|
XR RIBS BILATERAL 3 VIEWS
|
Facility
IP
|
$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
|
|
|
XR RIBS BILATERAL W PA CHEST
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 71101 TC
|
| 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 RIBS BILATERAL W PA CHEST
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 71101 TC
|
| 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 RIBS LT 2 VIEWS
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
XR RIBS LT 2 VIEWS
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
XR RIBS LT 3 VIEWS WITH PA CHEST
|
Facility
OP
|
$303.00
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
XR RIBS LT 3 VIEWS WITH PA CHEST
|
Facility
IP
|
$303.00
|
|
|
Service Code
|
CPT 71100 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
XR RIBS RT 2 VIEWS
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 71100 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
XR RIBS RT 2 VIEWS
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 71100 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
XR RIBS RT 3 VIEWS WITH PA CHEST
|
Facility
IP
|
$303.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
XR RIBS RT 3 VIEWS WITH PA CHEST
|
Facility
OP
|
$303.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
XR SACRUM COCCYX 2 VIEWS
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
XR SACRUM COCCYX 2 VIEWS
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
XR SCAPULA LT
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
XR SCAPULA LT
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 73010 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
XR SCAPULA RT
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
XR SCAPULA RT
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 73010 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
XR SC JOINTS 3 VIEWS
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR SC JOINTS 3 VIEWS
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
XR SCOLIOSIS STUDY
|
Facility
IP
|
$317.00
|
|
|
Service Code
|
CPT 72082 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: AETNA Commercial |
$301.15
|
| Rate for Payer: AETNA Medicare |
$285.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$301.15
|
| Rate for Payer: BCBS Healthlink |
$285.30
|
| Rate for Payer: BCBS HMK CHIP |
$285.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$285.30
|
| Rate for Payer: BCBS POS |
$301.15
|
| Rate for Payer: BCBS Traditional |
$317.00
|
| Rate for Payer: CASH_PRICE |
$253.60
|
| Rate for Payer: CIGNA Commercial |
$301.15
|
| Rate for Payer: CIGNA Medicare |
$285.30
|
| Rate for Payer: HUMANA Commercial |
$285.30
|
| Rate for Payer: MEDICAID Medicaid |
$291.64
|
| Rate for Payer: MEDICARE Medicare |
$221.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$301.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$307.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$301.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$301.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$269.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$253.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$253.60
|
|
|
XR SCOLIOSIS STUDY
|
Facility
OP
|
$317.00
|
|
|
Service Code
|
CPT 72082 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: AETNA Commercial |
$301.15
|
| Rate for Payer: AETNA Medicare |
$285.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$301.15
|
| Rate for Payer: BCBS Healthlink |
$285.30
|
| Rate for Payer: BCBS HMK CHIP |
$285.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$285.30
|
| Rate for Payer: BCBS POS |
$301.15
|
| Rate for Payer: BCBS Traditional |
$317.00
|
| Rate for Payer: CASH_PRICE |
$253.60
|
| Rate for Payer: CIGNA Commercial |
$301.15
|
| Rate for Payer: CIGNA Medicare |
$285.30
|
| Rate for Payer: HUMANA Commercial |
$285.30
|
| Rate for Payer: MEDICAID Medicaid |
$291.64
|
| Rate for Payer: MEDICARE Medicare |
$221.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$301.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$307.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$301.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$301.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$269.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$253.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$253.60
|
|
|
XR SCOLIOSIS STUDY 1 VIEW
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 72081 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 SCOLIOSIS STUDY 1 VIEW
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 72081 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 SCOLIOSIS STUDY 4-5 VIEWS
|
Facility
IP
|
$426.00
|
|
|
Service Code
|
CPT 72083 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: AETNA Commercial |
$404.70
|
| Rate for Payer: AETNA Medicare |
$383.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$404.70
|
| Rate for Payer: BCBS Healthlink |
$383.40
|
| Rate for Payer: BCBS HMK CHIP |
$383.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$383.40
|
| Rate for Payer: BCBS POS |
$404.70
|
| Rate for Payer: BCBS Traditional |
$426.00
|
| Rate for Payer: CASH_PRICE |
$340.80
|
| Rate for Payer: CIGNA Commercial |
$404.70
|
| Rate for Payer: CIGNA Medicare |
$383.40
|
| Rate for Payer: HUMANA Commercial |
$383.40
|
| Rate for Payer: MEDICAID Medicaid |
$391.92
|
| Rate for Payer: MEDICARE Medicare |
$298.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$404.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$413.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$404.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$404.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$362.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.80
|
|
|
XR SCOLIOSIS STUDY 4-5 VIEWS
|
Facility
OP
|
$426.00
|
|
|
Service Code
|
CPT 72083 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: AETNA Commercial |
$404.70
|
| Rate for Payer: AETNA Medicare |
$383.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$404.70
|
| Rate for Payer: BCBS Healthlink |
$383.40
|
| Rate for Payer: BCBS HMK CHIP |
$383.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$383.40
|
| Rate for Payer: BCBS POS |
$404.70
|
| Rate for Payer: BCBS Traditional |
$426.00
|
| Rate for Payer: CASH_PRICE |
$340.80
|
| Rate for Payer: CIGNA Commercial |
$404.70
|
| Rate for Payer: CIGNA Medicare |
$383.40
|
| Rate for Payer: HUMANA Commercial |
$383.40
|
| Rate for Payer: MEDICAID Medicaid |
$391.92
|
| Rate for Payer: MEDICARE Medicare |
$298.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$404.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$413.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$404.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$404.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$362.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.80
|
|
