|
LAB MULTIALLERGEN SCREEN
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 86005
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
LAB MYCOBACTERIUM CULTURE
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 87116
|
| 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 MYCOBACTERIUM CULTURE
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 87116
|
| 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 MYCOBACTERIUM DIRECT DETECTION
|
Facility
IP
|
$269.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$188.30 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: BCBS HMK CHIP |
$242.10
|
| Rate for Payer: AETNA Commercial |
$255.55
|
| Rate for Payer: AETNA Medicare |
$242.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$255.55
|
| Rate for Payer: BCBS Healthlink |
$242.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$242.10
|
| Rate for Payer: BCBS POS |
$255.55
|
| Rate for Payer: BCBS Traditional |
$269.00
|
| Rate for Payer: CASH_PRICE |
$215.20
|
| Rate for Payer: CIGNA Commercial |
$255.55
|
| Rate for Payer: CIGNA Medicare |
$242.10
|
| Rate for Payer: HUMANA Commercial |
$242.10
|
| Rate for Payer: MEDICAID Medicaid |
$247.48
|
| Rate for Payer: MEDICARE Medicare |
$188.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$255.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$260.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$255.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$255.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$228.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$215.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$215.20
|
|
|
LAB MYCOBACTERIUM DIRECT DETECTION
|
Facility
OP
|
$269.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$188.30 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: AETNA Commercial |
$255.55
|
| Rate for Payer: AETNA Medicare |
$242.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$255.55
|
| Rate for Payer: BCBS Healthlink |
$242.10
|
| Rate for Payer: BCBS HMK CHIP |
$242.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$242.10
|
| Rate for Payer: BCBS POS |
$255.55
|
| Rate for Payer: BCBS Traditional |
$269.00
|
| Rate for Payer: CASH_PRICE |
$215.20
|
| Rate for Payer: CIGNA Commercial |
$255.55
|
| Rate for Payer: CIGNA Medicare |
$242.10
|
| Rate for Payer: HUMANA Commercial |
$242.10
|
| Rate for Payer: MEDICAID Medicaid |
$247.48
|
| Rate for Payer: MEDICARE Medicare |
$188.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$255.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$260.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$255.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$255.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$228.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$215.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$215.20
|
|
|
LAB MYCOPLASMA PNEUMONIA
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
LAB MYCOPLASMA PNEUMONIA
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
LAB NK CELLS TOTAL COUNT
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: AETNA Commercial |
$143.45
|
| Rate for Payer: AETNA Medicare |
$135.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$143.45
|
| Rate for Payer: BCBS Healthlink |
$135.90
|
| Rate for Payer: BCBS HMK CHIP |
$135.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$135.90
|
| Rate for Payer: BCBS POS |
$143.45
|
| Rate for Payer: BCBS Traditional |
$151.00
|
| Rate for Payer: CASH_PRICE |
$120.80
|
| Rate for Payer: CIGNA Commercial |
$143.45
|
| Rate for Payer: CIGNA Medicare |
$135.90
|
| Rate for Payer: HUMANA Commercial |
$135.90
|
| Rate for Payer: MEDICAID Medicaid |
$138.92
|
| Rate for Payer: MEDICARE Medicare |
$105.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$143.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$146.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$143.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$143.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$128.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$120.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$120.80
|
|
|
LAB NK CELLS TOTAL COUNT
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: BCBS HMK CHIP |
$135.90
|
| Rate for Payer: AETNA Commercial |
$143.45
|
| Rate for Payer: AETNA Medicare |
$135.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$143.45
|
| Rate for Payer: BCBS Healthlink |
$135.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$135.90
|
| Rate for Payer: BCBS POS |
$143.45
|
| Rate for Payer: BCBS Traditional |
$151.00
|
| Rate for Payer: CASH_PRICE |
$120.80
|
| Rate for Payer: CIGNA Commercial |
$143.45
|
| Rate for Payer: CIGNA Medicare |
$135.90
|
| Rate for Payer: HUMANA Commercial |
$135.90
|
| Rate for Payer: MEDICAID Medicaid |
$138.92
|
| Rate for Payer: MEDICARE Medicare |
$105.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$143.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$146.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$143.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$143.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$128.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$120.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$120.80
|
|
|
LAB OXALATE
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
LAB OXALATE
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
LAB PARASITE EXAM
|
Facility
IP
|
$31.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: BCBS HMK CHIP |
$27.90
|
| Rate for Payer: AETNA Commercial |
$29.45
|
| Rate for Payer: AETNA Medicare |
$27.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$29.45
|
| Rate for Payer: BCBS Healthlink |
$27.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.90
|
| Rate for Payer: BCBS POS |
$29.45
|
| Rate for Payer: BCBS Traditional |
$31.00
|
| Rate for Payer: CASH_PRICE |
$24.80
|
| Rate for Payer: CIGNA Commercial |
$29.45
|
| Rate for Payer: CIGNA Medicare |
$27.90
|
| Rate for Payer: HUMANA Commercial |
$27.90
|
| Rate for Payer: MEDICAID Medicaid |
$28.52
|
| Rate for Payer: MEDICARE Medicare |
$21.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$29.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$30.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$29.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$29.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$26.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.80
|
|
|
LAB PARASITE EXAM
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: AETNA Commercial |
$29.45
|
| Rate for Payer: AETNA Medicare |
$27.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$29.45
|
| Rate for Payer: BCBS Healthlink |
$27.90
|
| Rate for Payer: BCBS HMK CHIP |
$27.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.90
|
| Rate for Payer: BCBS POS |
$29.45
|
| Rate for Payer: BCBS Traditional |
$31.00
|
| Rate for Payer: CASH_PRICE |
$24.80
|
| Rate for Payer: CIGNA Commercial |
$29.45
|
| Rate for Payer: CIGNA Medicare |
$27.90
|
| Rate for Payer: HUMANA Commercial |
$27.90
|
| Rate for Payer: MEDICAID Medicaid |
$28.52
|
| Rate for Payer: MEDICARE Medicare |
$21.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$29.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$30.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$29.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$29.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$26.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.80
|
|
|
LAB PARASITE ID
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
LAB PARASITE ID
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
LAB PARTICLE AGGLUTINATION
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
LAB PARTICLE AGGLUTINATION
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
LAB PARVOVIRUS B19 ABIGG
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
LAB PARVOVIRUS B19 ABIGG
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: AETNA Commercial |
$87.40
|
| Rate for Payer: AETNA Medicare |
$82.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$87.40
|
| Rate for Payer: BCBS Healthlink |
$82.80
|
| Rate for Payer: BCBS HMK CHIP |
$82.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$82.80
|
| Rate for Payer: BCBS POS |
$87.40
|
| Rate for Payer: BCBS Traditional |
$92.00
|
| Rate for Payer: CASH_PRICE |
$73.60
|
| Rate for Payer: CIGNA Commercial |
$87.40
|
| Rate for Payer: CIGNA Medicare |
$82.80
|
| Rate for Payer: HUMANA Commercial |
$82.80
|
| Rate for Payer: MEDICAID Medicaid |
$84.64
|
| Rate for Payer: MEDICARE Medicare |
$64.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$87.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$89.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$87.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$87.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$78.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$73.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$73.60
|
|
|
LAB PERIPHERAL BOLLD SMEAR
|
Facility
IP
|
$183.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.10 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: BCBS HMK CHIP |
$164.70
|
| Rate for Payer: AETNA Commercial |
$173.85
|
| Rate for Payer: AETNA Medicare |
$164.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$173.85
|
| Rate for Payer: BCBS Healthlink |
$164.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$164.70
|
| Rate for Payer: BCBS POS |
$173.85
|
| Rate for Payer: BCBS Traditional |
$183.00
|
| Rate for Payer: CASH_PRICE |
$146.40
|
| Rate for Payer: CIGNA Commercial |
$173.85
|
| Rate for Payer: CIGNA Medicare |
$164.70
|
| Rate for Payer: HUMANA Commercial |
$164.70
|
| Rate for Payer: MEDICAID Medicaid |
$168.36
|
| Rate for Payer: MEDICARE Medicare |
$128.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$173.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$177.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$173.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$173.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$155.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$146.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$146.40
|
|
|
LAB PERIPHERAL BOLLD SMEAR
|
Facility
OP
|
$183.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.10 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: AETNA Commercial |
$173.85
|
| Rate for Payer: AETNA Medicare |
$164.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$173.85
|
| Rate for Payer: BCBS Healthlink |
$164.70
|
| Rate for Payer: BCBS HMK CHIP |
$164.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$164.70
|
| Rate for Payer: BCBS POS |
$173.85
|
| Rate for Payer: BCBS Traditional |
$183.00
|
| Rate for Payer: CASH_PRICE |
$146.40
|
| Rate for Payer: CIGNA Commercial |
$173.85
|
| Rate for Payer: CIGNA Medicare |
$164.70
|
| Rate for Payer: HUMANA Commercial |
$164.70
|
| Rate for Payer: MEDICAID Medicaid |
$168.36
|
| Rate for Payer: MEDICARE Medicare |
$128.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$173.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$177.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$173.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$173.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$155.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$146.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$146.40
|
|
|
LAB PHOSPHATE
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: AETNA Commercial |
$34.20
|
| Rate for Payer: AETNA Medicare |
$32.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.20
|
| Rate for Payer: BCBS Healthlink |
$32.40
|
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.40
|
| Rate for Payer: BCBS POS |
$34.20
|
| Rate for Payer: BCBS Traditional |
$36.00
|
| Rate for Payer: CASH_PRICE |
$28.80
|
| Rate for Payer: CIGNA Commercial |
$34.20
|
| Rate for Payer: CIGNA Medicare |
$32.40
|
| Rate for Payer: HUMANA Commercial |
$32.40
|
| Rate for Payer: MEDICAID Medicaid |
$33.12
|
| Rate for Payer: MEDICARE Medicare |
$25.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.80
|
|
|
LAB PHOSPHATE
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: AETNA Commercial |
$34.20
|
| Rate for Payer: AETNA Medicare |
$32.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.20
|
| Rate for Payer: BCBS Healthlink |
$32.40
|
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.40
|
| Rate for Payer: BCBS POS |
$34.20
|
| Rate for Payer: BCBS Traditional |
$36.00
|
| Rate for Payer: CASH_PRICE |
$28.80
|
| Rate for Payer: CIGNA Commercial |
$34.20
|
| Rate for Payer: CIGNA Medicare |
$32.40
|
| Rate for Payer: HUMANA Commercial |
$32.40
|
| Rate for Payer: MEDICAID Medicaid |
$33.12
|
| Rate for Payer: MEDICARE Medicare |
$25.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.80
|
|
|
LAB: PICC LINE DRAW
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| 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 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: PICC LINE DRAW
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
