|
XR KNEE RT COMPLETE
|
Facility
IP
|
$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
|
|
|
XR KNEES BILATERAL 1 VIEW
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT 73560 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: AETNA Commercial |
$227.05
|
| Rate for Payer: AETNA Medicare |
$215.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$227.05
|
| Rate for Payer: BCBS Healthlink |
$215.10
|
| Rate for Payer: BCBS HMK CHIP |
$215.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$215.10
|
| Rate for Payer: BCBS POS |
$227.05
|
| Rate for Payer: BCBS Traditional |
$239.00
|
| Rate for Payer: CASH_PRICE |
$191.20
|
| Rate for Payer: CIGNA Commercial |
$227.05
|
| Rate for Payer: CIGNA Medicare |
$215.10
|
| Rate for Payer: HUMANA Commercial |
$215.10
|
| Rate for Payer: MEDICAID Medicaid |
$219.88
|
| Rate for Payer: MEDICARE Medicare |
$167.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$227.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$231.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$227.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$227.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$203.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$191.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$191.20
|
|
|
XR KNEES BILATERAL 1 VIEW
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT 73560 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: AETNA Commercial |
$227.05
|
| Rate for Payer: AETNA Medicare |
$215.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$227.05
|
| Rate for Payer: BCBS Healthlink |
$215.10
|
| Rate for Payer: BCBS HMK CHIP |
$215.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$215.10
|
| Rate for Payer: BCBS POS |
$227.05
|
| Rate for Payer: BCBS Traditional |
$239.00
|
| Rate for Payer: CASH_PRICE |
$191.20
|
| Rate for Payer: CIGNA Commercial |
$227.05
|
| Rate for Payer: CIGNA Medicare |
$215.10
|
| Rate for Payer: HUMANA Commercial |
$215.10
|
| Rate for Payer: MEDICAID Medicaid |
$219.88
|
| Rate for Payer: MEDICARE Medicare |
$167.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$227.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$231.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$227.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$227.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$203.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$191.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$191.20
|
|
|
XR KNEES BILATERAL 2 VIEWS
|
Facility
OP
|
$239.00
|
|
|
Service Code
|
CPT 73560 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: AETNA Commercial |
$227.05
|
| Rate for Payer: AETNA Medicare |
$215.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$227.05
|
| Rate for Payer: BCBS Healthlink |
$215.10
|
| Rate for Payer: BCBS HMK CHIP |
$215.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$215.10
|
| Rate for Payer: BCBS POS |
$227.05
|
| Rate for Payer: BCBS Traditional |
$239.00
|
| Rate for Payer: CASH_PRICE |
$191.20
|
| Rate for Payer: CIGNA Commercial |
$227.05
|
| Rate for Payer: CIGNA Medicare |
$215.10
|
| Rate for Payer: HUMANA Commercial |
$215.10
|
| Rate for Payer: MEDICAID Medicaid |
$219.88
|
| Rate for Payer: MEDICARE Medicare |
$167.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$227.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$231.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$227.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$227.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$203.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$191.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$191.20
|
|
|
XR KNEES BILATERAL 2 VIEWS
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
CPT 73560 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: AETNA Commercial |
$227.05
|
| Rate for Payer: AETNA Medicare |
$215.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$227.05
|
| Rate for Payer: BCBS Healthlink |
$215.10
|
| Rate for Payer: BCBS HMK CHIP |
$215.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$215.10
|
| Rate for Payer: BCBS POS |
$227.05
|
| Rate for Payer: BCBS Traditional |
$239.00
|
| Rate for Payer: CASH_PRICE |
$191.20
|
| Rate for Payer: CIGNA Commercial |
$227.05
|
| Rate for Payer: CIGNA Medicare |
$215.10
|
| Rate for Payer: HUMANA Commercial |
$215.10
|
| Rate for Payer: MEDICAID Medicaid |
$219.88
|
| Rate for Payer: MEDICARE Medicare |
$167.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$227.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$231.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$227.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$227.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$203.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$191.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$191.20
|
|
|
XR KNEES BILATERAL COMPLETE
|
Facility
OP
|
$783.00
|
|
|
Service Code
|
CPT 73564 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$548.10 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: AETNA Commercial |
$743.85
|
| Rate for Payer: AETNA Medicare |
$704.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$743.85
|
| Rate for Payer: BCBS Healthlink |
$704.70
|
| Rate for Payer: BCBS HMK CHIP |
$704.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$704.70
|
| Rate for Payer: BCBS POS |
$743.85
|
| Rate for Payer: BCBS Traditional |
$783.00
|
| Rate for Payer: CASH_PRICE |
$626.40
|
| Rate for Payer: CIGNA Commercial |
$743.85
|
| Rate for Payer: CIGNA Medicare |
$704.70
|
| Rate for Payer: HUMANA Commercial |
$704.70
|
| Rate for Payer: MEDICAID Medicaid |
$720.36
|
| Rate for Payer: MEDICARE Medicare |
$548.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$743.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$759.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$743.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$743.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$665.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$626.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$626.40
|
|
|
XR KNEES BILATERAL COMPLETE
|
Facility
IP
|
$783.00
|
|
|
Service Code
|
CPT 73564 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$548.10 |
| Max. Negotiated Rate |
$783.00 |
| Rate for Payer: AETNA Commercial |
$743.85
|
| Rate for Payer: AETNA Medicare |
$704.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$743.85
|
| Rate for Payer: BCBS Healthlink |
$704.70
|
| Rate for Payer: BCBS HMK CHIP |
$704.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$704.70
|
| Rate for Payer: BCBS POS |
$743.85
|
| Rate for Payer: BCBS Traditional |
$783.00
|
| Rate for Payer: CASH_PRICE |
$626.40
|
| Rate for Payer: CIGNA Commercial |
$743.85
|
| Rate for Payer: CIGNA Medicare |
$704.70
|
| Rate for Payer: HUMANA Commercial |
$704.70
|
| Rate for Payer: MEDICAID Medicaid |
$720.36
|
| Rate for Payer: MEDICARE Medicare |
$548.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$743.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$759.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$743.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$743.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$665.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$626.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$626.40
|
|
|
XR KNEES BILATERAL STAND AP
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT 73565 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
XR KNEES BILATERAL STAND AP
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 73565 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
XR LOWER EXTREMITY LT INFANT
|
Facility
OP
|
$137.00
|
|
|
Service Code
|
CPT 73592 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
XR LOWER EXTREMITY LT INFANT
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT 73592 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
XR LOWER EXTREMITY RT INFANT
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
XR LOWER EXTREMITY RT INFANT
|
Facility
OP
|
$137.00
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$137.00 |
| Rate for Payer: AETNA Commercial |
$130.15
|
| Rate for Payer: AETNA Medicare |
$123.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$130.15
|
| Rate for Payer: BCBS Healthlink |
$123.30
|
| Rate for Payer: BCBS HMK CHIP |
$123.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$123.30
|
| Rate for Payer: BCBS POS |
$130.15
|
| Rate for Payer: BCBS Traditional |
$137.00
|
| Rate for Payer: CASH_PRICE |
$109.60
|
| Rate for Payer: CIGNA Commercial |
$130.15
|
| Rate for Payer: CIGNA Medicare |
$123.30
|
| Rate for Payer: HUMANA Commercial |
$123.30
|
| Rate for Payer: MEDICAID Medicaid |
$126.04
|
| Rate for Payer: MEDICARE Medicare |
$95.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$130.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$132.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$130.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$130.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$116.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$109.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$109.60
|
|
|
XR LUMBAR SPINE 2 OR 3 VIEWS
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
XR LUMBAR SPINE 2 OR 3 VIEWS
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
XR LUMBAR SPINE 3 VIEWS
|
Facility
OP
|
$307.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: AETNA Commercial |
$291.65
|
| Rate for Payer: AETNA Medicare |
$276.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$291.65
|
| Rate for Payer: BCBS Healthlink |
$276.30
|
| Rate for Payer: BCBS HMK CHIP |
$276.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$276.30
|
| Rate for Payer: BCBS POS |
$291.65
|
| Rate for Payer: BCBS Traditional |
$307.00
|
| Rate for Payer: CASH_PRICE |
$245.60
|
| Rate for Payer: CIGNA Commercial |
$291.65
|
| Rate for Payer: CIGNA Medicare |
$276.30
|
| Rate for Payer: HUMANA Commercial |
$276.30
|
| Rate for Payer: MEDICAID Medicaid |
$282.44
|
| Rate for Payer: MEDICARE Medicare |
$214.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$291.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$297.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$291.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$291.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$260.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$245.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$245.60
|
|
|
XR LUMBAR SPINE 3 VIEWS
|
Facility
IP
|
$307.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$260.95
|
| Rate for Payer: AETNA Commercial |
$291.65
|
| Rate for Payer: AETNA Medicare |
$276.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$291.65
|
| Rate for Payer: BCBS Healthlink |
$276.30
|
| Rate for Payer: BCBS HMK CHIP |
$276.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$276.30
|
| Rate for Payer: BCBS POS |
$291.65
|
| Rate for Payer: BCBS Traditional |
$307.00
|
| Rate for Payer: CASH_PRICE |
$245.60
|
| Rate for Payer: CIGNA Commercial |
$291.65
|
| Rate for Payer: CIGNA Medicare |
$276.30
|
| Rate for Payer: HUMANA Commercial |
$276.30
|
| Rate for Payer: MEDICAID Medicaid |
$282.44
|
| Rate for Payer: MEDICARE Medicare |
$214.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$291.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$297.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$291.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$291.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$245.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$245.60
|
|
|
XR LUMBAR SPINE BEND ONLY
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
XR LUMBAR SPINE BEND ONLY
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
XR LUMBAR SPINE COMPLETE 4 VIEWS
|
Facility
IP
|
$454.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$454.00 |
| Rate for Payer: AETNA Commercial |
$431.30
|
| Rate for Payer: AETNA Medicare |
$408.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$431.30
|
| Rate for Payer: BCBS Healthlink |
$408.60
|
| Rate for Payer: BCBS HMK CHIP |
$408.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$408.60
|
| Rate for Payer: BCBS POS |
$431.30
|
| Rate for Payer: BCBS Traditional |
$454.00
|
| Rate for Payer: CASH_PRICE |
$363.20
|
| Rate for Payer: CIGNA Commercial |
$431.30
|
| Rate for Payer: CIGNA Medicare |
$408.60
|
| Rate for Payer: HUMANA Commercial |
$408.60
|
| Rate for Payer: MEDICAID Medicaid |
$417.68
|
| Rate for Payer: MEDICARE Medicare |
$317.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$431.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$440.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$431.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$431.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$385.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$363.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$363.20
|
|
|
XR LUMBAR SPINE COMPLETE 4 VIEWS
|
Facility
OP
|
$454.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$454.00 |
| Rate for Payer: AETNA Commercial |
$431.30
|
| Rate for Payer: AETNA Medicare |
$408.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$431.30
|
| Rate for Payer: BCBS Healthlink |
$408.60
|
| Rate for Payer: BCBS HMK CHIP |
$408.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$408.60
|
| Rate for Payer: BCBS POS |
$431.30
|
| Rate for Payer: BCBS Traditional |
$454.00
|
| Rate for Payer: CASH_PRICE |
$363.20
|
| Rate for Payer: CIGNA Commercial |
$431.30
|
| Rate for Payer: CIGNA Medicare |
$408.60
|
| Rate for Payer: HUMANA Commercial |
$408.60
|
| Rate for Payer: MEDICAID Medicaid |
$417.68
|
| Rate for Payer: MEDICARE Medicare |
$317.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$431.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$440.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$431.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$431.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$385.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$363.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$363.20
|
|
|
XR LUMBOSACRAL WITH FLEX AND EXT
|
Facility
IP
|
$565.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: AETNA Commercial |
$536.75
|
| Rate for Payer: AETNA Medicare |
$508.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$536.75
|
| Rate for Payer: BCBS Healthlink |
$508.50
|
| Rate for Payer: BCBS HMK CHIP |
$508.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$508.50
|
| Rate for Payer: BCBS POS |
$536.75
|
| Rate for Payer: BCBS Traditional |
$565.00
|
| Rate for Payer: CASH_PRICE |
$452.00
|
| Rate for Payer: CIGNA Commercial |
$536.75
|
| Rate for Payer: CIGNA Medicare |
$508.50
|
| Rate for Payer: HUMANA Commercial |
$508.50
|
| Rate for Payer: MEDICAID Medicaid |
$519.80
|
| Rate for Payer: MEDICARE Medicare |
$395.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$536.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$548.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$536.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$536.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$480.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$452.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$452.00
|
|
|
XR LUMBOSACRAL WITH FLEX AND EXT
|
Facility
OP
|
$565.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: AETNA Commercial |
$536.75
|
| Rate for Payer: AETNA Medicare |
$508.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$536.75
|
| Rate for Payer: BCBS Healthlink |
$508.50
|
| Rate for Payer: BCBS HMK CHIP |
$508.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$508.50
|
| Rate for Payer: BCBS POS |
$536.75
|
| Rate for Payer: BCBS Traditional |
$565.00
|
| Rate for Payer: CASH_PRICE |
$452.00
|
| Rate for Payer: CIGNA Commercial |
$536.75
|
| Rate for Payer: CIGNA Medicare |
$508.50
|
| Rate for Payer: HUMANA Commercial |
$508.50
|
| Rate for Payer: MEDICAID Medicaid |
$519.80
|
| Rate for Payer: MEDICARE Medicare |
$395.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$536.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$548.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$536.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$536.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$480.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$452.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$452.00
|
|
|
XR MANDIBLE 4 VIEWS
|
Facility
IP
|
$365.00
|
|
|
Service Code
|
CPT 70110 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: AETNA Commercial |
$346.75
|
| Rate for Payer: AETNA Medicare |
$328.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$346.75
|
| Rate for Payer: BCBS Healthlink |
$328.50
|
| Rate for Payer: BCBS HMK CHIP |
$328.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$328.50
|
| Rate for Payer: BCBS POS |
$346.75
|
| Rate for Payer: BCBS Traditional |
$365.00
|
| Rate for Payer: CASH_PRICE |
$292.00
|
| Rate for Payer: CIGNA Commercial |
$346.75
|
| Rate for Payer: CIGNA Medicare |
$328.50
|
| Rate for Payer: HUMANA Commercial |
$328.50
|
| Rate for Payer: MEDICAID Medicaid |
$335.80
|
| Rate for Payer: MEDICARE Medicare |
$255.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$346.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$354.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$346.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$346.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$310.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$292.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$292.00
|
|
|
XR MANDIBLE 4 VIEWS
|
Facility
OP
|
$365.00
|
|
|
Service Code
|
CPT 70110 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: AETNA Commercial |
$346.75
|
| Rate for Payer: AETNA Medicare |
$328.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$346.75
|
| Rate for Payer: BCBS Healthlink |
$328.50
|
| Rate for Payer: BCBS HMK CHIP |
$328.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$328.50
|
| Rate for Payer: BCBS POS |
$346.75
|
| Rate for Payer: BCBS Traditional |
$365.00
|
| Rate for Payer: CASH_PRICE |
$292.00
|
| Rate for Payer: CIGNA Commercial |
$346.75
|
| Rate for Payer: CIGNA Medicare |
$328.50
|
| Rate for Payer: HUMANA Commercial |
$328.50
|
| Rate for Payer: MEDICAID Medicaid |
$335.80
|
| Rate for Payer: MEDICARE Medicare |
$255.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$346.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$354.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$346.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$346.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$310.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$292.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$292.00
|
|
