|
XR FACIAL BONES LESS THAN 3 VIEWS
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR FACIAL BONES LESS THAN 3 VIEWS
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR FEET BILATERAL 2 VIEWS
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 73620 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
|
|
|
XR FEET BILATERAL 2 VIEWS
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 73620 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| 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 - 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 FEMUR LT 2 VIEWS
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR FEMUR LT 2 VIEWS
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR FEMUR RT 2 VIEWS
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR FEMUR RT 2 VIEWS
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR FINGERS LT
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 73140 LT
|
| 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 FINGERS LT
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 73140 LT
|
| 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 FINGERS RT
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 73140 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| 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 - 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 FINGERS RT
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 73140 RT
|
| 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 FOOT BILATERAL 3 OR MORE VIEWS
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 73630 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AETNA Commercial |
$256.50
|
| Rate for Payer: AETNA Medicare |
$243.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$256.50
|
| Rate for Payer: BCBS Healthlink |
$243.00
|
| Rate for Payer: BCBS HMK CHIP |
$243.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.00
|
| Rate for Payer: BCBS POS |
$256.50
|
| Rate for Payer: BCBS Traditional |
$270.00
|
| Rate for Payer: CASH_PRICE |
$216.00
|
| Rate for Payer: CIGNA Commercial |
$256.50
|
| Rate for Payer: CIGNA Medicare |
$243.00
|
| Rate for Payer: HUMANA Commercial |
$243.00
|
| Rate for Payer: MEDICAID Medicaid |
$248.40
|
| Rate for Payer: MEDICARE Medicare |
$189.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$256.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$261.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$256.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$256.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$229.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.00
|
|
|
XR FOOT BILATERAL 3 OR MORE VIEWS
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 73630 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AETNA Commercial |
$256.50
|
| Rate for Payer: AETNA Medicare |
$243.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$256.50
|
| Rate for Payer: BCBS Healthlink |
$243.00
|
| Rate for Payer: BCBS HMK CHIP |
$243.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.00
|
| Rate for Payer: BCBS POS |
$256.50
|
| Rate for Payer: BCBS Traditional |
$270.00
|
| Rate for Payer: CASH_PRICE |
$216.00
|
| Rate for Payer: CIGNA Commercial |
$256.50
|
| Rate for Payer: CIGNA Medicare |
$243.00
|
| Rate for Payer: HUMANA Commercial |
$243.00
|
| Rate for Payer: MEDICAID Medicaid |
$248.40
|
| Rate for Payer: MEDICARE Medicare |
$189.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$256.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$261.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$256.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$256.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$229.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.00
|
|
|
XR FOOT LT 2 VIEWS
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 73620 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 FOOT LT 2 VIEWS
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 73620 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 FOOT LT 3 VIEWS
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
XR FOOT LT 3 VIEWS
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
XR FOOT RT 2 VIEWS
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 73620 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 FOOT RT 2 VIEWS
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 73620 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 FOOT RT 3 VIEWS
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
XR FOOT RT 3 VIEWS
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
XR FOREARM, BILATERAL AP/LATERAL VIEW
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT 73090 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 FOREARM, BILATERAL AP/LATERAL VIEW
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 73090 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 FOREARM, LEFT AP/LATERAL VIEW
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 73090 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
|
|
