|
LAB THEOPHYLLINE
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
LAB THYROID STIMULATION IMMUNOGLOBULIN
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: AETNA Commercial |
$326.80
|
| Rate for Payer: AETNA Medicare |
$309.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$326.80
|
| Rate for Payer: BCBS Healthlink |
$309.60
|
| Rate for Payer: BCBS HMK CHIP |
$309.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$309.60
|
| Rate for Payer: BCBS POS |
$326.80
|
| Rate for Payer: BCBS Traditional |
$344.00
|
| Rate for Payer: CASH_PRICE |
$275.20
|
| Rate for Payer: CIGNA Commercial |
$326.80
|
| Rate for Payer: CIGNA Medicare |
$309.60
|
| Rate for Payer: HUMANA Commercial |
$309.60
|
| Rate for Payer: MEDICAID Medicaid |
$316.48
|
| Rate for Payer: MEDICARE Medicare |
$240.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$326.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$333.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$326.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$326.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$292.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$275.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$275.20
|
|
|
LAB THYROID STIMULATION IMMUNOGLOBULIN
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: BCBS HMK CHIP |
$309.60
|
| Rate for Payer: AETNA Commercial |
$326.80
|
| Rate for Payer: AETNA Medicare |
$309.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$326.80
|
| Rate for Payer: BCBS Healthlink |
$309.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$309.60
|
| Rate for Payer: BCBS POS |
$326.80
|
| Rate for Payer: BCBS Traditional |
$344.00
|
| Rate for Payer: CASH_PRICE |
$275.20
|
| Rate for Payer: CIGNA Commercial |
$326.80
|
| Rate for Payer: CIGNA Medicare |
$309.60
|
| Rate for Payer: HUMANA Commercial |
$309.60
|
| Rate for Payer: MEDICAID Medicaid |
$316.48
|
| Rate for Payer: MEDICARE Medicare |
$240.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$326.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$333.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$326.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$326.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$292.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$275.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$275.20
|
|
|
LAB TICKBORNE DISEASE PANEL
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
LAB TICKBORNE DISEASE PANEL
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
LAB TOBRAMYCIN LEVEL
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: BCBS HMK CHIP |
$100.80
|
| Rate for Payer: AETNA Commercial |
$106.40
|
| Rate for Payer: AETNA Medicare |
$100.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$106.40
|
| Rate for Payer: BCBS Healthlink |
$100.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$100.80
|
| Rate for Payer: BCBS POS |
$106.40
|
| Rate for Payer: BCBS Traditional |
$112.00
|
| Rate for Payer: CASH_PRICE |
$89.60
|
| Rate for Payer: CIGNA Commercial |
$106.40
|
| Rate for Payer: CIGNA Medicare |
$100.80
|
| Rate for Payer: HUMANA Commercial |
$100.80
|
| Rate for Payer: MEDICAID Medicaid |
$103.04
|
| Rate for Payer: MEDICARE Medicare |
$78.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$106.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$108.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$106.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$89.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$89.60
|
|
|
LAB TOBRAMYCIN LEVEL
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: AETNA Commercial |
$106.40
|
| Rate for Payer: AETNA Medicare |
$100.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$106.40
|
| Rate for Payer: BCBS Healthlink |
$100.80
|
| Rate for Payer: BCBS HMK CHIP |
$100.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$100.80
|
| Rate for Payer: BCBS POS |
$106.40
|
| Rate for Payer: BCBS Traditional |
$112.00
|
| Rate for Payer: CASH_PRICE |
$89.60
|
| Rate for Payer: CIGNA Commercial |
$106.40
|
| Rate for Payer: CIGNA Medicare |
$100.80
|
| Rate for Payer: HUMANA Commercial |
$100.80
|
| Rate for Payer: MEDICAID Medicaid |
$103.04
|
| Rate for Payer: MEDICARE Medicare |
$78.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$106.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$108.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$106.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$89.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$89.60
|
|
|
LAB TOXOPLASMASIS
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
LAB TOXOPLASMASIS
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
LAB TOXOPLASMASIS IGM
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
LAB TOXOPLASMASIS IGM
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
LAB TPMT ENZYME ACTIVITY
|
Facility
IP
|
$257.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
LAB TPMT ENZYME ACTIVITY
|
Facility
OP
|
$257.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.90 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: AETNA Commercial |
$244.15
|
| Rate for Payer: AETNA Medicare |
$231.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$244.15
|
| Rate for Payer: BCBS Healthlink |
$231.30
|
| Rate for Payer: BCBS HMK CHIP |
$231.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$231.30
|
| Rate for Payer: BCBS POS |
$244.15
|
| Rate for Payer: BCBS Traditional |
$257.00
|
| Rate for Payer: CASH_PRICE |
$205.60
|
| Rate for Payer: CIGNA Commercial |
$244.15
|
| Rate for Payer: CIGNA Medicare |
$231.30
|
| Rate for Payer: HUMANA Commercial |
$231.30
|
| Rate for Payer: MEDICAID Medicaid |
$236.44
|
| Rate for Payer: MEDICARE Medicare |
$179.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$244.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$249.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$244.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$244.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$218.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$205.60
|
|
|
LAB TRANXENE LEVELS
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
LAB TRANXENE LEVELS
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
LAB TRICHOMONAS VAGIN DIR
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT 87660
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
LAB TRICHOMONAS VAGIN DIR
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT 87660
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
LAB TROPONIN
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
LAB TROPONIN
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
LAB TSH RECETOR SITE AB
|
Facility
OP
|
$182.00
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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 TSH RECETOR SITE AB
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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 TULAREMIA SEROLOGY
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 86668
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
LAB TULAREMIA SEROLOGY
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 86668
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: BCBS HMK CHIP |
$93.60
|
| Rate for Payer: AETNA Commercial |
$98.80
|
| Rate for Payer: AETNA Medicare |
$93.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$98.80
|
| Rate for Payer: BCBS Healthlink |
$93.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$93.60
|
| Rate for Payer: BCBS POS |
$98.80
|
| Rate for Payer: BCBS Traditional |
$104.00
|
| Rate for Payer: CASH_PRICE |
$83.20
|
| Rate for Payer: CIGNA Commercial |
$98.80
|
| Rate for Payer: CIGNA Medicare |
$93.60
|
| Rate for Payer: HUMANA Commercial |
$93.60
|
| Rate for Payer: MEDICAID Medicaid |
$95.68
|
| Rate for Payer: MEDICARE Medicare |
$72.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$98.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$100.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$98.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$98.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$88.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$83.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$83.20
|
|
|
LAB URIC ACID/URINE
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 84560
|
| 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 URIC ACID/URINE
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 84560
|
| 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
|
|
