|
LAB RABIES ANTIBODY TITER
|
Facility
OP
|
$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: 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 RANDON URIN
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
LAB RANDON URIN
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
LAB RAPID STREP
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
20220501
|
|
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
|
|
|
LAB RAPID STREP
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
20220501
|
|
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 RESPIRATORY SYNCYTIAL VIRUS
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: AETNA Commercial |
$83.60
|
| Rate for Payer: AETNA Medicare |
$79.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$83.60
|
| Rate for Payer: BCBS Healthlink |
$79.20
|
| Rate for Payer: BCBS HMK CHIP |
$79.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$79.20
|
| Rate for Payer: BCBS POS |
$83.60
|
| Rate for Payer: BCBS Traditional |
$88.00
|
| Rate for Payer: CASH_PRICE |
$70.40
|
| Rate for Payer: CIGNA Commercial |
$83.60
|
| Rate for Payer: CIGNA Medicare |
$79.20
|
| Rate for Payer: HUMANA Commercial |
$79.20
|
| Rate for Payer: MEDICAID Medicaid |
$80.96
|
| Rate for Payer: MEDICARE Medicare |
$61.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$83.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$85.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$83.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$83.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$74.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$70.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$70.40
|
|
|
LAB RESPIRATORY SYNCYTIAL VIRUS
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: AETNA Commercial |
$83.60
|
| Rate for Payer: AETNA Medicare |
$79.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$83.60
|
| Rate for Payer: BCBS Healthlink |
$79.20
|
| Rate for Payer: BCBS HMK CHIP |
$79.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$79.20
|
| Rate for Payer: BCBS POS |
$83.60
|
| Rate for Payer: BCBS Traditional |
$88.00
|
| Rate for Payer: CASH_PRICE |
$70.40
|
| Rate for Payer: CIGNA Commercial |
$83.60
|
| Rate for Payer: CIGNA Medicare |
$79.20
|
| Rate for Payer: HUMANA Commercial |
$79.20
|
| Rate for Payer: MEDICAID Medicaid |
$80.96
|
| Rate for Payer: MEDICARE Medicare |
$61.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$83.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$85.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$83.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$83.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$74.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$70.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$70.40
|
|
|
LAB RETIC COUNT
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| 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 RETIC COUNT
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| 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 RETICULOCYTE COUNT
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| 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 RETICULOCYTE COUNT
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
305
|
| 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 ROCKY MTN SPOTTED FEVER
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: AETNA Commercial |
$113.05
|
| Rate for Payer: AETNA Medicare |
$107.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$113.05
|
| Rate for Payer: BCBS Healthlink |
$107.10
|
| Rate for Payer: BCBS HMK CHIP |
$107.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$107.10
|
| Rate for Payer: BCBS POS |
$113.05
|
| Rate for Payer: BCBS Traditional |
$119.00
|
| Rate for Payer: CASH_PRICE |
$95.20
|
| Rate for Payer: CIGNA Commercial |
$113.05
|
| Rate for Payer: CIGNA Medicare |
$107.10
|
| Rate for Payer: HUMANA Commercial |
$107.10
|
| Rate for Payer: MEDICAID Medicaid |
$109.48
|
| Rate for Payer: MEDICARE Medicare |
$83.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$113.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$115.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$113.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$101.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$95.20
|
|
|
LAB ROCKY MTN SPOTTED FEVER
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: BCBS HMK CHIP |
$107.10
|
| Rate for Payer: AETNA Commercial |
$113.05
|
| Rate for Payer: AETNA Medicare |
$107.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$113.05
|
| Rate for Payer: BCBS Healthlink |
$107.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$107.10
|
| Rate for Payer: BCBS POS |
$113.05
|
| Rate for Payer: BCBS Traditional |
$119.00
|
| Rate for Payer: CASH_PRICE |
$95.20
|
| Rate for Payer: CIGNA Commercial |
$113.05
|
| Rate for Payer: CIGNA Medicare |
$107.10
|
| Rate for Payer: HUMANA Commercial |
$107.10
|
| Rate for Payer: MEDICAID Medicaid |
$109.48
|
| Rate for Payer: MEDICARE Medicare |
$83.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$113.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$115.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$113.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$101.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$95.20
|
|
|
LAB ROTAVIRUS AG STOOL
|
Facility
IP
|
$133.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: AETNA Commercial |
$126.35
|
| Rate for Payer: AETNA Medicare |
$119.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$126.35
|
| Rate for Payer: BCBS Healthlink |
$119.70
|
| Rate for Payer: BCBS HMK CHIP |
$119.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$119.70
|
| Rate for Payer: BCBS POS |
$126.35
|
| Rate for Payer: BCBS Traditional |
$133.00
|
| Rate for Payer: CASH_PRICE |
$106.40
|
| Rate for Payer: CIGNA Commercial |
$126.35
|
| Rate for Payer: CIGNA Medicare |
$119.70
|
| Rate for Payer: HUMANA Commercial |
$119.70
|
| Rate for Payer: MEDICAID Medicaid |
$122.36
|
| Rate for Payer: MEDICARE Medicare |
$93.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$126.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$129.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$126.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$126.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$106.40
|
|
|
LAB ROTAVIRUS AG STOOL
|
Facility
OP
|
$133.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: AETNA Commercial |
$126.35
|
| Rate for Payer: AETNA Medicare |
$119.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$126.35
|
| Rate for Payer: BCBS Healthlink |
$119.70
|
| Rate for Payer: BCBS HMK CHIP |
$119.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$119.70
|
| Rate for Payer: BCBS POS |
$126.35
|
| Rate for Payer: BCBS Traditional |
$133.00
|
| Rate for Payer: CASH_PRICE |
$106.40
|
| Rate for Payer: CIGNA Commercial |
$126.35
|
| Rate for Payer: CIGNA Medicare |
$119.70
|
| Rate for Payer: HUMANA Commercial |
$119.70
|
| Rate for Payer: MEDICAID Medicaid |
$122.36
|
| Rate for Payer: MEDICARE Medicare |
$93.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$126.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$129.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$126.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$126.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$106.40
|
|
|
LAB RPR TITER
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: BCBS HMK CHIP |
$51.30
|
| 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 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 RPR TITER
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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 SARS-COV-2, RT PCR
|
Facility
IP
|
$201.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: AETNA Commercial |
$190.95
|
| Rate for Payer: AETNA Medicare |
$180.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.95
|
| Rate for Payer: BCBS Healthlink |
$180.90
|
| Rate for Payer: BCBS HMK CHIP |
$180.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.90
|
| Rate for Payer: BCBS POS |
$190.95
|
| Rate for Payer: BCBS Traditional |
$201.00
|
| Rate for Payer: CASH_PRICE |
$160.80
|
| Rate for Payer: CIGNA Commercial |
$190.95
|
| Rate for Payer: CIGNA Medicare |
$180.90
|
| Rate for Payer: HUMANA Commercial |
$180.90
|
| Rate for Payer: MEDICAID Medicaid |
$184.92
|
| Rate for Payer: MEDICARE Medicare |
$140.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.80
|
|
|
LAB SARS-COV-2, RT PCR
|
Facility
OP
|
$201.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: AETNA Commercial |
$190.95
|
| Rate for Payer: AETNA Medicare |
$180.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.95
|
| Rate for Payer: BCBS Healthlink |
$180.90
|
| Rate for Payer: BCBS HMK CHIP |
$180.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.90
|
| Rate for Payer: BCBS POS |
$190.95
|
| Rate for Payer: BCBS Traditional |
$201.00
|
| Rate for Payer: CASH_PRICE |
$160.80
|
| Rate for Payer: CIGNA Commercial |
$190.95
|
| Rate for Payer: CIGNA Medicare |
$180.90
|
| Rate for Payer: HUMANA Commercial |
$180.90
|
| Rate for Payer: MEDICAID Medicaid |
$184.92
|
| Rate for Payer: MEDICARE Medicare |
$140.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.80
|
|
|
LAB SENSITIVITY ANY SOURCE
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.80 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: AETNA Commercial |
$298.30
|
| Rate for Payer: AETNA Medicare |
$282.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$298.30
|
| Rate for Payer: BCBS Healthlink |
$282.60
|
| Rate for Payer: BCBS HMK CHIP |
$282.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$282.60
|
| Rate for Payer: BCBS POS |
$298.30
|
| Rate for Payer: BCBS Traditional |
$314.00
|
| Rate for Payer: CASH_PRICE |
$251.20
|
| Rate for Payer: CIGNA Commercial |
$298.30
|
| Rate for Payer: CIGNA Medicare |
$282.60
|
| Rate for Payer: HUMANA Commercial |
$282.60
|
| Rate for Payer: MEDICAID Medicaid |
$288.88
|
| Rate for Payer: MEDICARE Medicare |
$219.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$298.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$304.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$298.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$298.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$266.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$251.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$251.20
|
|
|
LAB SENSITIVITY ANY SOURCE
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 87184
|
| 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 SENSITIVITY ANY SOURCE
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 87184
|
| 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 SENSITIVITY ANY SOURCE
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.80 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: BCBS HMK CHIP |
$282.60
|
| Rate for Payer: AETNA Commercial |
$298.30
|
| Rate for Payer: AETNA Medicare |
$282.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$298.30
|
| Rate for Payer: BCBS Healthlink |
$282.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$282.60
|
| Rate for Payer: BCBS POS |
$298.30
|
| Rate for Payer: BCBS Traditional |
$314.00
|
| Rate for Payer: CASH_PRICE |
$251.20
|
| Rate for Payer: CIGNA Commercial |
$298.30
|
| Rate for Payer: CIGNA Medicare |
$282.60
|
| Rate for Payer: HUMANA Commercial |
$282.60
|
| Rate for Payer: MEDICAID Medicaid |
$288.88
|
| Rate for Payer: MEDICARE Medicare |
$219.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$298.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$304.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$298.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$298.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$266.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$251.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$251.20
|
|
|
LAB SEROTONIN
|
Facility
IP
|
$297.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: BCBS HMK CHIP |
$267.30
|
| Rate for Payer: AETNA Commercial |
$282.15
|
| Rate for Payer: AETNA Medicare |
$267.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$282.15
|
| Rate for Payer: BCBS Healthlink |
$267.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$267.30
|
| Rate for Payer: BCBS POS |
$282.15
|
| Rate for Payer: BCBS Traditional |
$297.00
|
| Rate for Payer: CASH_PRICE |
$237.60
|
| Rate for Payer: CIGNA Commercial |
$282.15
|
| Rate for Payer: CIGNA Medicare |
$267.30
|
| Rate for Payer: HUMANA Commercial |
$267.30
|
| Rate for Payer: MEDICAID Medicaid |
$273.24
|
| Rate for Payer: MEDICARE Medicare |
$207.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$282.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$288.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$282.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$282.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$252.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$237.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$237.60
|
|
|
LAB SEROTONIN
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: AETNA Commercial |
$282.15
|
| Rate for Payer: AETNA Medicare |
$267.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$282.15
|
| Rate for Payer: BCBS Healthlink |
$267.30
|
| Rate for Payer: BCBS HMK CHIP |
$267.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$267.30
|
| Rate for Payer: BCBS POS |
$282.15
|
| Rate for Payer: BCBS Traditional |
$297.00
|
| Rate for Payer: CASH_PRICE |
$237.60
|
| Rate for Payer: CIGNA Commercial |
$282.15
|
| Rate for Payer: CIGNA Medicare |
$267.30
|
| Rate for Payer: HUMANA Commercial |
$267.30
|
| Rate for Payer: MEDICAID Medicaid |
$273.24
|
| Rate for Payer: MEDICARE Medicare |
$207.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$282.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$288.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$282.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$282.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$252.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$237.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$237.60
|
|
