|
XR FOREARM, LEFT AP/LATERAL VIEW
|
Facility
OP
|
$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
|
|
|
XR FOREARM, RIGHT AP/LATERAL VIEW
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 73090 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 FOREARM, RIGHT AP/LATERAL VIEW
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 73090 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 GUIDANCE FOR NEEDLE PLACE 77002
|
Facility
OP
|
$464.00
|
|
|
Service Code
|
CPT 77002
|
| 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 GUIDANCE FOR NEEDLE PLACE 77002
|
Facility
IP
|
$464.00
|
|
|
Service Code
|
CPT 77002
|
| 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 GUIDANCE SPINAL INJ 77003
|
Facility
IP
|
$510.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: AETNA Commercial |
$484.50
|
| Rate for Payer: AETNA Medicare |
$459.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$484.50
|
| Rate for Payer: BCBS Healthlink |
$459.00
|
| Rate for Payer: BCBS HMK CHIP |
$459.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$459.00
|
| Rate for Payer: BCBS POS |
$484.50
|
| Rate for Payer: BCBS Traditional |
$510.00
|
| Rate for Payer: CASH_PRICE |
$408.00
|
| Rate for Payer: CIGNA Commercial |
$484.50
|
| Rate for Payer: CIGNA Medicare |
$459.00
|
| Rate for Payer: HUMANA Commercial |
$459.00
|
| Rate for Payer: MEDICAID Medicaid |
$469.20
|
| Rate for Payer: MEDICARE Medicare |
$357.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$484.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$494.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$484.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$484.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$433.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$408.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$408.00
|
|
|
XR GUIDANCE SPINAL INJ 77003
|
Facility
OP
|
$510.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: AETNA Commercial |
$484.50
|
| Rate for Payer: AETNA Medicare |
$459.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$484.50
|
| Rate for Payer: BCBS Healthlink |
$459.00
|
| Rate for Payer: BCBS HMK CHIP |
$459.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$459.00
|
| Rate for Payer: BCBS POS |
$484.50
|
| Rate for Payer: BCBS Traditional |
$510.00
|
| Rate for Payer: CASH_PRICE |
$408.00
|
| Rate for Payer: CIGNA Commercial |
$484.50
|
| Rate for Payer: CIGNA Medicare |
$459.00
|
| Rate for Payer: HUMANA Commercial |
$459.00
|
| Rate for Payer: MEDICAID Medicaid |
$469.20
|
| Rate for Payer: MEDICARE Medicare |
$357.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$484.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$494.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$484.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$484.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$433.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$408.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$408.00
|
|
|
XR HAND LT 2 VIEWS
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR HAND LT 2 VIEWS
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR HAND LT 3 VIEWS
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 73130 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 HAND LT 3 VIEWS
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 73130 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 HAND RT 2 VIEWS
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR HAND RT 2 VIEWS
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR HAND RT 3 VIEWS
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 73130 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 HAND RT 3 VIEWS
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 73130 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 HANDS BILATERAL 1 VIEW
|
Facility
IP
|
$234.00
|
|
|
Service Code
|
CPT 73120 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: AETNA Commercial |
$222.30
|
| Rate for Payer: AETNA Medicare |
$210.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$222.30
|
| Rate for Payer: BCBS Healthlink |
$210.60
|
| Rate for Payer: BCBS HMK CHIP |
$210.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$210.60
|
| Rate for Payer: BCBS POS |
$222.30
|
| Rate for Payer: BCBS Traditional |
$234.00
|
| Rate for Payer: CASH_PRICE |
$187.20
|
| Rate for Payer: CIGNA Commercial |
$222.30
|
| Rate for Payer: CIGNA Medicare |
$210.60
|
| Rate for Payer: HUMANA Commercial |
$210.60
|
| Rate for Payer: MEDICAID Medicaid |
$215.28
|
| Rate for Payer: MEDICARE Medicare |
$163.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$222.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$222.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$222.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$187.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$187.20
|
|
|
XR HANDS BILATERAL 1 VIEW
|
Facility
OP
|
$234.00
|
|
|
Service Code
|
CPT 73120 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: AETNA Commercial |
$222.30
|
| Rate for Payer: AETNA Medicare |
$210.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$222.30
|
| Rate for Payer: BCBS Healthlink |
$210.60
|
| Rate for Payer: BCBS HMK CHIP |
$210.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$210.60
|
| Rate for Payer: BCBS POS |
$222.30
|
| Rate for Payer: BCBS Traditional |
$234.00
|
| Rate for Payer: CASH_PRICE |
$187.20
|
| Rate for Payer: CIGNA Commercial |
$222.30
|
| Rate for Payer: CIGNA Medicare |
$210.60
|
| Rate for Payer: HUMANA Commercial |
$210.60
|
| Rate for Payer: MEDICAID Medicaid |
$215.28
|
| Rate for Payer: MEDICARE Medicare |
$163.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$222.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$222.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$222.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$187.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$187.20
|
|
|
XR HANDS BILATERAL 2 VIEWS
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 73120 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR HANDS BILATERAL 2 VIEWS
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 73120 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR HANDS BILATERAL 3 VIEWS
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 73130 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 HANDS BILATERAL 3 VIEWS
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 73130 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 HIP LT 1 VIEW
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 73501 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 HIP LT 1 VIEW
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 73501 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 HIP LT 2 VIEWS
|
Facility
IP
|
$256.00
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: AETNA Commercial |
$243.20
|
| Rate for Payer: AETNA Medicare |
$230.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$243.20
|
| Rate for Payer: BCBS Healthlink |
$230.40
|
| Rate for Payer: BCBS HMK CHIP |
$230.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$230.40
|
| Rate for Payer: BCBS POS |
$243.20
|
| Rate for Payer: BCBS Traditional |
$256.00
|
| Rate for Payer: CASH_PRICE |
$204.80
|
| Rate for Payer: CIGNA Commercial |
$243.20
|
| Rate for Payer: CIGNA Medicare |
$230.40
|
| Rate for Payer: HUMANA Commercial |
$230.40
|
| Rate for Payer: MEDICAID Medicaid |
$235.52
|
| Rate for Payer: MEDICARE Medicare |
$179.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$243.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$248.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$243.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$243.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$217.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$204.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$204.80
|
|
|
XR HIP LT 2 VIEWS
|
Facility
OP
|
$256.00
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: AETNA Commercial |
$243.20
|
| Rate for Payer: AETNA Medicare |
$230.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$243.20
|
| Rate for Payer: BCBS Healthlink |
$230.40
|
| Rate for Payer: BCBS HMK CHIP |
$230.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$230.40
|
| Rate for Payer: BCBS POS |
$243.20
|
| Rate for Payer: BCBS Traditional |
$256.00
|
| Rate for Payer: CASH_PRICE |
$204.80
|
| Rate for Payer: CIGNA Commercial |
$243.20
|
| Rate for Payer: CIGNA Medicare |
$230.40
|
| Rate for Payer: HUMANA Commercial |
$230.40
|
| Rate for Payer: MEDICAID Medicaid |
$235.52
|
| Rate for Payer: MEDICARE Medicare |
$179.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$243.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$248.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$243.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$243.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$217.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$204.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$204.80
|
|
