|
| Rate for Payer: MEDICARE Medicare |
$2,239.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,039.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,103.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,039.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,039.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,559.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,559.20
|
|
|
XR CTA THORACIC AORTA W OR W/O CONTRAST
|
Facility
IP
|
$3,199.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,239.30 |
| Max. Negotiated Rate |
$3,199.00 |
| Rate for Payer: AETNA Commercial |
$3,039.05
|
| Rate for Payer: AETNA Medicare |
$2,879.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,039.05
|
| Rate for Payer: BCBS Healthlink |
$2,879.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,879.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,879.10
|
| Rate for Payer: BCBS POS |
$3,039.05
|
| Rate for Payer: BCBS Traditional |
$3,199.00
|
| Rate for Payer: CASH_PRICE |
$2,559.20
|
| Rate for Payer: CIGNA Commercial |
$3,039.05
|
| Rate for Payer: CIGNA Medicare |
$2,879.10
|
| Rate for Payer: HUMANA Commercial |
$2,879.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,943.08
|
| Rate for Payer: MEDICARE Medicare |
$2,239.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,039.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,103.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,039.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,039.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,719.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,559.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,559.20
|
|
|
XR ELBOW BILATERAL 2 VIEWS
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 73070 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
XR ELBOW BILATERAL 2 VIEWS
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT 73070 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
XR ELBOW BILATERAL 3 VIEWS
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
CPT 73080 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 ELBOW BILATERAL 3 VIEWS
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
CPT 73080 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| 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 MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
XR ELBOW LT 2 VIEWS
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 73070 LT
|
| 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 ELBOW LT 2 VIEWS
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 73070 LT
|
| 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 ELBOW LT 3 VIEWS
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 73080 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 ELBOW LT 3 VIEWS
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 73080 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 ELBOW RT 2 VIEWS
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 73070 RT
|
| 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 ELBOW RT 2 VIEWS
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 73070 RT
|
| 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 ELBOW RT 3 VIEWS
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 73080 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 ELBOW RT 3 VIEWS
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 73080 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 ENTIRE SPINE W SKULL 2 OR 3 VIEWS
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 72082 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: AETNA Commercial |
$316.35
|
| Rate for Payer: AETNA Medicare |
$299.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$316.35
|
| Rate for Payer: BCBS Healthlink |
$299.70
|
| Rate for Payer: BCBS HMK CHIP |
$299.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$299.70
|
| Rate for Payer: BCBS POS |
$316.35
|
| Rate for Payer: BCBS Traditional |
$333.00
|
| Rate for Payer: CASH_PRICE |
$266.40
|
| Rate for Payer: CIGNA Commercial |
$316.35
|
| Rate for Payer: CIGNA Medicare |
$299.70
|
| Rate for Payer: HUMANA Commercial |
$299.70
|
| Rate for Payer: MEDICAID Medicaid |
$306.36
|
| Rate for Payer: MEDICARE Medicare |
$233.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$316.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$316.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$316.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$266.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$266.40
|
|
|
XR ENTIRE SPINE W SKULL 2 OR 3 VIEWS
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 72082 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: AETNA Commercial |
$316.35
|
| Rate for Payer: AETNA Medicare |
$299.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$316.35
|
| Rate for Payer: BCBS Healthlink |
$299.70
|
| Rate for Payer: BCBS HMK CHIP |
$299.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$299.70
|
| Rate for Payer: BCBS POS |
$316.35
|
| Rate for Payer: BCBS Traditional |
$333.00
|
| Rate for Payer: CASH_PRICE |
$266.40
|
| Rate for Payer: CIGNA Commercial |
$316.35
|
| Rate for Payer: CIGNA Medicare |
$299.70
|
| Rate for Payer: HUMANA Commercial |
$299.70
|
| Rate for Payer: MEDICAID Medicaid |
$306.36
|
| Rate for Payer: MEDICARE Medicare |
$233.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$316.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$316.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$316.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$266.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$266.40
|
|
|
XR ENTIRE SPINE W SKULL 4 OR 5 VIEWS
|
Facility
OP
|
$502.00
|
|
|
Service Code
|
CPT 72083 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.40 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: AETNA Commercial |
$476.90
|
| Rate for Payer: AETNA Medicare |
$451.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$476.90
|
| Rate for Payer: BCBS Healthlink |
$451.80
|
| Rate for Payer: BCBS HMK CHIP |
$451.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$451.80
|
| Rate for Payer: BCBS POS |
$476.90
|
| Rate for Payer: BCBS Traditional |
$502.00
|
| Rate for Payer: CASH_PRICE |
$401.60
|
| Rate for Payer: CIGNA Commercial |
$476.90
|
| Rate for Payer: CIGNA Medicare |
$451.80
|
| Rate for Payer: HUMANA Commercial |
$451.80
|
| Rate for Payer: MEDICAID Medicaid |
$461.84
|
| Rate for Payer: MEDICARE Medicare |
$351.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$476.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$486.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$476.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$476.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$426.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$401.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$401.60
|
|
|
XR ENTIRE SPINE W SKULL 4 OR 5 VIEWS
|
Facility
IP
|
$502.00
|
|
|
Service Code
|
CPT 72083 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.40 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: AETNA Commercial |
$476.90
|
| Rate for Payer: AETNA Medicare |
$451.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$476.90
|
| Rate for Payer: BCBS Healthlink |
$451.80
|
| Rate for Payer: BCBS HMK CHIP |
$451.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$451.80
|
| Rate for Payer: BCBS POS |
$476.90
|
| Rate for Payer: BCBS Traditional |
$502.00
|
| Rate for Payer: CASH_PRICE |
$401.60
|
| Rate for Payer: CIGNA Commercial |
$476.90
|
| Rate for Payer: CIGNA Medicare |
$451.80
|
| Rate for Payer: HUMANA Commercial |
$451.80
|
| Rate for Payer: MEDICAID Medicaid |
$461.84
|
| Rate for Payer: MEDICARE Medicare |
$351.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$476.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$486.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$476.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$476.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$426.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$401.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$401.60
|
|
|
XR EYE FOREIGN BODY
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 70030 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR EYE FOREIGN BODY
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 70030 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR FACIAL BONES COMPLETE 3 VIEWS
|
Facility
OP
|
$392.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: AETNA Commercial |
$372.40
|
| Rate for Payer: AETNA Medicare |
$352.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$372.40
|
| Rate for Payer: BCBS Healthlink |
$352.80
|
| Rate for Payer: BCBS HMK CHIP |
$352.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$352.80
|
| Rate for Payer: BCBS POS |
$372.40
|
| Rate for Payer: BCBS Traditional |
$392.00
|
| Rate for Payer: CASH_PRICE |
$313.60
|
| Rate for Payer: CIGNA Commercial |
$372.40
|
| Rate for Payer: CIGNA Medicare |
$352.80
|
| Rate for Payer: HUMANA Commercial |
$352.80
|
| Rate for Payer: MEDICAID Medicaid |
$360.64
|
| Rate for Payer: MEDICARE Medicare |
$274.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$372.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$380.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$372.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$372.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$333.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$313.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$313.60
|
|
|
XR FACIAL BONES COMPLETE 3 VIEWS
|
Facility
IP
|
$392.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: AETNA Commercial |
$372.40
|
| Rate for Payer: AETNA Medicare |
$352.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$372.40
|
| Rate for Payer: BCBS Healthlink |
$352.80
|
| Rate for Payer: BCBS HMK CHIP |
$352.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$352.80
|
| Rate for Payer: BCBS POS |
$372.40
|
| Rate for Payer: BCBS Traditional |
$392.00
|
| Rate for Payer: CASH_PRICE |
$313.60
|
| Rate for Payer: CIGNA Commercial |
$372.40
|
| Rate for Payer: CIGNA Medicare |
$352.80
|
| Rate for Payer: HUMANA Commercial |
$352.80
|
| Rate for Payer: MEDICAID Medicaid |
$360.64
|
| Rate for Payer: MEDICARE Medicare |
$274.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$372.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$380.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$372.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$372.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$333.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$313.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$313.60
|
|
