|
MTHFR (511238)
|
Facility
OP
|
$219.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: AETNA Commercial |
$208.05
|
| Rate for Payer: AETNA Medicare |
$197.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$208.05
|
| Rate for Payer: BCBS Healthlink |
$197.10
|
| Rate for Payer: BCBS HMK CHIP |
$197.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$197.10
|
| Rate for Payer: BCBS POS |
$208.05
|
| Rate for Payer: BCBS Traditional |
$219.00
|
| Rate for Payer: CASH_PRICE |
$175.20
|
| Rate for Payer: CIGNA Commercial |
$208.05
|
| Rate for Payer: CIGNA Medicare |
$197.10
|
| Rate for Payer: HUMANA Commercial |
$197.10
|
| Rate for Payer: MEDICAID Medicaid |
$201.48
|
| Rate for Payer: MEDICARE Medicare |
$153.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$208.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$212.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$208.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$208.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$186.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$175.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$175.20
|
|
|
MTHFR (511238)
|
Facility
IP
|
$219.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: AETNA Commercial |
$208.05
|
| Rate for Payer: AETNA Medicare |
$197.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$208.05
|
| Rate for Payer: BCBS Healthlink |
$197.10
|
| Rate for Payer: BCBS HMK CHIP |
$197.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$197.10
|
| Rate for Payer: BCBS POS |
$208.05
|
| Rate for Payer: BCBS Traditional |
$219.00
|
| Rate for Payer: CASH_PRICE |
$175.20
|
| Rate for Payer: CIGNA Commercial |
$208.05
|
| Rate for Payer: CIGNA Medicare |
$197.10
|
| Rate for Payer: HUMANA Commercial |
$197.10
|
| Rate for Payer: MEDICAID Medicaid |
$201.48
|
| Rate for Payer: MEDICARE Medicare |
$153.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$208.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$212.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$208.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$208.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$186.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$175.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$175.20
|
|
|
MULTI VITAMIN TAB ADULT
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
MULTI VITAMIN TAB ADULT
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
MUMPS AB, IGG (096552)
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
MUMPS AB, IGG (096552)
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
MUMPS AB, IGM (160499)
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
MUMPS AB, IGM (160499)
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
MUMPS VIRAL CULTURE (186150)
|
Facility
IP
|
$507.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$507.00 |
| Rate for Payer: AETNA Commercial |
$481.65
|
| Rate for Payer: AETNA Medicare |
$456.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$481.65
|
| Rate for Payer: BCBS Healthlink |
$456.30
|
| Rate for Payer: BCBS HMK CHIP |
$456.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$456.30
|
| Rate for Payer: BCBS POS |
$481.65
|
| Rate for Payer: BCBS Traditional |
$507.00
|
| Rate for Payer: CASH_PRICE |
$405.60
|
| Rate for Payer: CIGNA Commercial |
$481.65
|
| Rate for Payer: CIGNA Medicare |
$456.30
|
| Rate for Payer: HUMANA Commercial |
$456.30
|
| Rate for Payer: MEDICAID Medicaid |
$466.44
|
| Rate for Payer: MEDICARE Medicare |
$354.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$481.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$491.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$481.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$481.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$430.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$405.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$405.60
|
|
|
MUMPS VIRAL CULTURE (186150)
|
Facility
OP
|
$507.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$507.00 |
| Rate for Payer: AETNA Commercial |
$481.65
|
| Rate for Payer: AETNA Medicare |
$456.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$481.65
|
| Rate for Payer: BCBS Healthlink |
$456.30
|
| Rate for Payer: BCBS HMK CHIP |
$456.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$456.30
|
| Rate for Payer: BCBS POS |
$481.65
|
| Rate for Payer: BCBS Traditional |
$507.00
|
| Rate for Payer: CASH_PRICE |
$405.60
|
| Rate for Payer: CIGNA Commercial |
$481.65
|
| Rate for Payer: CIGNA Medicare |
$456.30
|
| Rate for Payer: HUMANA Commercial |
$456.30
|
| Rate for Payer: MEDICAID Medicaid |
$466.44
|
| Rate for Payer: MEDICARE Medicare |
$354.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$481.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$491.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$481.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$481.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$430.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$405.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$405.60
|
|
|
MUPIROCIN (BACTROBAN) OINT 2% 22GM
|
Facility
IP
|
$144.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: AETNA Commercial |
$136.80
|
| Rate for Payer: AETNA Medicare |
$129.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$136.80
|
| Rate for Payer: BCBS Healthlink |
$129.60
|
| Rate for Payer: BCBS HMK CHIP |
$129.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$129.60
|
| Rate for Payer: BCBS POS |
$136.80
|
| Rate for Payer: BCBS Traditional |
$144.00
|
| Rate for Payer: CASH_PRICE |
$115.20
|
| Rate for Payer: CIGNA Commercial |
$136.80
|
| Rate for Payer: CIGNA Medicare |
$129.60
|
| Rate for Payer: HUMANA Commercial |
$129.60
|
| Rate for Payer: MEDICAID Medicaid |
$132.48
|
| Rate for Payer: MEDICARE Medicare |
$100.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$136.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$139.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$136.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$115.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$115.20
|
|
|
MUPIROCIN (BACTROBAN) OINT 2% 22GM
|
Facility
OP
|
$144.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: AETNA Commercial |
$136.80
|
| Rate for Payer: AETNA Medicare |
$129.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$136.80
|
| Rate for Payer: BCBS Healthlink |
$129.60
|
| Rate for Payer: BCBS HMK CHIP |
$129.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$129.60
|
| Rate for Payer: BCBS POS |
$136.80
|
| Rate for Payer: BCBS Traditional |
$144.00
|
| Rate for Payer: CASH_PRICE |
$115.20
|
| Rate for Payer: CIGNA Commercial |
$136.80
|
| Rate for Payer: CIGNA Medicare |
$129.60
|
| Rate for Payer: HUMANA Commercial |
$129.60
|
| Rate for Payer: MEDICAID Medicaid |
$132.48
|
| Rate for Payer: MEDICARE Medicare |
$100.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$136.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$139.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$136.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$115.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$115.20
|
|
|
MUSCLE TEST, 2 LIMBS
|
Facility
OP
|
$372.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: AETNA Commercial |
$353.40
|
| Rate for Payer: AETNA Medicare |
$334.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$353.40
|
| Rate for Payer: BCBS Healthlink |
$334.80
|
| Rate for Payer: BCBS HMK CHIP |
$334.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$334.80
|
| Rate for Payer: BCBS POS |
$353.40
|
| Rate for Payer: BCBS Traditional |
$372.00
|
| Rate for Payer: CASH_PRICE |
$297.60
|
| Rate for Payer: CIGNA Commercial |
$353.40
|
| Rate for Payer: CIGNA Medicare |
$334.80
|
| Rate for Payer: HUMANA Commercial |
$334.80
|
| Rate for Payer: MEDICAID Medicaid |
$342.24
|
| Rate for Payer: MEDICARE Medicare |
$260.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$353.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$360.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$353.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$353.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$316.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$297.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$297.60
|
|
|
MUSCLE TEST, 2 LIMBS
|
Facility
IP
|
$372.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: AETNA Commercial |
$353.40
|
| Rate for Payer: AETNA Medicare |
$334.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$353.40
|
| Rate for Payer: BCBS Healthlink |
$334.80
|
| Rate for Payer: BCBS HMK CHIP |
$334.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$334.80
|
| Rate for Payer: BCBS POS |
$353.40
|
| Rate for Payer: BCBS Traditional |
$372.00
|
| Rate for Payer: CASH_PRICE |
$297.60
|
| Rate for Payer: CIGNA Commercial |
$353.40
|
| Rate for Payer: CIGNA Medicare |
$334.80
|
| Rate for Payer: HUMANA Commercial |
$334.80
|
| Rate for Payer: MEDICAID Medicaid |
$342.24
|
| Rate for Payer: MEDICARE Medicare |
$260.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$353.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$360.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$353.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$353.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$316.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$297.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$297.60
|
|
|
MVI ADULT VITS FOR INFUSION
|
Facility
IP
|
$639.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$447.30 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: AETNA Commercial |
$607.05
|
| Rate for Payer: AETNA Medicare |
$575.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$607.05
|
| Rate for Payer: BCBS Healthlink |
$575.10
|
| Rate for Payer: BCBS HMK CHIP |
$575.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$575.10
|
| Rate for Payer: BCBS POS |
$607.05
|
| Rate for Payer: BCBS Traditional |
$639.00
|
| Rate for Payer: CASH_PRICE |
$511.20
|
| Rate for Payer: CIGNA Commercial |
$607.05
|
| Rate for Payer: CIGNA Medicare |
$575.10
|
| Rate for Payer: HUMANA Commercial |
$575.10
|
| Rate for Payer: MEDICAID Medicaid |
$587.88
|
| Rate for Payer: MEDICARE Medicare |
$447.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$607.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$619.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$607.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$607.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$543.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$511.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$511.20
|
|
|
MVI ADULT VITS FOR INFUSION
|
Facility
OP
|
$639.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$447.30 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: AETNA Commercial |
$607.05
|
| Rate for Payer: AETNA Medicare |
$575.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$607.05
|
| Rate for Payer: BCBS Healthlink |
$575.10
|
| Rate for Payer: BCBS HMK CHIP |
$575.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$575.10
|
| Rate for Payer: BCBS POS |
$607.05
|
| Rate for Payer: BCBS Traditional |
$639.00
|
| Rate for Payer: CASH_PRICE |
$511.20
|
| Rate for Payer: CIGNA Commercial |
$607.05
|
| Rate for Payer: CIGNA Medicare |
$575.10
|
| Rate for Payer: HUMANA Commercial |
$575.10
|
| Rate for Payer: MEDICAID Medicaid |
$587.88
|
| Rate for Payer: MEDICARE Medicare |
$447.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$607.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$619.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$607.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$607.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$543.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$511.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$511.20
|
|
|
MYCOPHENOLIC ACID (716795)
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: AETNA Commercial |
$245.10
|
| Rate for Payer: AETNA Medicare |
$232.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$245.10
|
| Rate for Payer: BCBS Healthlink |
$232.20
|
| Rate for Payer: BCBS HMK CHIP |
$232.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$232.20
|
| Rate for Payer: BCBS POS |
$245.10
|
| Rate for Payer: BCBS Traditional |
$258.00
|
| Rate for Payer: CASH_PRICE |
$206.40
|
| Rate for Payer: CIGNA Commercial |
$245.10
|
| Rate for Payer: CIGNA Medicare |
$232.20
|
| Rate for Payer: HUMANA Commercial |
$232.20
|
| Rate for Payer: MEDICAID Medicaid |
$237.36
|
| Rate for Payer: MEDICARE Medicare |
$180.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$245.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$250.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$245.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$245.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$219.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$206.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$206.40
|
|
|
MYCOPHENOLIC ACID (716795)
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: AETNA Commercial |
$245.10
|
| Rate for Payer: AETNA Medicare |
$232.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$245.10
|
| Rate for Payer: BCBS Healthlink |
$232.20
|
| Rate for Payer: BCBS HMK CHIP |
$232.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$232.20
|
| Rate for Payer: BCBS POS |
$245.10
|
| Rate for Payer: BCBS Traditional |
$258.00
|
| Rate for Payer: CASH_PRICE |
$206.40
|
| Rate for Payer: CIGNA Commercial |
$245.10
|
| Rate for Payer: CIGNA Medicare |
$232.20
|
| Rate for Payer: HUMANA Commercial |
$232.20
|
| Rate for Payer: MEDICAID Medicaid |
$237.36
|
| Rate for Payer: MEDICARE Medicare |
$180.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$245.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$250.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$245.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$245.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$219.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$206.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$206.40
|
|
|
MYOGLOBIN (010405)
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
MYOGLOBIN (010405)
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
NACL 0.9% FLUSH [10 ML]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
NACL 0.9% FLUSH [10 ML]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
NACL 0.9% INJ [10 ML]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT A4216
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
NACL 0.9% INJ [10 ML]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT A4216
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
NALBUPHINE INJ [10 MG/ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
