|
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
|
|
|
LAB IGF PROTEIN
|
Facility
IP
|
$203.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: BCBS HMK CHIP |
$182.70
|
| Rate for Payer: AETNA Commercial |
$192.85
|
| Rate for Payer: AETNA Medicare |
$182.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$192.85
|
| Rate for Payer: BCBS Healthlink |
$182.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$182.70
|
| Rate for Payer: BCBS POS |
$192.85
|
| Rate for Payer: BCBS Traditional |
$203.00
|
| Rate for Payer: CASH_PRICE |
$162.40
|
| Rate for Payer: CIGNA Commercial |
$192.85
|
| Rate for Payer: CIGNA Medicare |
$182.70
|
| Rate for Payer: HUMANA Commercial |
$182.70
|
| Rate for Payer: MEDICAID Medicaid |
$186.76
|
| Rate for Payer: MEDICARE Medicare |
$142.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$192.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$196.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$192.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$192.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$172.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$162.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$162.40
|
|
|
LAB IGF PROTEIN
|
Facility
OP
|
$203.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: AETNA Commercial |
$192.85
|
| Rate for Payer: AETNA Medicare |
$182.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$192.85
|
| Rate for Payer: BCBS Healthlink |
$182.70
|
| Rate for Payer: BCBS HMK CHIP |
$182.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$182.70
|
| Rate for Payer: BCBS POS |
$192.85
|
| Rate for Payer: BCBS Traditional |
$203.00
|
| Rate for Payer: CASH_PRICE |
$162.40
|
| Rate for Payer: CIGNA Commercial |
$192.85
|
| Rate for Payer: CIGNA Medicare |
$182.70
|
| Rate for Payer: HUMANA Commercial |
$182.70
|
| Rate for Payer: MEDICAID Medicaid |
$186.76
|
| Rate for Payer: MEDICARE Medicare |
$142.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$192.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$196.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$192.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$192.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$172.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$162.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$162.40
|
|
|
LAB IMMUNOCHEM QUAL FECAL SCREEN
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: AETNA Commercial |
$54.15
|
| Rate for Payer: AETNA Medicare |
$51.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$54.15
|
| Rate for Payer: BCBS Healthlink |
$51.30
|
| Rate for Payer: BCBS HMK CHIP |
$51.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$51.30
|
| Rate for Payer: BCBS POS |
$54.15
|
| Rate for Payer: BCBS Traditional |
$57.00
|
| Rate for Payer: CASH_PRICE |
$45.60
|
| Rate for Payer: CIGNA Commercial |
$54.15
|
| Rate for Payer: CIGNA Medicare |
$51.30
|
| Rate for Payer: HUMANA Commercial |
$51.30
|
| Rate for Payer: MEDICAID Medicaid |
$52.44
|
| Rate for Payer: MEDICARE Medicare |
$39.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$54.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$55.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$54.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$54.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$45.60
|
|
|
LAB IMMUNOCHEM QUAL FECAL SCREEN
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: AETNA Commercial |
$54.15
|
| Rate for Payer: AETNA Medicare |
$51.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$54.15
|
| Rate for Payer: BCBS Healthlink |
$51.30
|
| Rate for Payer: BCBS HMK CHIP |
$51.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$51.30
|
| Rate for Payer: BCBS POS |
$54.15
|
| Rate for Payer: BCBS Traditional |
$57.00
|
| Rate for Payer: CASH_PRICE |
$45.60
|
| Rate for Payer: CIGNA Commercial |
$54.15
|
| Rate for Payer: CIGNA Medicare |
$51.30
|
| Rate for Payer: HUMANA Commercial |
$51.30
|
| Rate for Payer: MEDICAID Medicaid |
$52.44
|
| Rate for Payer: MEDICARE Medicare |
$39.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$54.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$55.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$54.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$54.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$45.60
|
|
|
LAB INFLUENZA A&B
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 87400 91
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: AETNA Commercial |
$93.10
|
| Rate for Payer: AETNA Medicare |
$88.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$93.10
|
| Rate for Payer: BCBS Healthlink |
$88.20
|
| Rate for Payer: BCBS HMK CHIP |
$88.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$88.20
|
| Rate for Payer: BCBS POS |
$93.10
|
| Rate for Payer: BCBS Traditional |
$98.00
|
| Rate for Payer: CASH_PRICE |
$78.40
|
| Rate for Payer: CIGNA Commercial |
$93.10
|
| Rate for Payer: CIGNA Medicare |
$88.20
|
| Rate for Payer: HUMANA Commercial |
$88.20
|
| Rate for Payer: MEDICAID Medicaid |
$90.16
|
| Rate for Payer: MEDICARE Medicare |
$68.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$93.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$95.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$93.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$93.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$83.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$78.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$78.40
|
|
|
LAB INFLUENZA A&B
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: AETNA Commercial |
$93.10
|
| Rate for Payer: AETNA Medicare |
$88.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$93.10
|
| Rate for Payer: BCBS Healthlink |
$88.20
|
| Rate for Payer: BCBS HMK CHIP |
$88.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$88.20
|
| Rate for Payer: BCBS POS |
$93.10
|
| Rate for Payer: BCBS Traditional |
$98.00
|
| Rate for Payer: CASH_PRICE |
$78.40
|
| Rate for Payer: CIGNA Commercial |
$93.10
|
| Rate for Payer: CIGNA Medicare |
$88.20
|
| Rate for Payer: HUMANA Commercial |
$88.20
|
| Rate for Payer: MEDICAID Medicaid |
$90.16
|
| Rate for Payer: MEDICARE Medicare |
$68.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$93.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$95.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$93.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$93.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$83.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$78.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$78.40
|
|
|
LAB INFLUENZA A&B
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: AETNA Commercial |
$93.10
|
| Rate for Payer: AETNA Medicare |
$88.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$93.10
|
| Rate for Payer: BCBS Healthlink |
$88.20
|
| Rate for Payer: BCBS HMK CHIP |
$88.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$88.20
|
| Rate for Payer: BCBS POS |
$93.10
|
| Rate for Payer: BCBS Traditional |
$98.00
|
| Rate for Payer: CASH_PRICE |
$78.40
|
| Rate for Payer: CIGNA Commercial |
$93.10
|
| Rate for Payer: CIGNA Medicare |
$88.20
|
| Rate for Payer: HUMANA Commercial |
$88.20
|
| Rate for Payer: MEDICAID Medicaid |
$90.16
|
| Rate for Payer: MEDICARE Medicare |
$68.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$93.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$95.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$93.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$93.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$83.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$78.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$78.40
|
|
|
LAB INFLUENZA A&B
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 87400 91
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: BCBS HMK CHIP |
$88.20
|
| Rate for Payer: AETNA Commercial |
$93.10
|
| Rate for Payer: AETNA Medicare |
$88.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$93.10
|
| Rate for Payer: BCBS Healthlink |
$88.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$88.20
|
| Rate for Payer: BCBS POS |
$93.10
|
| Rate for Payer: BCBS Traditional |
$98.00
|
| Rate for Payer: CASH_PRICE |
$78.40
|
| Rate for Payer: CIGNA Commercial |
$93.10
|
| Rate for Payer: CIGNA Medicare |
$88.20
|
| Rate for Payer: HUMANA Commercial |
$88.20
|
| Rate for Payer: MEDICAID Medicaid |
$90.16
|
| Rate for Payer: MEDICARE Medicare |
$68.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$93.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$95.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$93.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$93.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$83.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$78.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$78.40
|
|
|
LAB INFLUENZA/RAPID
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| 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 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 INFLUENZA/RAPID
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 86710
|
| 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 INSULIN AB
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: AETNA Commercial |
$133.00
|
| Rate for Payer: AETNA Medicare |
$126.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$133.00
|
| Rate for Payer: BCBS Healthlink |
$126.00
|
| Rate for Payer: BCBS HMK CHIP |
$126.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$126.00
|
| Rate for Payer: BCBS POS |
$133.00
|
| Rate for Payer: BCBS Traditional |
$140.00
|
| Rate for Payer: CASH_PRICE |
$112.00
|
| Rate for Payer: CIGNA Commercial |
$133.00
|
| Rate for Payer: CIGNA Medicare |
$126.00
|
| Rate for Payer: HUMANA Commercial |
$126.00
|
| Rate for Payer: MEDICAID Medicaid |
$128.80
|
| Rate for Payer: MEDICARE Medicare |
$98.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$133.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$135.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$133.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$133.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$119.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$112.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$112.00
|
|
|
LAB INSULIN AB
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: AETNA Commercial |
$133.00
|
| Rate for Payer: AETNA Medicare |
$126.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$133.00
|
| Rate for Payer: BCBS Healthlink |
$126.00
|
| Rate for Payer: BCBS HMK CHIP |
$126.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$126.00
|
| Rate for Payer: BCBS POS |
$133.00
|
| Rate for Payer: BCBS Traditional |
$140.00
|
| Rate for Payer: CASH_PRICE |
$112.00
|
| Rate for Payer: CIGNA Commercial |
$133.00
|
| Rate for Payer: CIGNA Medicare |
$126.00
|
| Rate for Payer: HUMANA Commercial |
$126.00
|
| Rate for Payer: MEDICAID Medicaid |
$128.80
|
| Rate for Payer: MEDICARE Medicare |
$98.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$133.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$135.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$133.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$133.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$119.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$112.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$112.00
|
|
|
LAB INSURANCE COLLECTION & HANDLING
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
LAB INSURANCE COLLECTION & HANDLING
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
LAB ISLET CELL AB SCREEN
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
LAB ISLET CELL AB SCREEN
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
LAB JCV ANTIBODY
|
Facility
OP
|
$208.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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 JCV ANTIBODY
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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 LACTOFERRIN, FECAL, QUALITATIVE
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: AETNA Commercial |
$108.30
|
| Rate for Payer: AETNA Medicare |
$102.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$108.30
|
| Rate for Payer: BCBS Healthlink |
$102.60
|
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$102.60
|
| Rate for Payer: BCBS POS |
$108.30
|
| Rate for Payer: BCBS Traditional |
$114.00
|
| Rate for Payer: CASH_PRICE |
$91.20
|
| Rate for Payer: CIGNA Commercial |
$108.30
|
| Rate for Payer: CIGNA Medicare |
$102.60
|
| Rate for Payer: HUMANA Commercial |
$102.60
|
| Rate for Payer: MEDICAID Medicaid |
$104.88
|
| Rate for Payer: MEDICARE Medicare |
$79.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$108.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$110.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$108.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$108.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$91.20
|
|
|
LAB LACTOFERRIN, FECAL, QUALITATIVE
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: AETNA Commercial |
$108.30
|
| Rate for Payer: AETNA Medicare |
$102.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$108.30
|
| Rate for Payer: BCBS Healthlink |
$102.60
|
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$102.60
|
| Rate for Payer: BCBS POS |
$108.30
|
| Rate for Payer: BCBS Traditional |
$114.00
|
| Rate for Payer: CASH_PRICE |
$91.20
|
| Rate for Payer: CIGNA Commercial |
$108.30
|
| Rate for Payer: CIGNA Medicare |
$102.60
|
| Rate for Payer: HUMANA Commercial |
$102.60
|
| Rate for Payer: MEDICAID Medicaid |
$104.88
|
| Rate for Payer: MEDICARE Medicare |
$79.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$108.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$110.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$108.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$108.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$91.20
|
|
|
LAB LDH ISOENZYMES
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
LAB LDH ISOENZYMES
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
LAB LEGIONELLA AB URINE
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 87450
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
LAB LEGIONELLA AB URINE
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 87450
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
