|
XR SINUS COMPLETE
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 70220 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: AETNA Commercial |
$332.50
|
| Rate for Payer: AETNA Medicare |
$315.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$332.50
|
| Rate for Payer: BCBS Healthlink |
$315.00
|
| Rate for Payer: BCBS HMK CHIP |
$315.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$315.00
|
| Rate for Payer: BCBS POS |
$332.50
|
| Rate for Payer: BCBS Traditional |
$350.00
|
| Rate for Payer: CASH_PRICE |
$280.00
|
| Rate for Payer: CIGNA Commercial |
$332.50
|
| Rate for Payer: CIGNA Medicare |
$315.00
|
| Rate for Payer: HUMANA Commercial |
$315.00
|
| Rate for Payer: MEDICAID Medicaid |
$322.00
|
| Rate for Payer: MEDICARE Medicare |
$245.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$332.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$339.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$332.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$332.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$297.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$280.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$280.00
|
|
|
XR SKULL 1 TO 3 VIEWS
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
XR SKULL 1 TO 3 VIEWS
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
XR SKULL COMPLETE 4 VIEWS
|
Facility
OP
|
$415.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: AETNA Commercial |
$394.25
|
| Rate for Payer: AETNA Medicare |
$373.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$394.25
|
| Rate for Payer: BCBS Healthlink |
$373.50
|
| Rate for Payer: BCBS HMK CHIP |
$373.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$373.50
|
| Rate for Payer: BCBS POS |
$394.25
|
| Rate for Payer: BCBS Traditional |
$415.00
|
| Rate for Payer: CASH_PRICE |
$332.00
|
| Rate for Payer: CIGNA Commercial |
$394.25
|
| Rate for Payer: CIGNA Medicare |
$373.50
|
| Rate for Payer: HUMANA Commercial |
$373.50
|
| Rate for Payer: MEDICAID Medicaid |
$381.80
|
| Rate for Payer: MEDICARE Medicare |
$290.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$394.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$402.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$394.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$394.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$352.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$332.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$332.00
|
|
|
XR SKULL COMPLETE 4 VIEWS
|
Facility
IP
|
$415.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: AETNA Commercial |
$394.25
|
| Rate for Payer: AETNA Medicare |
$373.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$394.25
|
| Rate for Payer: BCBS Healthlink |
$373.50
|
| Rate for Payer: BCBS HMK CHIP |
$373.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$373.50
|
| Rate for Payer: BCBS POS |
$394.25
|
| Rate for Payer: BCBS Traditional |
$415.00
|
| Rate for Payer: CASH_PRICE |
$332.00
|
| Rate for Payer: CIGNA Commercial |
$394.25
|
| Rate for Payer: CIGNA Medicare |
$373.50
|
| Rate for Payer: HUMANA Commercial |
$373.50
|
| Rate for Payer: MEDICAID Medicaid |
$381.80
|
| Rate for Payer: MEDICARE Medicare |
$290.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$394.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$402.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$394.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$394.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$352.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$332.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$332.00
|
|
|
XR SOFT TISSUE NECK
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 70360 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 SOFT TISSUE NECK
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 70360 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 STERNUM
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 71120 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 STERNUM
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 71120 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 THORACIC SPINE 1 VIEW
|
Facility
OP
|
$246.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR THORACIC SPINE 1 VIEW
|
Facility
IP
|
$246.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.20 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: AETNA Commercial |
$233.70
|
| Rate for Payer: AETNA Medicare |
$221.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$233.70
|
| Rate for Payer: BCBS Healthlink |
$221.40
|
| Rate for Payer: BCBS HMK CHIP |
$221.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$221.40
|
| Rate for Payer: BCBS POS |
$233.70
|
| Rate for Payer: BCBS Traditional |
$246.00
|
| Rate for Payer: CASH_PRICE |
$196.80
|
| Rate for Payer: CIGNA Commercial |
$233.70
|
| Rate for Payer: CIGNA Medicare |
$221.40
|
| Rate for Payer: HUMANA Commercial |
$221.40
|
| Rate for Payer: MEDICAID Medicaid |
$226.32
|
| Rate for Payer: MEDICARE Medicare |
$172.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$233.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$238.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$233.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$233.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$209.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$196.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$196.80
|
|
|
XR THORACIC SPINE 2 VIEWS
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 72070 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 THORACIC SPINE 2 VIEWS
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 72070 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 THORACIC SPINE 3 VIEWS
|
Facility
OP
|
$343.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: AETNA Commercial |
$325.85
|
| Rate for Payer: AETNA Medicare |
$308.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$325.85
|
| Rate for Payer: BCBS Healthlink |
$308.70
|
| Rate for Payer: BCBS HMK CHIP |
$308.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$308.70
|
| Rate for Payer: BCBS POS |
$325.85
|
| Rate for Payer: BCBS Traditional |
$343.00
|
| Rate for Payer: CASH_PRICE |
$274.40
|
| Rate for Payer: CIGNA Commercial |
$325.85
|
| Rate for Payer: CIGNA Medicare |
$308.70
|
| Rate for Payer: HUMANA Commercial |
$308.70
|
| Rate for Payer: MEDICAID Medicaid |
$315.56
|
| Rate for Payer: MEDICARE Medicare |
$240.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$325.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$332.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$325.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$325.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$291.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$274.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$274.40
|
|
|
XR THORACIC SPINE 3 VIEWS
|
Facility
IP
|
$343.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: AETNA Commercial |
$325.85
|
| Rate for Payer: AETNA Medicare |
$308.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$325.85
|
| Rate for Payer: BCBS Healthlink |
$308.70
|
| Rate for Payer: BCBS HMK CHIP |
$308.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$308.70
|
| Rate for Payer: BCBS POS |
$325.85
|
| Rate for Payer: BCBS Traditional |
$343.00
|
| Rate for Payer: CASH_PRICE |
$274.40
|
| Rate for Payer: CIGNA Commercial |
$325.85
|
| Rate for Payer: CIGNA Medicare |
$308.70
|
| Rate for Payer: HUMANA Commercial |
$308.70
|
| Rate for Payer: MEDICAID Medicaid |
$315.56
|
| Rate for Payer: MEDICARE Medicare |
$240.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$325.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$332.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$325.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$325.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$291.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$274.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$274.40
|
|
|
XR THORACIC SPINE 4 VIEWS
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
20211001
|
|
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 THORACIC SPINE 4 VIEWS
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
20211001
|
|
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 THORACOLUMBAR JUNCTION 2 VIEWS
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 72080 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| 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 MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
XR THORACOLUMBAR JUNCTION 2 VIEWS
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 72080 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 TIB FIB BILATERAL
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 73590 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: AETNA Commercial |
$247.00
|
| Rate for Payer: AETNA Medicare |
$234.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$247.00
|
| Rate for Payer: BCBS Healthlink |
$234.00
|
| Rate for Payer: BCBS HMK CHIP |
$234.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$234.00
|
| Rate for Payer: BCBS POS |
$247.00
|
| Rate for Payer: BCBS Traditional |
$260.00
|
| Rate for Payer: CASH_PRICE |
$208.00
|
| Rate for Payer: CIGNA Commercial |
$247.00
|
| Rate for Payer: CIGNA Medicare |
$234.00
|
| Rate for Payer: HUMANA Commercial |
$234.00
|
| Rate for Payer: MEDICAID Medicaid |
$239.20
|
| Rate for Payer: MEDICARE Medicare |
$182.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$247.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$252.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$247.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$247.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$221.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$208.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$208.00
|
|
|
XR TIB FIB BILATERAL
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 73590 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: AETNA Commercial |
$247.00
|
| Rate for Payer: AETNA Medicare |
$234.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$247.00
|
| Rate for Payer: BCBS Healthlink |
$234.00
|
| Rate for Payer: BCBS HMK CHIP |
$234.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$234.00
|
| Rate for Payer: BCBS POS |
$247.00
|
| Rate for Payer: BCBS Traditional |
$260.00
|
| Rate for Payer: CASH_PRICE |
$208.00
|
| Rate for Payer: CIGNA Commercial |
$247.00
|
| Rate for Payer: CIGNA Medicare |
$234.00
|
| Rate for Payer: HUMANA Commercial |
$234.00
|
| Rate for Payer: MEDICAID Medicaid |
$239.20
|
| Rate for Payer: MEDICARE Medicare |
$182.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$247.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$252.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$247.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$247.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$221.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$208.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$208.00
|
|
|
XR TIB FIB LT
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 73590 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 TIB FIB LT
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 73590 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| 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 MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
XR TIB FIB RT
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 73590 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 TIB FIB RT
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 73590 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
|
|
