|
XR MANDIBLE BILATERAL 1 OR 2 VIEWS
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 70100 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR MANDIBLE BILATERAL 1 OR 2 VIEWS
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 70100 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR MANDIBLE LT 1-2 VIEW
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 70100 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR MANDIBLE LT 1-2 VIEW
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 70100 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR MANDIBLE RT 1-2 VIEW
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 70100 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR MANDIBLE RT 1-2 VIEW
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 70100 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
XR MASTOIDS GREATER THAN 3 PER SIDE
|
Facility
OP
|
$265.00
|
|
|
Service Code
|
CPT 70130 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.50 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: AETNA Commercial |
$251.75
|
| Rate for Payer: AETNA Medicare |
$238.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$251.75
|
| Rate for Payer: BCBS Healthlink |
$238.50
|
| Rate for Payer: BCBS HMK CHIP |
$238.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$238.50
|
| Rate for Payer: BCBS POS |
$251.75
|
| Rate for Payer: BCBS Traditional |
$265.00
|
| Rate for Payer: CASH_PRICE |
$212.00
|
| Rate for Payer: CIGNA Commercial |
$251.75
|
| Rate for Payer: CIGNA Medicare |
$238.50
|
| Rate for Payer: HUMANA Commercial |
$238.50
|
| Rate for Payer: MEDICAID Medicaid |
$243.80
|
| Rate for Payer: MEDICARE Medicare |
$185.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$251.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$257.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$251.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$251.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$225.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$212.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$212.00
|
|
|
XR MASTOIDS GREATER THAN 3 PER SIDE
|
Facility
IP
|
$265.00
|
|
|
Service Code
|
CPT 70130 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.50 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: AETNA Commercial |
$251.75
|
| Rate for Payer: AETNA Medicare |
$238.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$251.75
|
| Rate for Payer: BCBS Healthlink |
$238.50
|
| Rate for Payer: BCBS HMK CHIP |
$238.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$238.50
|
| Rate for Payer: BCBS POS |
$251.75
|
| Rate for Payer: BCBS Traditional |
$265.00
|
| Rate for Payer: CASH_PRICE |
$212.00
|
| Rate for Payer: CIGNA Commercial |
$251.75
|
| Rate for Payer: CIGNA Medicare |
$238.50
|
| Rate for Payer: HUMANA Commercial |
$238.50
|
| Rate for Payer: MEDICAID Medicaid |
$243.80
|
| Rate for Payer: MEDICARE Medicare |
$185.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$251.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$257.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$251.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$251.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$225.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$212.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$212.00
|
|
|
XR MASTOIDS LESS THAN 3 PER SIDE
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 70120 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
XR MASTOIDS LESS THAN 3 PER SIDE
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 70120 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
XR NASAL BONES 3 VIEWS
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| 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 - 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 NASAL BONES 3 VIEWS
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 70160 TC
|
| 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 OP MAJOR JOINT INJ W/US 20611
|
Facility
OP
|
$983.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
409
|
| Min. Negotiated Rate |
$688.10 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: AETNA Commercial |
$933.85
|
| Rate for Payer: AETNA Medicare |
$884.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$933.85
|
| Rate for Payer: BCBS Healthlink |
$884.70
|
| Rate for Payer: BCBS HMK CHIP |
$884.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$884.70
|
| Rate for Payer: BCBS POS |
$933.85
|
| Rate for Payer: BCBS Traditional |
$983.00
|
| Rate for Payer: CASH_PRICE |
$786.40
|
| Rate for Payer: CIGNA Commercial |
$933.85
|
| Rate for Payer: CIGNA Medicare |
$884.70
|
| Rate for Payer: HUMANA Commercial |
$884.70
|
| Rate for Payer: MEDICAID Medicaid |
$904.36
|
| Rate for Payer: MEDICARE Medicare |
$688.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$933.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$953.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$933.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$933.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$835.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$786.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$786.40
|
|
|
XR OP MAJOR JOINT INJ W/US 20611
|
Facility
IP
|
$983.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
409
|
| Min. Negotiated Rate |
$688.10 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: AETNA Commercial |
$933.85
|
| Rate for Payer: AETNA Medicare |
$884.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$933.85
|
| Rate for Payer: BCBS Healthlink |
$884.70
|
| Rate for Payer: BCBS HMK CHIP |
$884.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$884.70
|
| Rate for Payer: BCBS POS |
$933.85
|
| Rate for Payer: BCBS Traditional |
$983.00
|
| Rate for Payer: CASH_PRICE |
$786.40
|
| Rate for Payer: CIGNA Commercial |
$933.85
|
| Rate for Payer: CIGNA Medicare |
$884.70
|
| Rate for Payer: HUMANA Commercial |
$884.70
|
| Rate for Payer: MEDICAID Medicaid |
$904.36
|
| Rate for Payer: MEDICARE Medicare |
$688.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$933.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$953.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$933.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$933.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$835.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$786.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$786.40
|
|
|
XR ORBITS 1 VIEW
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 70190 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
XR ORBITS 1 VIEW
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 70190 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
XR ORBITS COMPLETE 4 VIEWS
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 70200 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 ORBITS COMPLETE 4 VIEWS
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 70200 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 PELVIS 1 VIEW
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 72170 TC
|
| 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 PELVIS 1 VIEW
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| 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 - 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 PELVIS 2 VIEWS
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: AETNA Commercial |
$237.50
|
| Rate for Payer: AETNA Medicare |
$225.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$237.50
|
| Rate for Payer: BCBS Healthlink |
$225.00
|
| Rate for Payer: BCBS HMK CHIP |
$225.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.00
|
| Rate for Payer: BCBS POS |
$237.50
|
| Rate for Payer: BCBS Traditional |
$250.00
|
| Rate for Payer: CASH_PRICE |
$200.00
|
| Rate for Payer: CIGNA Commercial |
$237.50
|
| Rate for Payer: CIGNA Medicare |
$225.00
|
| Rate for Payer: HUMANA Commercial |
$225.00
|
| Rate for Payer: MEDICAID Medicaid |
$230.00
|
| Rate for Payer: MEDICARE Medicare |
$175.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$237.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$242.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$237.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$237.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$212.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.00
|
|
|
XR PELVIS 2 VIEWS
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: AETNA Commercial |
$237.50
|
| Rate for Payer: AETNA Medicare |
$225.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$237.50
|
| Rate for Payer: BCBS Healthlink |
$225.00
|
| Rate for Payer: BCBS HMK CHIP |
$225.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.00
|
| Rate for Payer: BCBS POS |
$237.50
|
| Rate for Payer: BCBS Traditional |
$250.00
|
| Rate for Payer: CASH_PRICE |
$200.00
|
| Rate for Payer: CIGNA Commercial |
$237.50
|
| Rate for Payer: CIGNA Medicare |
$225.00
|
| Rate for Payer: HUMANA Commercial |
$225.00
|
| Rate for Payer: MEDICAID Medicaid |
$230.00
|
| Rate for Payer: MEDICARE Medicare |
$175.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$237.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$242.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$237.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$237.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$212.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.00
|
|
|
XR PELVIS 3 VIEWS
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 72190 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
XR PELVIS 3 VIEWS
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 72190 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
XR RIBS BILATERAL 3 VIEWS
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: AETNA Commercial |
$342.00
|
| Rate for Payer: AETNA Medicare |
$324.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$342.00
|
| Rate for Payer: BCBS Healthlink |
$324.00
|
| Rate for Payer: BCBS HMK CHIP |
$324.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$324.00
|
| Rate for Payer: BCBS POS |
$342.00
|
| Rate for Payer: BCBS Traditional |
$360.00
|
| Rate for Payer: CASH_PRICE |
$288.00
|
| Rate for Payer: CIGNA Commercial |
$342.00
|
| Rate for Payer: CIGNA Medicare |
$324.00
|
| Rate for Payer: HUMANA Commercial |
$324.00
|
| Rate for Payer: MEDICAID Medicaid |
$331.20
|
| Rate for Payer: MEDICARE Medicare |
$252.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$342.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$349.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$342.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$342.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$306.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$288.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$288.00
|
|
