|
LAB PINWORM EXAM
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
LAB PINWORM EXAM
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
LAB PKU
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AETNA Commercial |
$48.45
|
| Rate for Payer: AETNA Medicare |
$45.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$48.45
|
| Rate for Payer: BCBS Healthlink |
$45.90
|
| Rate for Payer: BCBS HMK CHIP |
$45.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.90
|
| Rate for Payer: BCBS POS |
$48.45
|
| Rate for Payer: BCBS Traditional |
$51.00
|
| Rate for Payer: CASH_PRICE |
$40.80
|
| Rate for Payer: CIGNA Commercial |
$48.45
|
| Rate for Payer: CIGNA Medicare |
$45.90
|
| Rate for Payer: HUMANA Commercial |
$45.90
|
| Rate for Payer: MEDICAID Medicaid |
$46.92
|
| Rate for Payer: MEDICARE Medicare |
$35.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$48.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$49.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$48.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$43.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.80
|
|
|
LAB PKU
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 84030
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: AETNA Commercial |
$48.45
|
| Rate for Payer: AETNA Medicare |
$45.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$48.45
|
| Rate for Payer: BCBS Healthlink |
$45.90
|
| Rate for Payer: BCBS HMK CHIP |
$45.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.90
|
| Rate for Payer: BCBS POS |
$48.45
|
| Rate for Payer: BCBS Traditional |
$51.00
|
| Rate for Payer: CASH_PRICE |
$40.80
|
| Rate for Payer: CIGNA Commercial |
$48.45
|
| Rate for Payer: CIGNA Medicare |
$45.90
|
| Rate for Payer: HUMANA Commercial |
$45.90
|
| Rate for Payer: MEDICAID Medicaid |
$46.92
|
| Rate for Payer: MEDICARE Medicare |
$35.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$48.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$49.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$48.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$43.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.80
|
|
|
LAB PLATELET FUNCTION
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: AETNA Commercial |
$123.50
|
| Rate for Payer: AETNA Medicare |
$117.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$123.50
|
| Rate for Payer: BCBS Healthlink |
$117.00
|
| Rate for Payer: BCBS HMK CHIP |
$117.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.00
|
| Rate for Payer: BCBS POS |
$123.50
|
| Rate for Payer: BCBS Traditional |
$130.00
|
| Rate for Payer: CASH_PRICE |
$104.00
|
| Rate for Payer: CIGNA Commercial |
$123.50
|
| Rate for Payer: CIGNA Medicare |
$117.00
|
| Rate for Payer: HUMANA Commercial |
$117.00
|
| Rate for Payer: MEDICAID Medicaid |
$119.60
|
| Rate for Payer: MEDICARE Medicare |
$91.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$123.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$126.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$123.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$123.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$110.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.00
|
|
|
LAB PLATELET FUNCTION
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: BCBS HMK CHIP |
$117.00
|
| Rate for Payer: AETNA Commercial |
$123.50
|
| Rate for Payer: AETNA Medicare |
$117.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$123.50
|
| Rate for Payer: BCBS Healthlink |
$117.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.00
|
| Rate for Payer: BCBS POS |
$123.50
|
| Rate for Payer: BCBS Traditional |
$130.00
|
| Rate for Payer: CASH_PRICE |
$104.00
|
| Rate for Payer: CIGNA Commercial |
$123.50
|
| Rate for Payer: CIGNA Medicare |
$117.00
|
| Rate for Payer: HUMANA Commercial |
$117.00
|
| Rate for Payer: MEDICAID Medicaid |
$119.60
|
| Rate for Payer: MEDICARE Medicare |
$91.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$123.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$126.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$123.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$123.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$110.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.00
|
|
|
LAB PORPHYRINS URINE QUANT & FRACTIONATN
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: AETNA Commercial |
$123.50
|
| Rate for Payer: AETNA Medicare |
$117.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$123.50
|
| Rate for Payer: BCBS Healthlink |
$117.00
|
| Rate for Payer: BCBS HMK CHIP |
$117.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.00
|
| Rate for Payer: BCBS POS |
$123.50
|
| Rate for Payer: BCBS Traditional |
$130.00
|
| Rate for Payer: CASH_PRICE |
$104.00
|
| Rate for Payer: CIGNA Commercial |
$123.50
|
| Rate for Payer: CIGNA Medicare |
$117.00
|
| Rate for Payer: HUMANA Commercial |
$117.00
|
| Rate for Payer: MEDICAID Medicaid |
$119.60
|
| Rate for Payer: MEDICARE Medicare |
$91.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$123.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$126.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$123.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$123.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$110.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.00
|
|
|
LAB PORPHYRINS URINE QUANT & FRACTIONATN
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: AETNA Commercial |
$123.50
|
| Rate for Payer: AETNA Medicare |
$117.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$123.50
|
| Rate for Payer: BCBS Healthlink |
$117.00
|
| Rate for Payer: BCBS HMK CHIP |
$117.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.00
|
| Rate for Payer: BCBS POS |
$123.50
|
| Rate for Payer: BCBS Traditional |
$130.00
|
| Rate for Payer: CASH_PRICE |
$104.00
|
| Rate for Payer: CIGNA Commercial |
$123.50
|
| Rate for Payer: CIGNA Medicare |
$117.00
|
| Rate for Payer: HUMANA Commercial |
$117.00
|
| Rate for Payer: MEDICAID Medicaid |
$119.60
|
| Rate for Payer: MEDICARE Medicare |
$91.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$123.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$126.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$123.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$123.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$110.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.00
|
|
|
LAB PRENATAL PROFILE
|
Facility
OP
|
$182.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: AETNA Commercial |
$172.90
|
| Rate for Payer: AETNA Medicare |
$163.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$172.90
|
| Rate for Payer: BCBS Healthlink |
$163.80
|
| Rate for Payer: BCBS HMK CHIP |
$163.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$163.80
|
| Rate for Payer: BCBS POS |
$172.90
|
| Rate for Payer: BCBS Traditional |
$182.00
|
| Rate for Payer: CASH_PRICE |
$145.60
|
| Rate for Payer: CIGNA Commercial |
$172.90
|
| Rate for Payer: CIGNA Medicare |
$163.80
|
| Rate for Payer: HUMANA Commercial |
$163.80
|
| Rate for Payer: MEDICAID Medicaid |
$167.44
|
| Rate for Payer: MEDICARE Medicare |
$127.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$172.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$176.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$172.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$172.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$154.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$145.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$145.60
|
|
|
LAB PRENATAL PROFILE
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
CPT 80055
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: BCBS HMK CHIP |
$163.80
|
| Rate for Payer: AETNA Commercial |
$172.90
|
| Rate for Payer: AETNA Medicare |
$163.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$172.90
|
| Rate for Payer: BCBS Healthlink |
$163.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$163.80
|
| Rate for Payer: BCBS POS |
$172.90
|
| Rate for Payer: BCBS Traditional |
$182.00
|
| Rate for Payer: CASH_PRICE |
$145.60
|
| Rate for Payer: CIGNA Commercial |
$172.90
|
| Rate for Payer: CIGNA Medicare |
$163.80
|
| Rate for Payer: HUMANA Commercial |
$163.80
|
| Rate for Payer: MEDICAID Medicaid |
$167.44
|
| Rate for Payer: MEDICARE Medicare |
$127.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$172.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$176.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$172.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$172.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$154.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$145.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$145.60
|
|
|
LAB PRIMIDONE
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
|
LAB PRIMIDONE
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
|
LAB PRO INSULIN
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: AETNA Commercial |
$179.55
|
| Rate for Payer: AETNA Medicare |
$170.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
LAB PRO INSULIN
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: AETNA Commercial |
$179.55
|
| Rate for Payer: AETNA Medicare |
$170.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$179.55
|
| Rate for Payer: BCBS Healthlink |
$170.10
|
| Rate for Payer: BCBS HMK CHIP |
$170.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$170.10
|
| Rate for Payer: BCBS POS |
$179.55
|
| Rate for Payer: BCBS Traditional |
$189.00
|
| Rate for Payer: CASH_PRICE |
$151.20
|
| Rate for Payer: CIGNA Commercial |
$179.55
|
| Rate for Payer: CIGNA Medicare |
$170.10
|
| Rate for Payer: HUMANA Commercial |
$170.10
|
| Rate for Payer: MEDICAID Medicaid |
$173.88
|
| Rate for Payer: MEDICARE Medicare |
$132.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$179.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$183.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$179.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$179.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$160.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$151.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$151.20
|
|
|
LAB PROSTATE ACID PHOSPHATASE
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
LAB PROSTATE ACID PHOSPHATASE
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
LAB PSA COMPLEXED
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84152
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
LAB PSA COMPLEXED
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 84152
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
LAB PSA SCREENING ONLY
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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 PSA SCREENING ONLY
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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 PSEUDOCHOLINESTERASE
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: BCBS HMK CHIP |
$112.50
|
| Rate for Payer: AETNA Commercial |
$118.75
|
| Rate for Payer: AETNA Medicare |
$112.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$118.75
|
| Rate for Payer: BCBS Healthlink |
$112.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$112.50
|
| Rate for Payer: BCBS POS |
$118.75
|
| Rate for Payer: BCBS Traditional |
$125.00
|
| Rate for Payer: CASH_PRICE |
$100.00
|
| Rate for Payer: CIGNA Commercial |
$118.75
|
| Rate for Payer: CIGNA Medicare |
$112.50
|
| Rate for Payer: HUMANA Commercial |
$112.50
|
| Rate for Payer: MEDICAID Medicaid |
$115.00
|
| Rate for Payer: MEDICARE Medicare |
$87.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$118.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$121.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$118.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$118.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$106.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.00
|
|
|
LAB PSEUDOCHOLINESTERASE
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: AETNA Commercial |
$118.75
|
| Rate for Payer: AETNA Medicare |
$112.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$118.75
|
| Rate for Payer: BCBS Healthlink |
$112.50
|
| Rate for Payer: BCBS HMK CHIP |
$112.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$112.50
|
| Rate for Payer: BCBS POS |
$118.75
|
| Rate for Payer: BCBS Traditional |
$125.00
|
| Rate for Payer: CASH_PRICE |
$100.00
|
| Rate for Payer: CIGNA Commercial |
$118.75
|
| Rate for Payer: CIGNA Medicare |
$112.50
|
| Rate for Payer: HUMANA Commercial |
$112.50
|
| Rate for Payer: MEDICAID Medicaid |
$115.00
|
| Rate for Payer: MEDICARE Medicare |
$87.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$118.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$121.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$118.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$118.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$106.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.00
|
|
|
LAB PYROLINKS-D
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
LAB PYROLINKS-D
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
LAB RABIES ANTIBODY TITER
|
Facility
IP
|
$208.00
|
|
|
Service Code
|
CPT 86382
|
| 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
|
|
