|
LAB URINALYSIS ANY COMPONENT
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
LAB URINALYSIS ANY COMPONENT
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
LAB URINE CULTURE BACT W/PRESUMTIVE ISOL
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
LAB URINE CULTURE BACT W/PRESUMTIVE ISOL
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
LAB URINE DRUG COLLECTION
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
LAB URINE DRUG COLLECTION
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
LAB URINE IMMUNOELECTROPHORESIS
|
Facility
IP
|
$206.00
|
|
|
Service Code
|
CPT 86325
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: AETNA Commercial |
$195.70
|
| Rate for Payer: AETNA Medicare |
$185.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$195.70
|
| Rate for Payer: BCBS Healthlink |
$185.40
|
| Rate for Payer: BCBS HMK CHIP |
$185.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$185.40
|
| Rate for Payer: BCBS POS |
$195.70
|
| Rate for Payer: BCBS Traditional |
$206.00
|
| Rate for Payer: CASH_PRICE |
$164.80
|
| Rate for Payer: CIGNA Commercial |
$195.70
|
| Rate for Payer: CIGNA Medicare |
$185.40
|
| Rate for Payer: HUMANA Commercial |
$185.40
|
| Rate for Payer: MEDICAID Medicaid |
$189.52
|
| Rate for Payer: MEDICARE Medicare |
$144.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$195.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$199.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$195.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$195.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.80
|
|
|
LAB URINE IMMUNOELECTROPHORESIS
|
Facility
OP
|
$206.00
|
|
|
Service Code
|
CPT 86325
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: AETNA Commercial |
$195.70
|
| Rate for Payer: AETNA Medicare |
$185.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$195.70
|
| Rate for Payer: BCBS Healthlink |
$185.40
|
| Rate for Payer: BCBS HMK CHIP |
$185.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$185.40
|
| Rate for Payer: BCBS POS |
$195.70
|
| Rate for Payer: BCBS Traditional |
$206.00
|
| Rate for Payer: CASH_PRICE |
$164.80
|
| Rate for Payer: CIGNA Commercial |
$195.70
|
| Rate for Payer: CIGNA Medicare |
$185.40
|
| Rate for Payer: HUMANA Commercial |
$185.40
|
| Rate for Payer: MEDICAID Medicaid |
$189.52
|
| Rate for Payer: MEDICARE Medicare |
$144.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$195.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$199.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$195.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$195.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.80
|
|
|
LAB URINE UREA
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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 URINE UREA
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 84540
|
| 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 VAP CHOLESTEROL PANEL
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: AETNA Commercial |
$58.90
|
| Rate for Payer: AETNA Medicare |
$55.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$58.90
|
| Rate for Payer: BCBS Healthlink |
$55.80
|
| Rate for Payer: BCBS HMK CHIP |
$55.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$55.80
|
| Rate for Payer: BCBS POS |
$58.90
|
| Rate for Payer: BCBS Traditional |
$62.00
|
| Rate for Payer: CASH_PRICE |
$49.60
|
| Rate for Payer: CIGNA Commercial |
$58.90
|
| Rate for Payer: CIGNA Medicare |
$55.80
|
| Rate for Payer: HUMANA Commercial |
$55.80
|
| Rate for Payer: MEDICAID Medicaid |
$57.04
|
| Rate for Payer: MEDICARE Medicare |
$43.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$58.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$60.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$58.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$58.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$52.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$49.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$49.60
|
|
|
LAB VAP CHOLESTEROL PANEL
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: AETNA Commercial |
$58.90
|
| Rate for Payer: AETNA Medicare |
$55.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$58.90
|
| Rate for Payer: BCBS Healthlink |
$55.80
|
| Rate for Payer: BCBS HMK CHIP |
$55.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$55.80
|
| Rate for Payer: BCBS POS |
$58.90
|
| Rate for Payer: BCBS Traditional |
$62.00
|
| Rate for Payer: CASH_PRICE |
$49.60
|
| Rate for Payer: CIGNA Commercial |
$58.90
|
| Rate for Payer: CIGNA Medicare |
$55.80
|
| Rate for Payer: HUMANA Commercial |
$55.80
|
| Rate for Payer: MEDICAID Medicaid |
$57.04
|
| Rate for Payer: MEDICARE Medicare |
$43.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$58.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$60.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$58.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$58.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$52.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$49.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$49.60
|
|
|
LAB VENIPUNCTURE
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
LAB VENIPUNCTURE
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
LAB VIPER VENOM PROTHROMBIN TIME
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 85612
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
LAB VIPER VENOM PROTHROMBIN TIME
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 85612
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
LAB VIRUS/ANY CULTURE
|
Facility
OP
|
$156.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: AETNA Commercial |
$148.20
|
| Rate for Payer: AETNA Medicare |
$140.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$148.20
|
| Rate for Payer: BCBS Healthlink |
$140.40
|
| Rate for Payer: BCBS HMK CHIP |
$140.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$140.40
|
| Rate for Payer: BCBS POS |
$148.20
|
| Rate for Payer: BCBS Traditional |
$156.00
|
| Rate for Payer: CASH_PRICE |
$124.80
|
| Rate for Payer: CIGNA Commercial |
$148.20
|
| Rate for Payer: CIGNA Medicare |
$140.40
|
| Rate for Payer: HUMANA Commercial |
$140.40
|
| Rate for Payer: MEDICAID Medicaid |
$143.52
|
| Rate for Payer: MEDICARE Medicare |
$109.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$148.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$151.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$148.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$148.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$132.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.80
|
|
|
LAB VIRUS/ANY CULTURE
|
Facility
IP
|
$156.00
|
|
|
Service Code
|
CPT 87252
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: BCBS HMK CHIP |
$140.40
|
| Rate for Payer: AETNA Commercial |
$148.20
|
| Rate for Payer: AETNA Medicare |
$140.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$148.20
|
| Rate for Payer: BCBS Healthlink |
$140.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$140.40
|
| Rate for Payer: BCBS POS |
$148.20
|
| Rate for Payer: BCBS Traditional |
$156.00
|
| Rate for Payer: CASH_PRICE |
$124.80
|
| Rate for Payer: CIGNA Commercial |
$148.20
|
| Rate for Payer: CIGNA Medicare |
$140.40
|
| Rate for Payer: HUMANA Commercial |
$140.40
|
| Rate for Payer: MEDICAID Medicaid |
$143.52
|
| Rate for Payer: MEDICARE Medicare |
$109.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$148.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$151.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$148.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$148.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$132.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.80
|
|
|
LAB VMA
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 84585
|
| 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 VMA
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 84585
|
| 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 VWF ACTIVITY
|
Facility
OP
|
$373.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$261.10 |
| Max. Negotiated Rate |
$373.00 |
| Rate for Payer: AETNA Commercial |
$354.35
|
| Rate for Payer: AETNA Medicare |
$335.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$354.35
|
| Rate for Payer: BCBS Healthlink |
$335.70
|
| Rate for Payer: BCBS HMK CHIP |
$335.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$335.70
|
| Rate for Payer: BCBS POS |
$354.35
|
| Rate for Payer: BCBS Traditional |
$373.00
|
| Rate for Payer: CASH_PRICE |
$298.40
|
| Rate for Payer: CIGNA Commercial |
$354.35
|
| Rate for Payer: CIGNA Medicare |
$335.70
|
| Rate for Payer: HUMANA Commercial |
$335.70
|
| Rate for Payer: MEDICAID Medicaid |
$343.16
|
| Rate for Payer: MEDICARE Medicare |
$261.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$354.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$361.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$354.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$354.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$317.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$298.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$298.40
|
|
|
LAB VWF ACTIVITY
|
Facility
IP
|
$373.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$261.10 |
| Max. Negotiated Rate |
$373.00 |
| Rate for Payer: BCBS HMK CHIP |
$335.70
|
| Rate for Payer: AETNA Commercial |
$354.35
|
| Rate for Payer: AETNA Medicare |
$335.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$354.35
|
| Rate for Payer: BCBS Healthlink |
$335.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$335.70
|
| Rate for Payer: BCBS POS |
$354.35
|
| Rate for Payer: BCBS Traditional |
$373.00
|
| Rate for Payer: CASH_PRICE |
$298.40
|
| Rate for Payer: CIGNA Commercial |
$354.35
|
| Rate for Payer: CIGNA Medicare |
$335.70
|
| Rate for Payer: HUMANA Commercial |
$335.70
|
| Rate for Payer: MEDICAID Medicaid |
$343.16
|
| Rate for Payer: MEDICARE Medicare |
$261.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$354.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$361.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$354.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$354.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$317.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$298.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$298.40
|
|
|
LAB WBC ALKALINE PHOSPHATASE
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
LAB WBC ALKALINE PHOSPHATASE
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
LAB WEST NILE VIRUS IGG (SERUM)
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
