|
XR TMJ
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
CPT 70328 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
XR TMJ
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT 70328 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
XR TMJ LT
|
Facility
IP
|
$311.00
|
|
|
Service Code
|
CPT 70330 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
XR TMJ LT
|
Facility
OP
|
$311.00
|
|
|
Service Code
|
CPT 70330 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
XR TMJ RT
|
Facility
IP
|
$311.00
|
|
|
Service Code
|
CPT 70330 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
XR TMJ RT
|
Facility
OP
|
$311.00
|
|
|
Service Code
|
CPT 70330 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
XR TOES BILATERAL
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 73660 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR TOES BILATERAL
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 73660 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR TOES LT
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 73660 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
XR TOES LT
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 73660 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
XR TOES RT
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 73660 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
XR TOES RT
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 73660 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
XR ULTRASOUND NEEDLE GUID 76942
|
Facility
OP
|
$1,194.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$835.80 |
| Max. Negotiated Rate |
$1,194.00 |
| Rate for Payer: AETNA Commercial |
$1,134.30
|
| Rate for Payer: AETNA Medicare |
$1,074.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,134.30
|
| Rate for Payer: BCBS Healthlink |
$1,074.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,074.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,074.60
|
| Rate for Payer: BCBS POS |
$1,134.30
|
| Rate for Payer: BCBS Traditional |
$1,194.00
|
| Rate for Payer: CASH_PRICE |
$955.20
|
| Rate for Payer: CIGNA Commercial |
$1,134.30
|
| Rate for Payer: CIGNA Medicare |
$1,074.60
|
| Rate for Payer: HUMANA Commercial |
$1,074.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,098.48
|
| Rate for Payer: MEDICARE Medicare |
$835.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,134.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,158.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,134.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,134.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,014.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$955.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$955.20
|
|
|
XR ULTRASOUND NEEDLE GUID 76942
|
Facility
IP
|
$1,194.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$835.80 |
| Max. Negotiated Rate |
$1,194.00 |
| Rate for Payer: AETNA Commercial |
$1,134.30
|
| Rate for Payer: AETNA Medicare |
$1,074.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,134.30
|
| Rate for Payer: BCBS Healthlink |
$1,074.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,074.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,074.60
|
| Rate for Payer: BCBS POS |
$1,134.30
|
| Rate for Payer: BCBS Traditional |
$1,194.00
|
| Rate for Payer: CASH_PRICE |
$955.20
|
| Rate for Payer: CIGNA Commercial |
$1,134.30
|
| Rate for Payer: CIGNA Medicare |
$1,074.60
|
| Rate for Payer: HUMANA Commercial |
$1,074.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,098.48
|
| Rate for Payer: MEDICARE Medicare |
$835.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,134.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,158.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,134.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,134.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,014.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$955.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$955.20
|
|
|
XR UPPER EXTREMITY LT INFANT
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 73092 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR UPPER EXTREMITY LT INFANT
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 73092 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR UPPER EXTREMITY RT INFANT
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 73092 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR UPPER EXTREMITY RT INFANT
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 73092 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XR WRIST BILATERAL 2 VIEWS
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT 73100 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
XR WRIST BILATERAL 2 VIEWS
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 73100 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: AETNA Commercial |
$212.80
|
| Rate for Payer: AETNA Medicare |
$201.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$212.80
|
| Rate for Payer: BCBS Healthlink |
$201.60
|
| Rate for Payer: BCBS HMK CHIP |
$201.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$201.60
|
| Rate for Payer: BCBS POS |
$212.80
|
| Rate for Payer: BCBS Traditional |
$224.00
|
| Rate for Payer: CASH_PRICE |
$179.20
|
| Rate for Payer: CIGNA Commercial |
$212.80
|
| Rate for Payer: CIGNA Medicare |
$201.60
|
| Rate for Payer: HUMANA Commercial |
$201.60
|
| Rate for Payer: MEDICAID Medicaid |
$206.08
|
| Rate for Payer: MEDICARE Medicare |
$156.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$212.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$217.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$212.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$179.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$179.20
|
|
|
XR WRIST BILATERAL 3 VIEWS
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 73110 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AETNA Commercial |
$256.50
|
| Rate for Payer: AETNA Medicare |
$243.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$256.50
|
| Rate for Payer: BCBS Healthlink |
$243.00
|
| Rate for Payer: BCBS HMK CHIP |
$243.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.00
|
| Rate for Payer: BCBS POS |
$256.50
|
| Rate for Payer: BCBS Traditional |
$270.00
|
| Rate for Payer: CASH_PRICE |
$216.00
|
| Rate for Payer: CIGNA Commercial |
$256.50
|
| Rate for Payer: CIGNA Medicare |
$243.00
|
| Rate for Payer: HUMANA Commercial |
$243.00
|
| Rate for Payer: MEDICAID Medicaid |
$248.40
|
| Rate for Payer: MEDICARE Medicare |
$189.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$256.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$261.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$256.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$256.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$229.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.00
|
|
|
XR WRIST BILATERAL 3 VIEWS
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 73110 TC
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$256.50
|
| Rate for Payer: AETNA Commercial |
$256.50
|
| Rate for Payer: AETNA Medicare |
$243.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$256.50
|
| Rate for Payer: BCBS Healthlink |
$243.00
|
| Rate for Payer: BCBS HMK CHIP |
$243.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.00
|
| Rate for Payer: BCBS POS |
$256.50
|
| Rate for Payer: BCBS Traditional |
$270.00
|
| Rate for Payer: CASH_PRICE |
$216.00
|
| Rate for Payer: CIGNA Commercial |
$256.50
|
| Rate for Payer: CIGNA Medicare |
$243.00
|
| Rate for Payer: HUMANA Commercial |
$243.00
|
| Rate for Payer: MEDICAID Medicaid |
$248.40
|
| Rate for Payer: MEDICARE Medicare |
$189.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$261.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$256.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$256.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$229.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.00
|
|
|
XR WRIST LT 2 VIEWS
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 73100 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 WRIST LT 2 VIEWS
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 73100 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 WRIST LT COMPLETE
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 73110 LT
|
| 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
|
|
