|
LAB HEMOGLOBINOPATHY EVALUATION
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
LAB HEMOGLOBINOPATHY EVALUATION
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: BCBS HMK CHIP |
$187.20
|
| Rate for Payer: AETNA Commercial |
$197.60
|
| Rate for Payer: AETNA Medicare |
$187.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$197.60
|
| Rate for Payer: BCBS Healthlink |
$187.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$187.20
|
| Rate for Payer: BCBS POS |
$197.60
|
| Rate for Payer: BCBS Traditional |
$208.00
|
| Rate for Payer: CASH_PRICE |
$166.40
|
| Rate for Payer: CIGNA Commercial |
$197.60
|
| Rate for Payer: CIGNA Medicare |
$187.20
|
| Rate for Payer: HUMANA Commercial |
$187.20
|
| Rate for Payer: MEDICAID Medicaid |
$191.36
|
| Rate for Payer: MEDICARE Medicare |
$145.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$197.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$201.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$197.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$197.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$166.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$166.40
|
|
|
LAB HEPATITIS B SURFACE
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 86280
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: AETNA Commercial |
$49.40
|
| Rate for Payer: AETNA Medicare |
$46.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$49.40
|
| Rate for Payer: BCBS Healthlink |
$46.80
|
| Rate for Payer: BCBS HMK CHIP |
$46.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$46.80
|
| Rate for Payer: BCBS POS |
$49.40
|
| Rate for Payer: BCBS Traditional |
$52.00
|
| Rate for Payer: CASH_PRICE |
$41.60
|
| Rate for Payer: CIGNA Commercial |
$49.40
|
| Rate for Payer: CIGNA Medicare |
$46.80
|
| Rate for Payer: HUMANA Commercial |
$46.80
|
| Rate for Payer: MEDICAID Medicaid |
$47.84
|
| Rate for Payer: MEDICARE Medicare |
$36.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$49.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$50.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$49.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$49.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$44.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$41.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$41.60
|
|
|
LAB HEPATITIS B SURFACE
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 86280
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: AETNA Commercial |
$49.40
|
| Rate for Payer: AETNA Medicare |
$46.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$49.40
|
| Rate for Payer: BCBS Healthlink |
$46.80
|
| Rate for Payer: BCBS HMK CHIP |
$46.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$46.80
|
| Rate for Payer: BCBS POS |
$49.40
|
| Rate for Payer: BCBS Traditional |
$52.00
|
| Rate for Payer: CASH_PRICE |
$41.60
|
| Rate for Payer: CIGNA Commercial |
$49.40
|
| Rate for Payer: CIGNA Medicare |
$46.80
|
| Rate for Payer: HUMANA Commercial |
$46.80
|
| Rate for Payer: MEDICAID Medicaid |
$47.84
|
| Rate for Payer: MEDICARE Medicare |
$36.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$49.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$50.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$49.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$49.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$44.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$41.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$41.60
|
|
|
LAB HEPATITIS C VIRUS RNA,QT
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$385.70 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: BCBS HMK CHIP |
$495.90
|
| Rate for Payer: AETNA Commercial |
$523.45
|
| Rate for Payer: AETNA Medicare |
$495.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$523.45
|
| Rate for Payer: BCBS Healthlink |
$495.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$495.90
|
| Rate for Payer: BCBS POS |
$523.45
|
| Rate for Payer: BCBS Traditional |
$551.00
|
| Rate for Payer: CASH_PRICE |
$440.80
|
| Rate for Payer: CIGNA Commercial |
$523.45
|
| Rate for Payer: CIGNA Medicare |
$495.90
|
| Rate for Payer: HUMANA Commercial |
$495.90
|
| Rate for Payer: MEDICAID Medicaid |
$506.92
|
| Rate for Payer: MEDICARE Medicare |
$385.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$523.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$534.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$523.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$523.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$468.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$440.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$440.80
|
|
|
LAB HEPATITIS C VIRUS RNA,QT
|
Facility
OP
|
$551.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$385.70 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: AETNA Commercial |
$523.45
|
| Rate for Payer: AETNA Medicare |
$495.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$523.45
|
| Rate for Payer: BCBS Healthlink |
$495.90
|
| Rate for Payer: BCBS HMK CHIP |
$495.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$495.90
|
| Rate for Payer: BCBS POS |
$523.45
|
| Rate for Payer: BCBS Traditional |
$551.00
|
| Rate for Payer: CASH_PRICE |
$440.80
|
| Rate for Payer: CIGNA Commercial |
$523.45
|
| Rate for Payer: CIGNA Medicare |
$495.90
|
| Rate for Payer: HUMANA Commercial |
$495.90
|
| Rate for Payer: MEDICAID Medicaid |
$506.92
|
| Rate for Payer: MEDICARE Medicare |
$385.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$523.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$534.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$523.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$523.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$468.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$440.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$440.80
|
|
|
LAB HIV-1
|
Facility
OP
|
$97.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: AETNA Commercial |
$92.15
|
| Rate for Payer: AETNA Medicare |
$87.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$92.15
|
| Rate for Payer: BCBS Healthlink |
$87.30
|
| Rate for Payer: BCBS HMK CHIP |
$87.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$87.30
|
| Rate for Payer: BCBS POS |
$92.15
|
| Rate for Payer: BCBS Traditional |
$97.00
|
| Rate for Payer: CASH_PRICE |
$77.60
|
| Rate for Payer: CIGNA Commercial |
$92.15
|
| Rate for Payer: CIGNA Medicare |
$87.30
|
| Rate for Payer: HUMANA Commercial |
$87.30
|
| Rate for Payer: MEDICAID Medicaid |
$89.24
|
| Rate for Payer: MEDICARE Medicare |
$67.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$92.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$94.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$92.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$92.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$82.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$77.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$77.60
|
|
|
LAB HIV-1
|
Facility
IP
|
$97.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: AETNA Commercial |
$92.15
|
| Rate for Payer: AETNA Medicare |
$87.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$92.15
|
| Rate for Payer: BCBS Healthlink |
$87.30
|
| Rate for Payer: BCBS HMK CHIP |
$87.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$87.30
|
| Rate for Payer: BCBS POS |
$92.15
|
| Rate for Payer: BCBS Traditional |
$97.00
|
| Rate for Payer: CASH_PRICE |
$77.60
|
| Rate for Payer: CIGNA Commercial |
$92.15
|
| Rate for Payer: CIGNA Medicare |
$87.30
|
| Rate for Payer: HUMANA Commercial |
$87.30
|
| Rate for Payer: MEDICAID Medicaid |
$89.24
|
| Rate for Payer: MEDICARE Medicare |
$67.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$92.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$94.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$92.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$92.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$82.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$77.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$77.60
|
|
|
LAB HIV-1/2 RAPID
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: AETNA Commercial |
$74.10
|
| Rate for Payer: AETNA Medicare |
$70.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$74.10
|
| Rate for Payer: BCBS Healthlink |
$70.20
|
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$70.20
|
| Rate for Payer: BCBS POS |
$74.10
|
| Rate for Payer: BCBS Traditional |
$78.00
|
| Rate for Payer: CASH_PRICE |
$62.40
|
| Rate for Payer: CIGNA Commercial |
$74.10
|
| Rate for Payer: CIGNA Medicare |
$70.20
|
| Rate for Payer: HUMANA Commercial |
$70.20
|
| Rate for Payer: MEDICAID Medicaid |
$71.76
|
| Rate for Payer: MEDICARE Medicare |
$54.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$74.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$75.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$74.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$74.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$66.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$62.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$62.40
|
|
|
LAB HIV-1/2 RAPID
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: AETNA Commercial |
$74.10
|
| Rate for Payer: AETNA Medicare |
$70.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$74.10
|
| Rate for Payer: BCBS Healthlink |
$70.20
|
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$70.20
|
| Rate for Payer: BCBS POS |
$74.10
|
| Rate for Payer: BCBS Traditional |
$78.00
|
| Rate for Payer: CASH_PRICE |
$62.40
|
| Rate for Payer: CIGNA Commercial |
$74.10
|
| Rate for Payer: CIGNA Medicare |
$70.20
|
| Rate for Payer: HUMANA Commercial |
$70.20
|
| Rate for Payer: MEDICAID Medicaid |
$71.76
|
| Rate for Payer: MEDICARE Medicare |
$54.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$74.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$75.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$74.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$74.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$66.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$62.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$62.40
|
|
|
LAB HIV-1 GENOTYPE
|
Facility
IP
|
$770.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: BCBS HMK CHIP |
$693.00
|
| Rate for Payer: AETNA Commercial |
$731.50
|
| Rate for Payer: AETNA Medicare |
$693.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$731.50
|
| Rate for Payer: BCBS Healthlink |
$693.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$693.00
|
| Rate for Payer: BCBS POS |
$731.50
|
| Rate for Payer: BCBS Traditional |
$770.00
|
| Rate for Payer: CASH_PRICE |
$616.00
|
| Rate for Payer: CIGNA Commercial |
$731.50
|
| Rate for Payer: CIGNA Medicare |
$693.00
|
| Rate for Payer: HUMANA Commercial |
$693.00
|
| Rate for Payer: MEDICAID Medicaid |
$708.40
|
| Rate for Payer: MEDICARE Medicare |
$539.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$731.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$746.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$731.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$731.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$654.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$616.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$616.00
|
|
|
LAB HIV-1 GENOTYPE
|
Facility
OP
|
$770.00
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: AETNA Commercial |
$731.50
|
| Rate for Payer: AETNA Medicare |
$693.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$731.50
|
| Rate for Payer: BCBS Healthlink |
$693.00
|
| Rate for Payer: BCBS HMK CHIP |
$693.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$693.00
|
| Rate for Payer: BCBS POS |
$731.50
|
| Rate for Payer: BCBS Traditional |
$770.00
|
| Rate for Payer: CASH_PRICE |
$616.00
|
| Rate for Payer: CIGNA Commercial |
$731.50
|
| Rate for Payer: CIGNA Medicare |
$693.00
|
| Rate for Payer: HUMANA Commercial |
$693.00
|
| Rate for Payer: MEDICAID Medicaid |
$708.40
|
| Rate for Payer: MEDICARE Medicare |
$539.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$731.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$746.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$731.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$731.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$654.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$616.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$616.00
|
|
|
LAB HIV-2
|
Facility
IP
|
$187.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
LAB HIV-2
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
LAB HOMOCYSTEINE CARDIO
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 33030
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: AETNA Commercial |
$188.10
|
| Rate for Payer: AETNA Medicare |
$178.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$188.10
|
| Rate for Payer: BCBS Healthlink |
$178.20
|
| Rate for Payer: BCBS HMK CHIP |
$178.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$178.20
|
| Rate for Payer: BCBS POS |
$188.10
|
| Rate for Payer: BCBS Traditional |
$198.00
|
| Rate for Payer: CASH_PRICE |
$158.40
|
| Rate for Payer: CIGNA Commercial |
$188.10
|
| Rate for Payer: CIGNA Medicare |
$178.20
|
| Rate for Payer: HUMANA Commercial |
$178.20
|
| Rate for Payer: MEDICAID Medicaid |
$182.16
|
| Rate for Payer: MEDICARE Medicare |
$138.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$188.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$192.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$188.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$188.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$168.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$158.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$158.40
|
|
|
LAB HOMOCYSTEINE CARDIO
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 33030
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: AETNA Commercial |
$188.10
|
| Rate for Payer: AETNA Medicare |
$178.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$188.10
|
| Rate for Payer: BCBS Healthlink |
$178.20
|
| Rate for Payer: BCBS HMK CHIP |
$178.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$178.20
|
| Rate for Payer: BCBS POS |
$188.10
|
| Rate for Payer: BCBS Traditional |
$198.00
|
| Rate for Payer: CASH_PRICE |
$158.40
|
| Rate for Payer: CIGNA Commercial |
$188.10
|
| Rate for Payer: CIGNA Medicare |
$178.20
|
| Rate for Payer: HUMANA Commercial |
$178.20
|
| Rate for Payer: MEDICAID Medicaid |
$182.16
|
| Rate for Payer: MEDICARE Medicare |
$138.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$188.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$192.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$188.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$188.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$168.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$158.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$158.40
|
|
|
LAB HPV HIGH RISK TYPES
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
LAB HPV HIGH RISK TYPES
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
LAB H PYLOR BREATH ADMIN COLLECTION FEE
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: AETNA Commercial |
$41.80
|
| Rate for Payer: AETNA Medicare |
$39.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$41.80
|
| Rate for Payer: BCBS Healthlink |
$39.60
|
| Rate for Payer: BCBS HMK CHIP |
$39.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.60
|
| Rate for Payer: BCBS POS |
$41.80
|
| Rate for Payer: BCBS Traditional |
$44.00
|
| Rate for Payer: CASH_PRICE |
$35.20
|
| Rate for Payer: CIGNA Commercial |
$41.80
|
| Rate for Payer: CIGNA Medicare |
$39.60
|
| Rate for Payer: HUMANA Commercial |
$39.60
|
| Rate for Payer: MEDICAID Medicaid |
$40.48
|
| Rate for Payer: MEDICARE Medicare |
$30.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$41.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$42.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$41.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$41.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.20
|
|
|
LAB H PYLOR BREATH ADMIN COLLECTION FEE
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: BCBS HMK CHIP |
$39.60
|
| Rate for Payer: AETNA Commercial |
$41.80
|
| Rate for Payer: AETNA Medicare |
$39.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$41.80
|
| Rate for Payer: BCBS Healthlink |
$39.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.60
|
| Rate for Payer: BCBS POS |
$41.80
|
| Rate for Payer: BCBS Traditional |
$44.00
|
| Rate for Payer: CASH_PRICE |
$35.20
|
| Rate for Payer: CIGNA Commercial |
$41.80
|
| Rate for Payer: CIGNA Medicare |
$39.60
|
| Rate for Payer: HUMANA Commercial |
$39.60
|
| Rate for Payer: MEDICAID Medicaid |
$40.48
|
| Rate for Payer: MEDICARE Medicare |
$30.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$41.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$42.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$41.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$41.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.20
|
|
|
LAB HSV CULTURE TYPE 1
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
LAB HSV CULTURE TYPE 1
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
LAB HSV CULTURE TYPE 2
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
LAB HSV CULTURE TYPE 2
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
LAB HSV IG M
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: AETNA Commercial |
$60.80
|
| Rate for Payer: AETNA Medicare |
$57.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$60.80
|
| Rate for Payer: BCBS Healthlink |
$57.60
|
| Rate for Payer: BCBS HMK CHIP |
$57.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$57.60
|
| Rate for Payer: BCBS POS |
$60.80
|
| Rate for Payer: BCBS Traditional |
$64.00
|
| Rate for Payer: CASH_PRICE |
$51.20
|
| Rate for Payer: CIGNA Commercial |
$60.80
|
| Rate for Payer: CIGNA Medicare |
$57.60
|
| Rate for Payer: HUMANA Commercial |
$57.60
|
| Rate for Payer: MEDICAID Medicaid |
$58.88
|
| Rate for Payer: MEDICARE Medicare |
$44.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$60.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$62.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$60.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$51.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$51.20
|
|
