|
XR HIP RT 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 RT 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 RT 2 VIEWS
|
Facility
OP
|
$256.00
|
|
|
Service Code
|
CPT 73502 RT
|
| 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 RT 2 VIEWS
|
Facility
IP
|
$256.00
|
|
|
Service Code
|
CPT 73502 RT
|
| 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 HIPS BILATERAL 2 VIEWS W PELVIS
|
Facility
OP
|
$508.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
20230404
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: BCBS HMK CHIP |
$457.20
|
| Rate for Payer: AETNA Commercial |
$482.60
|
| Rate for Payer: AETNA Medicare |
$457.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$482.60
|
| Rate for Payer: BCBS Healthlink |
$457.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$457.20
|
| Rate for Payer: BCBS POS |
$482.60
|
| Rate for Payer: BCBS Traditional |
$508.00
|
| Rate for Payer: CASH_PRICE |
$406.40
|
| Rate for Payer: CIGNA Commercial |
$482.60
|
| Rate for Payer: CIGNA Medicare |
$457.20
|
| Rate for Payer: HUMANA Commercial |
$457.20
|
| Rate for Payer: MEDICAID Medicaid |
$467.36
|
| Rate for Payer: MEDICARE Medicare |
$355.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$482.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$492.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$482.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$482.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$431.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$406.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$406.40
|
|
|
XR HIPS BILATERAL 2 VIEWS W PELVIS
|
Facility
IP
|
$508.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
20230404
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: AETNA Commercial |
$482.60
|
| Rate for Payer: AETNA Medicare |
$457.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$482.60
|
| Rate for Payer: BCBS Healthlink |
$457.20
|
| Rate for Payer: BCBS HMK CHIP |
$457.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$457.20
|
| Rate for Payer: BCBS POS |
$482.60
|
| Rate for Payer: BCBS Traditional |
$508.00
|
| Rate for Payer: CASH_PRICE |
$406.40
|
| Rate for Payer: CIGNA Commercial |
$482.60
|
| Rate for Payer: CIGNA Medicare |
$457.20
|
| Rate for Payer: HUMANA Commercial |
$457.20
|
| Rate for Payer: MEDICAID Medicaid |
$467.36
|
| Rate for Payer: MEDICARE Medicare |
$355.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$482.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$492.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$482.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$482.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$431.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$406.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$406.40
|
|
|
XR HUMERUS LT 2 VIEWS
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 73060 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 HUMERUS LT 2 VIEWS
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 73060 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 HUMERUS RT 2 VIEWS
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 73060 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 HUMERUS RT 2 VIEWS
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 73060 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 IJ SINGLE/MULT TRGR PT 3+ MUSCL 20553
|
Facility
IP
|
$410.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: AETNA Commercial |
$389.50
|
| Rate for Payer: AETNA Medicare |
$369.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$389.50
|
| Rate for Payer: BCBS Healthlink |
$369.00
|
| Rate for Payer: BCBS HMK CHIP |
$369.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$369.00
|
| Rate for Payer: BCBS POS |
$389.50
|
| Rate for Payer: BCBS Traditional |
$410.00
|
| Rate for Payer: CASH_PRICE |
$328.00
|
| Rate for Payer: CIGNA Commercial |
$389.50
|
| Rate for Payer: CIGNA Medicare |
$369.00
|
| Rate for Payer: HUMANA Commercial |
$369.00
|
| Rate for Payer: MEDICAID Medicaid |
$377.20
|
| Rate for Payer: MEDICARE Medicare |
$287.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$389.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$397.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$389.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$389.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$348.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$328.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$328.00
|
|
|
XR IJ SINGLE/MULT TRGR PT 3+ MUSCL 20553
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: AETNA Commercial |
$389.50
|
| Rate for Payer: AETNA Medicare |
$369.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$389.50
|
| Rate for Payer: BCBS Healthlink |
$369.00
|
| Rate for Payer: BCBS HMK CHIP |
$369.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$369.00
|
| Rate for Payer: BCBS POS |
$389.50
|
| Rate for Payer: BCBS Traditional |
$410.00
|
| Rate for Payer: CASH_PRICE |
$328.00
|
| Rate for Payer: CIGNA Commercial |
$389.50
|
| Rate for Payer: CIGNA Medicare |
$369.00
|
| Rate for Payer: HUMANA Commercial |
$369.00
|
| Rate for Payer: MEDICAID Medicaid |
$377.20
|
| Rate for Payer: MEDICARE Medicare |
$287.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$389.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$397.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$389.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$389.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$348.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$328.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$328.00
|
|
|
XR JOINT SURVEY BILATERAL 2 VIEWS
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 77077 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
XR JOINT SURVEY BILATERAL 2 VIEWS
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 77077 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: AETNA Commercial |
$202.35
|
| Rate for Payer: AETNA Medicare |
$191.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$202.35
|
| Rate for Payer: BCBS Healthlink |
$191.70
|
| Rate for Payer: BCBS HMK CHIP |
$191.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$191.70
|
| Rate for Payer: BCBS POS |
$202.35
|
| Rate for Payer: BCBS Traditional |
$213.00
|
| Rate for Payer: CASH_PRICE |
$170.40
|
| Rate for Payer: CIGNA Commercial |
$202.35
|
| Rate for Payer: CIGNA Medicare |
$191.70
|
| Rate for Payer: HUMANA Commercial |
$191.70
|
| Rate for Payer: MEDICAID Medicaid |
$195.96
|
| Rate for Payer: MEDICARE Medicare |
$149.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$202.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$206.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$202.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$202.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$170.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$170.40
|
|
|
XR KNEE LT 2 VIEWS
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 73560 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 KNEE LT 2 VIEWS
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 73560 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 KNEE LT 3 VIEWS
|
Facility
IP
|
$306.00
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: AETNA Commercial |
$290.70
|
| Rate for Payer: AETNA Medicare |
$275.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$290.70
|
| Rate for Payer: BCBS Healthlink |
$275.40
|
| Rate for Payer: BCBS HMK CHIP |
$275.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$275.40
|
| Rate for Payer: BCBS POS |
$290.70
|
| Rate for Payer: BCBS Traditional |
$306.00
|
| Rate for Payer: CASH_PRICE |
$244.80
|
| Rate for Payer: CIGNA Commercial |
$290.70
|
| Rate for Payer: CIGNA Medicare |
$275.40
|
| Rate for Payer: HUMANA Commercial |
$275.40
|
| Rate for Payer: MEDICAID Medicaid |
$281.52
|
| Rate for Payer: MEDICARE Medicare |
$214.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$290.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$296.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$290.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$290.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$260.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$244.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$244.80
|
|
|
XR KNEE LT 3 VIEWS
|
Facility
OP
|
$306.00
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: AETNA Commercial |
$290.70
|
| Rate for Payer: AETNA Medicare |
$275.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$290.70
|
| Rate for Payer: BCBS Healthlink |
$275.40
|
| Rate for Payer: BCBS HMK CHIP |
$275.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$275.40
|
| Rate for Payer: BCBS POS |
$290.70
|
| Rate for Payer: BCBS Traditional |
$306.00
|
| Rate for Payer: CASH_PRICE |
$244.80
|
| Rate for Payer: CIGNA Commercial |
$290.70
|
| Rate for Payer: CIGNA Medicare |
$275.40
|
| Rate for Payer: HUMANA Commercial |
$275.40
|
| Rate for Payer: MEDICAID Medicaid |
$281.52
|
| Rate for Payer: MEDICARE Medicare |
$214.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$290.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$296.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$290.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$290.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$260.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$244.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$244.80
|
|
|
XR KNEE LT COMPLETE
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
XR KNEE LT COMPLETE
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
XR KNEE RT 2 VIEWS
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 73560 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 KNEE RT 2 VIEWS
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 73560 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 KNEE RT 3 VIEWS
|
Facility
OP
|
$306.00
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: AETNA Commercial |
$290.70
|
| Rate for Payer: AETNA Medicare |
$275.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$290.70
|
| Rate for Payer: BCBS Healthlink |
$275.40
|
| Rate for Payer: BCBS HMK CHIP |
$275.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$275.40
|
| Rate for Payer: BCBS POS |
$290.70
|
| Rate for Payer: BCBS Traditional |
$306.00
|
| Rate for Payer: CASH_PRICE |
$244.80
|
| Rate for Payer: CIGNA Commercial |
$290.70
|
| Rate for Payer: CIGNA Medicare |
$275.40
|
| Rate for Payer: HUMANA Commercial |
$275.40
|
| Rate for Payer: MEDICAID Medicaid |
$281.52
|
| Rate for Payer: MEDICARE Medicare |
$214.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$290.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$296.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$290.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$290.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$260.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$244.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$244.80
|
|
|
XR KNEE RT 3 VIEWS
|
Facility
IP
|
$306.00
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: AETNA Commercial |
$290.70
|
| Rate for Payer: AETNA Medicare |
$275.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$290.70
|
| Rate for Payer: BCBS Healthlink |
$275.40
|
| Rate for Payer: BCBS HMK CHIP |
$275.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$275.40
|
| Rate for Payer: BCBS POS |
$290.70
|
| Rate for Payer: BCBS Traditional |
$306.00
|
| Rate for Payer: CASH_PRICE |
$244.80
|
| Rate for Payer: CIGNA Commercial |
$290.70
|
| Rate for Payer: CIGNA Medicare |
$275.40
|
| Rate for Payer: HUMANA Commercial |
$275.40
|
| Rate for Payer: MEDICAID Medicaid |
$281.52
|
| Rate for Payer: MEDICARE Medicare |
$214.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$290.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$296.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$290.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$290.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$260.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$244.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$244.80
|
|
|
XR KNEE RT COMPLETE
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
