|
ANTICARDIOLIPIN AB, IGM (161828)
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
ANTICARDIOLIPIN AB, IGM (161828)
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
ANTI-DSDNA ANTIBODIES (096339)
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ANTI-DSDNA ANTIBODIES (096339)
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ANTI-JO-1 AB (520032)
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: AETNA Commercial |
$257.45
|
| Rate for Payer: AETNA Medicare |
$243.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$257.45
|
| Rate for Payer: BCBS Healthlink |
$243.90
|
| Rate for Payer: BCBS HMK CHIP |
$243.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.90
|
| Rate for Payer: BCBS POS |
$257.45
|
| Rate for Payer: BCBS Traditional |
$271.00
|
| Rate for Payer: CASH_PRICE |
$216.80
|
| Rate for Payer: CIGNA Commercial |
$257.45
|
| Rate for Payer: CIGNA Medicare |
$243.90
|
| Rate for Payer: HUMANA Commercial |
$243.90
|
| Rate for Payer: MEDICAID Medicaid |
$249.32
|
| Rate for Payer: MEDICARE Medicare |
$189.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$257.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$262.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$257.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$257.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$230.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.80
|
|
|
ANTI-JO-1 AB (520032)
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$271.00 |
| Rate for Payer: AETNA Commercial |
$257.45
|
| Rate for Payer: AETNA Medicare |
$243.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$257.45
|
| Rate for Payer: BCBS Healthlink |
$243.90
|
| Rate for Payer: BCBS HMK CHIP |
$243.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.90
|
| Rate for Payer: BCBS POS |
$257.45
|
| Rate for Payer: BCBS Traditional |
$271.00
|
| Rate for Payer: CASH_PRICE |
$216.80
|
| Rate for Payer: CIGNA Commercial |
$257.45
|
| Rate for Payer: CIGNA Medicare |
$243.90
|
| Rate for Payer: HUMANA Commercial |
$243.90
|
| Rate for Payer: MEDICAID Medicaid |
$249.32
|
| Rate for Payer: MEDICARE Medicare |
$189.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$257.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$262.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$257.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$257.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$230.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.80
|
|
|
ANTI-MULLERIAN HORMONE (500183)
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: AETNA Commercial |
$191.90
|
| Rate for Payer: AETNA Medicare |
$181.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$191.90
|
| Rate for Payer: BCBS Healthlink |
$181.80
|
| Rate for Payer: BCBS HMK CHIP |
$181.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$181.80
|
| Rate for Payer: BCBS POS |
$191.90
|
| Rate for Payer: BCBS Traditional |
$202.00
|
| Rate for Payer: CASH_PRICE |
$161.60
|
| Rate for Payer: CIGNA Commercial |
$191.90
|
| Rate for Payer: CIGNA Medicare |
$181.80
|
| Rate for Payer: HUMANA Commercial |
$181.80
|
| Rate for Payer: MEDICAID Medicaid |
$185.84
|
| Rate for Payer: MEDICARE Medicare |
$141.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$191.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$195.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$191.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$191.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$171.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$161.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$161.60
|
|
|
ANTI-MULLERIAN HORMONE (500183)
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: BCBS HMK CHIP |
$181.80
|
| Rate for Payer: AETNA Commercial |
$191.90
|
| Rate for Payer: AETNA Medicare |
$181.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$191.90
|
| Rate for Payer: BCBS Healthlink |
$181.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$181.80
|
| Rate for Payer: BCBS POS |
$191.90
|
| Rate for Payer: BCBS Traditional |
$202.00
|
| Rate for Payer: CASH_PRICE |
$161.60
|
| Rate for Payer: CIGNA Commercial |
$191.90
|
| Rate for Payer: CIGNA Medicare |
$181.80
|
| Rate for Payer: HUMANA Commercial |
$181.80
|
| Rate for Payer: MEDICAID Medicaid |
$185.84
|
| Rate for Payer: MEDICARE Medicare |
$141.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$191.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$195.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$191.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$191.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$171.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$161.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$161.60
|
|
|
ANTIMULLERIAN HORMONE (BLOD1157)
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: AETNA Commercial |
$149.15
|
| Rate for Payer: AETNA Medicare |
$141.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$149.15
|
| Rate for Payer: BCBS Healthlink |
$141.30
|
| Rate for Payer: BCBS HMK CHIP |
$141.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$141.30
|
| Rate for Payer: BCBS POS |
$149.15
|
| Rate for Payer: BCBS Traditional |
$157.00
|
| Rate for Payer: CASH_PRICE |
$125.60
|
| Rate for Payer: CIGNA Commercial |
$149.15
|
| Rate for Payer: CIGNA Medicare |
$141.30
|
| Rate for Payer: HUMANA Commercial |
$141.30
|
| Rate for Payer: MEDICAID Medicaid |
$144.44
|
| Rate for Payer: MEDICARE Medicare |
$109.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$149.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$152.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$149.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$149.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$133.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$125.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$125.60
|
|
|
ANTIMULLERIAN HORMONE (BLOD1157)
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: AETNA Commercial |
$149.15
|
| Rate for Payer: AETNA Medicare |
$141.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$149.15
|
| Rate for Payer: BCBS Healthlink |
$141.30
|
| Rate for Payer: BCBS HMK CHIP |
$141.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$141.30
|
| Rate for Payer: BCBS POS |
$149.15
|
| Rate for Payer: BCBS Traditional |
$157.00
|
| Rate for Payer: CASH_PRICE |
$125.60
|
| Rate for Payer: CIGNA Commercial |
$149.15
|
| Rate for Payer: CIGNA Medicare |
$141.30
|
| Rate for Payer: HUMANA Commercial |
$141.30
|
| Rate for Payer: MEDICAID Medicaid |
$144.44
|
| Rate for Payer: MEDICARE Medicare |
$109.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$149.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$152.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$149.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$149.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$133.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$125.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$125.60
|
|
|
ANTIRIBOSOMAL P ANTIBODIES (012700)
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: BCBS HMK CHIP |
$214.20
|
| Rate for Payer: AETNA Commercial |
$226.10
|
| Rate for Payer: AETNA Medicare |
$214.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$226.10
|
| Rate for Payer: BCBS Healthlink |
$214.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$214.20
|
| Rate for Payer: BCBS POS |
$226.10
|
| Rate for Payer: BCBS Traditional |
$238.00
|
| Rate for Payer: CASH_PRICE |
$190.40
|
| Rate for Payer: CIGNA Commercial |
$226.10
|
| Rate for Payer: CIGNA Medicare |
$214.20
|
| Rate for Payer: HUMANA Commercial |
$214.20
|
| Rate for Payer: MEDICAID Medicaid |
$218.96
|
| Rate for Payer: MEDICARE Medicare |
$166.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$226.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$230.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$226.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$226.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$202.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$190.40
|
|
|
ANTIRIBOSOMAL P ANTIBODIES (012700)
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: AETNA Commercial |
$226.10
|
| Rate for Payer: AETNA Medicare |
$214.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$226.10
|
| Rate for Payer: BCBS Healthlink |
$214.20
|
| Rate for Payer: BCBS HMK CHIP |
$214.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$214.20
|
| Rate for Payer: BCBS POS |
$226.10
|
| Rate for Payer: BCBS Traditional |
$238.00
|
| Rate for Payer: CASH_PRICE |
$190.40
|
| Rate for Payer: CIGNA Commercial |
$226.10
|
| Rate for Payer: CIGNA Medicare |
$214.20
|
| Rate for Payer: HUMANA Commercial |
$214.20
|
| Rate for Payer: MEDICAID Medicaid |
$218.96
|
| Rate for Payer: MEDICARE Medicare |
$166.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$226.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$230.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$226.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$226.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$202.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$190.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$190.40
|
|
|
ANTISCLERODERMA-70 AB (018705)
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
ANTISCLERODERMA-70 AB (018705)
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
ANTITHROMBIN ACTIVITY (015040)
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
ANTITHROMBIN ACTIVITY (015040)
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
IP
|
$35.90
|
|
| Hospital Charge Code |
20230110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$35.90 |
| Rate for Payer: AETNA Commercial |
$34.10
|
| Rate for Payer: AETNA Medicare |
$32.31
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.10
|
| Rate for Payer: BCBS Healthlink |
$32.31
|
| Rate for Payer: BCBS HMK CHIP |
$32.31
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.31
|
| Rate for Payer: BCBS POS |
$34.10
|
| Rate for Payer: BCBS Traditional |
$35.90
|
| Rate for Payer: CASH_PRICE |
$28.72
|
| Rate for Payer: CIGNA Commercial |
$34.10
|
| Rate for Payer: CIGNA Medicare |
$32.31
|
| Rate for Payer: HUMANA Commercial |
$32.31
|
| Rate for Payer: MEDICAID Medicaid |
$33.03
|
| Rate for Payer: MEDICARE Medicare |
$25.13
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.51
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.72
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.72
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
OP
|
$35.90
|
|
| Hospital Charge Code |
20230110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$35.90 |
| Rate for Payer: AETNA Commercial |
$34.10
|
| Rate for Payer: AETNA Medicare |
$32.31
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.10
|
| Rate for Payer: BCBS Healthlink |
$32.31
|
| Rate for Payer: BCBS HMK CHIP |
$32.31
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.31
|
| Rate for Payer: BCBS POS |
$34.10
|
| Rate for Payer: BCBS Traditional |
$35.90
|
| Rate for Payer: CASH_PRICE |
$28.72
|
| Rate for Payer: CIGNA Commercial |
$34.10
|
| Rate for Payer: CIGNA Medicare |
$32.31
|
| Rate for Payer: HUMANA Commercial |
$32.31
|
| Rate for Payer: MEDICAID Medicaid |
$33.03
|
| Rate for Payer: MEDICARE Medicare |
$25.13
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.51
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.72
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.72
|
|
|
APIXABAN TAB [5 MG]
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
APIXABAN TAB [5 MG]
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| 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 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
|
|
|
APPLICATION CAST ELBOW-FINGER
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
APPLICATION CAST ELBOW-FINGER
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
APPLICATION CAST LONG LEG THIGH-TOE
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
APPLICATION CAST LONG LEG THIGH-TOE
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
APPLICATION CAST SHOULDER-FINGER
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
