|
1,25-DIHYDROXYVITAMIN D (081091)
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
1,25-DIHYDROXYVITAMIN D (081091)
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
17-HYDROXYPROGESTERONE (070085)
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
17-HYDROXYPROGESTERONE (070085)
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
25-HYDROXYVITAMIN D2 AND D3 (504115)
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
25-HYDROXYVITAMIN D2 AND D3 (504115)
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
5-HIAA, 24 HOUR URINE (004069)
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
5-HIAA, 24 HOUR URINE (004069)
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
ABDOMINA L BINDER
|
Facility
OP
|
$51.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AETNA Commercial |
$48.45
|
| Rate for Payer: AETNA Medicare |
$45.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$48.45
|
| Rate for Payer: BCBS Healthlink |
$45.90
|
| Rate for Payer: BCBS HMK CHIP |
$45.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.90
|
| Rate for Payer: BCBS POS |
$48.45
|
| Rate for Payer: BCBS Traditional |
$51.00
|
| Rate for Payer: CASH_PRICE |
$40.80
|
| Rate for Payer: CIGNA Commercial |
$48.45
|
| Rate for Payer: CIGNA Medicare |
$45.90
|
| Rate for Payer: HUMANA Commercial |
$45.90
|
| Rate for Payer: MEDICAID Medicaid |
$46.92
|
| Rate for Payer: MEDICARE Medicare |
$35.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$48.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$49.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$48.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$43.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.80
|
|
|
ABDOMINA L BINDER
|
Facility
IP
|
$51.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AETNA Commercial |
$48.45
|
| Rate for Payer: AETNA Medicare |
$45.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$48.45
|
| Rate for Payer: BCBS Healthlink |
$45.90
|
| Rate for Payer: BCBS HMK CHIP |
$45.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.90
|
| Rate for Payer: BCBS POS |
$48.45
|
| Rate for Payer: BCBS Traditional |
$51.00
|
| Rate for Payer: CASH_PRICE |
$40.80
|
| Rate for Payer: CIGNA Commercial |
$48.45
|
| Rate for Payer: CIGNA Medicare |
$45.90
|
| Rate for Payer: HUMANA Commercial |
$45.90
|
| Rate for Payer: MEDICAID Medicaid |
$46.92
|
| Rate for Payer: MEDICARE Medicare |
$35.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$48.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$49.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$48.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$43.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.80
|
|
|
ABDOMINAL BINDER 10'' X-LG
|
Facility
OP
|
$41.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
ABDOMINAL BINDER 10'' X-LG
|
Facility
IP
|
$41.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
ABO TYPE
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
ABO TYPE
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
ABSOLUTE CD4/CD8 COUNT W/ RATIO (505271)
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
ABSOLUTE CD4/CD8 COUNT W/ RATIO (505271)
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
ACE BANDAGE < 3
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT A6448
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
ACE BANDAGE < 3
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT A6448
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
ACE BANDAGE 3-5
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
ACE BANDAGE 3-5
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
ACE BANDAGE 3" W/VELCRO
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: BCBS HMK CHIP |
$0.90
|
| Rate for Payer: AETNA Commercial |
$0.95
|
| Rate for Payer: AETNA Medicare |
$0.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$0.95
|
| Rate for Payer: BCBS Healthlink |
$0.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$0.90
|
| Rate for Payer: BCBS POS |
$0.95
|
| Rate for Payer: BCBS Traditional |
$1.00
|
| Rate for Payer: CASH_PRICE |
$0.80
|
| Rate for Payer: CIGNA Commercial |
$0.95
|
| Rate for Payer: CIGNA Medicare |
$0.90
|
| Rate for Payer: HUMANA Commercial |
$0.90
|
| Rate for Payer: MEDICAID Medicaid |
$0.92
|
| Rate for Payer: MEDICARE Medicare |
$0.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$0.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$0.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$0.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$0.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$0.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$0.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$0.80
|
|
|
ACE BANDAGE 3" W/VELCRO
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: AETNA Commercial |
$0.95
|
| Rate for Payer: AETNA Medicare |
$0.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$0.95
|
| Rate for Payer: BCBS Healthlink |
$0.90
|
| Rate for Payer: BCBS HMK CHIP |
$0.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$0.90
|
| Rate for Payer: BCBS POS |
$0.95
|
| Rate for Payer: BCBS Traditional |
$1.00
|
| Rate for Payer: CASH_PRICE |
$0.80
|
| Rate for Payer: CIGNA Commercial |
$0.95
|
| Rate for Payer: CIGNA Medicare |
$0.90
|
| Rate for Payer: HUMANA Commercial |
$0.90
|
| Rate for Payer: MEDICAID Medicaid |
$0.92
|
| Rate for Payer: MEDICARE Medicare |
$0.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$0.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$0.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$0.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$0.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$0.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$0.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$0.80
|
|
|
ACE BANDAGE 4" W/VELCRO
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: BCBS HMK CHIP |
$0.90
|
| Rate for Payer: AETNA Commercial |
$0.95
|
| Rate for Payer: AETNA Medicare |
$0.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$0.95
|
| Rate for Payer: BCBS Healthlink |
$0.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$0.90
|
| Rate for Payer: BCBS POS |
$0.95
|
| Rate for Payer: BCBS Traditional |
$1.00
|
| Rate for Payer: CASH_PRICE |
$0.80
|
| Rate for Payer: CIGNA Commercial |
$0.95
|
| Rate for Payer: CIGNA Medicare |
$0.90
|
| Rate for Payer: HUMANA Commercial |
$0.90
|
| Rate for Payer: MEDICAID Medicaid |
$0.92
|
| Rate for Payer: MEDICARE Medicare |
$0.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$0.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$0.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$0.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$0.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$0.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$0.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$0.80
|
|
|
ACE BANDAGE 4" W/VELCRO
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: AETNA Commercial |
$0.95
|
| Rate for Payer: AETNA Medicare |
$0.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$0.95
|
| Rate for Payer: BCBS Healthlink |
$0.90
|
| Rate for Payer: BCBS HMK CHIP |
$0.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$0.90
|
| Rate for Payer: BCBS POS |
$0.95
|
| Rate for Payer: BCBS Traditional |
$1.00
|
| Rate for Payer: CASH_PRICE |
$0.80
|
| Rate for Payer: CIGNA Commercial |
$0.95
|
| Rate for Payer: CIGNA Medicare |
$0.90
|
| Rate for Payer: HUMANA Commercial |
$0.90
|
| Rate for Payer: MEDICAID Medicaid |
$0.92
|
| Rate for Payer: MEDICARE Medicare |
$0.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$0.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$0.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$0.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$0.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$0.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$0.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$0.80
|
|
|
ACE BANDAGE 6'' W/ VELCRO
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
CPT A4590
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: AETNA Commercial |
$5.70
|
| Rate for Payer: AETNA Medicare |
$5.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$5.70
|
| Rate for Payer: BCBS Healthlink |
$5.40
|
| Rate for Payer: BCBS HMK CHIP |
$5.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$5.40
|
| Rate for Payer: BCBS POS |
$5.70
|
| Rate for Payer: BCBS Traditional |
$6.00
|
| Rate for Payer: CASH_PRICE |
$4.80
|
| Rate for Payer: CIGNA Commercial |
$5.70
|
| Rate for Payer: CIGNA Medicare |
$5.40
|
| Rate for Payer: HUMANA Commercial |
$5.40
|
| Rate for Payer: MEDICAID Medicaid |
$5.52
|
| Rate for Payer: MEDICARE Medicare |
$4.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$5.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$5.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$5.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$5.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.80
|
|
