|
OV DISABILITY WC OR MEDICAL EVAL
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 99455
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
OV EXTENDED ESTAB PATIENT (99215)
|
Facility
OP
|
$317.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: AETNA Commercial |
$301.15
|
| Rate for Payer: AETNA Medicare |
$285.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$301.15
|
| Rate for Payer: BCBS Healthlink |
$285.30
|
| Rate for Payer: BCBS HMK CHIP |
$285.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$285.30
|
| Rate for Payer: BCBS POS |
$301.15
|
| Rate for Payer: BCBS Traditional |
$317.00
|
| Rate for Payer: CASH_PRICE |
$253.60
|
| Rate for Payer: CIGNA Commercial |
$301.15
|
| Rate for Payer: CIGNA Medicare |
$285.30
|
| Rate for Payer: HUMANA Commercial |
$285.30
|
| Rate for Payer: MEDICAID Medicaid |
$291.64
|
| Rate for Payer: MEDICARE Medicare |
$221.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$301.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$307.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$301.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$301.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$269.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$253.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$253.60
|
|
|
OV EXTENDED ESTAB PATIENT (99215)
|
Facility
IP
|
$317.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: AETNA Commercial |
$301.15
|
| Rate for Payer: AETNA Medicare |
$285.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$301.15
|
| Rate for Payer: BCBS Healthlink |
$285.30
|
| Rate for Payer: BCBS HMK CHIP |
$285.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$285.30
|
| Rate for Payer: BCBS POS |
$301.15
|
| Rate for Payer: BCBS Traditional |
$317.00
|
| Rate for Payer: CASH_PRICE |
$253.60
|
| Rate for Payer: CIGNA Commercial |
$301.15
|
| Rate for Payer: CIGNA Medicare |
$285.30
|
| Rate for Payer: HUMANA Commercial |
$285.30
|
| Rate for Payer: MEDICAID Medicaid |
$291.64
|
| Rate for Payer: MEDICARE Medicare |
$221.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$301.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$307.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$301.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$301.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$269.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$253.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$253.60
|
|
|
OV EXTENDED NEW PATIENT (99204)
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
OV EXTENDED NEW PATIENT (99204)
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
OV INTERMEDIATE ESTAB PATIENT (99214)
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
OV INTERMEDIATE ESTAB PATIENT (99214)
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
OV INTERMEDIATE NEW PATIENT (99203)
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
OV INTERMEDIATE NEW PATIENT (99203)
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
OV LIFE, DOT, SPORTS EVAL
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 99450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
OV LIFE, DOT, SPORTS EVAL
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 99450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: AETNA Commercial |
$163.40
|
| Rate for Payer: AETNA Medicare |
$154.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.40
|
| Rate for Payer: BCBS Healthlink |
$154.80
|
| Rate for Payer: BCBS HMK CHIP |
$154.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$154.80
|
| Rate for Payer: BCBS POS |
$163.40
|
| Rate for Payer: BCBS Traditional |
$172.00
|
| Rate for Payer: CASH_PRICE |
$137.60
|
| Rate for Payer: CIGNA Commercial |
$163.40
|
| Rate for Payer: CIGNA Medicare |
$154.80
|
| Rate for Payer: HUMANA Commercial |
$154.80
|
| Rate for Payer: MEDICAID Medicaid |
$158.24
|
| Rate for Payer: MEDICARE Medicare |
$120.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$166.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.60
|
|
|
OV LIMITED ESTAB PATIENT (99213)
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
OV LIMITED ESTAB PATIENT (99213)
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
OV LIMITED NEW PATIENT (99202)
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
OV LIMITED NEW PATIENT (99202)
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
OV MINIMAL - NURSE ONLY (99211)
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
OV MINIMAL - NURSE ONLY (99211)
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
OV PROSTATE SCREEN MCR ONLY BRIEF
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT G0102
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: AETNA Commercial |
$54.15
|
| Rate for Payer: AETNA Medicare |
$51.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$54.15
|
| Rate for Payer: BCBS Healthlink |
$51.30
|
| Rate for Payer: BCBS HMK CHIP |
$51.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$51.30
|
| Rate for Payer: BCBS POS |
$54.15
|
| Rate for Payer: BCBS Traditional |
$57.00
|
| Rate for Payer: CASH_PRICE |
$45.60
|
| Rate for Payer: CIGNA Commercial |
$54.15
|
| Rate for Payer: CIGNA Medicare |
$51.30
|
| Rate for Payer: HUMANA Commercial |
$51.30
|
| Rate for Payer: MEDICAID Medicaid |
$52.44
|
| Rate for Payer: MEDICARE Medicare |
$39.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$54.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$55.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$54.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$54.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$45.60
|
|
|
OV PROSTATE SCREEN MCR ONLY BRIEF
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT G0102
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: AETNA Commercial |
$54.15
|
| Rate for Payer: AETNA Medicare |
$51.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$54.15
|
| Rate for Payer: BCBS Healthlink |
$51.30
|
| Rate for Payer: BCBS HMK CHIP |
$51.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$51.30
|
| Rate for Payer: BCBS POS |
$54.15
|
| Rate for Payer: BCBS Traditional |
$57.00
|
| Rate for Payer: CASH_PRICE |
$45.60
|
| Rate for Payer: CIGNA Commercial |
$54.15
|
| Rate for Payer: CIGNA Medicare |
$51.30
|
| Rate for Payer: HUMANA Commercial |
$51.30
|
| Rate for Payer: MEDICAID Medicaid |
$52.44
|
| Rate for Payer: MEDICARE Medicare |
$39.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$54.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$55.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$54.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$54.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$48.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$45.60
|
|
|
OXACILLIN 10 GRAM VIAL-NF
|
Facility
OP
|
$223.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$156.10 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: AETNA Commercial |
$211.85
|
| Rate for Payer: AETNA Medicare |
$200.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$211.85
|
| Rate for Payer: BCBS Healthlink |
$200.70
|
| Rate for Payer: BCBS HMK CHIP |
$200.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$200.70
|
| Rate for Payer: BCBS POS |
$211.85
|
| Rate for Payer: BCBS Traditional |
$223.00
|
| Rate for Payer: CASH_PRICE |
$178.40
|
| Rate for Payer: CIGNA Commercial |
$211.85
|
| Rate for Payer: CIGNA Medicare |
$200.70
|
| Rate for Payer: HUMANA Commercial |
$200.70
|
| Rate for Payer: MEDICAID Medicaid |
$205.16
|
| Rate for Payer: MEDICARE Medicare |
$156.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$211.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$216.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$211.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$211.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$189.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$178.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$178.40
|
|
|
OXACILLIN 10 GRAM VIAL-NF
|
Facility
IP
|
$223.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$156.10 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: AETNA Commercial |
$211.85
|
| Rate for Payer: AETNA Medicare |
$200.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$211.85
|
| Rate for Payer: BCBS Healthlink |
$200.70
|
| Rate for Payer: BCBS HMK CHIP |
$200.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$200.70
|
| Rate for Payer: BCBS POS |
$211.85
|
| Rate for Payer: BCBS Traditional |
$223.00
|
| Rate for Payer: CASH_PRICE |
$178.40
|
| Rate for Payer: CIGNA Commercial |
$211.85
|
| Rate for Payer: CIGNA Medicare |
$200.70
|
| Rate for Payer: HUMANA Commercial |
$200.70
|
| Rate for Payer: MEDICAID Medicaid |
$205.16
|
| Rate for Payer: MEDICARE Medicare |
$156.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$211.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$216.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$211.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$211.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$189.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$178.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$178.40
|
|
|
OXACILLIN 2 GRAM VIAL-NF
|
Facility
OP
|
$97.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: AETNA Commercial |
$92.15
|
| Rate for Payer: AETNA Medicare |
$87.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$92.15
|
| Rate for Payer: BCBS Healthlink |
$87.30
|
| Rate for Payer: BCBS HMK CHIP |
$87.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$87.30
|
| Rate for Payer: BCBS POS |
$92.15
|
| Rate for Payer: BCBS Traditional |
$97.00
|
| Rate for Payer: CASH_PRICE |
$77.60
|
| Rate for Payer: CIGNA Commercial |
$92.15
|
| Rate for Payer: CIGNA Medicare |
$87.30
|
| Rate for Payer: HUMANA Commercial |
$87.30
|
| Rate for Payer: MEDICAID Medicaid |
$89.24
|
| Rate for Payer: MEDICARE Medicare |
$67.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$92.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$94.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$92.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$92.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$82.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$77.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$77.60
|
|
|
OXACILLIN 2 GRAM VIAL-NF
|
Facility
IP
|
$97.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.90 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: AETNA Commercial |
$92.15
|
| Rate for Payer: AETNA Medicare |
$87.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$92.15
|
| Rate for Payer: BCBS Healthlink |
$87.30
|
| Rate for Payer: BCBS HMK CHIP |
$87.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$87.30
|
| Rate for Payer: BCBS POS |
$92.15
|
| Rate for Payer: BCBS Traditional |
$97.00
|
| Rate for Payer: CASH_PRICE |
$77.60
|
| Rate for Payer: CIGNA Commercial |
$92.15
|
| Rate for Payer: CIGNA Medicare |
$87.30
|
| Rate for Payer: HUMANA Commercial |
$87.30
|
| Rate for Payer: MEDICAID Medicaid |
$89.24
|
| Rate for Payer: MEDICARE Medicare |
$67.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$92.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$94.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$92.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$92.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$82.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$77.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$77.60
|
|
|
OXCARBAZEPINE METABOLITE (716928)
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
OXCARBAZEPINE METABOLITE (716928)
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
