|
AZITHROMYCIN SUSP [100 MG/5 ML]
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
AZITHROMYCIN SUSP [100 MG/5 ML]
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
AZITHROMYCIN TAB [250 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT Q0144
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
AZITHROMYCIN TAB [250 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT Q0144
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
AZITHROMYCIN Z-PACK TAB [250 MG] 6 TABS
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT Q0144
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: BCBS HMK CHIP |
$141.30
|
| 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 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
|
|
|
AZITHROMYCIN Z-PACK TAB [250 MG] 6 TABS
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT Q0144
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
BACLOFEN TAB [10 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
BACLOFEN TAB [10 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
BAIR HUGGER BLANKET
|
Facility
IP
|
$32.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
BAIR HUGGER BLANKET
|
Facility
OP
|
$32.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
BASIC METABOLIC PANEL
|
Facility
OP
|
$158.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: AETNA Commercial |
$150.10
|
| Rate for Payer: AETNA Medicare |
$142.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$150.10
|
| Rate for Payer: BCBS Healthlink |
$142.20
|
| Rate for Payer: BCBS HMK CHIP |
$142.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$142.20
|
| Rate for Payer: BCBS POS |
$150.10
|
| Rate for Payer: BCBS Traditional |
$158.00
|
| Rate for Payer: CASH_PRICE |
$126.40
|
| Rate for Payer: CIGNA Commercial |
$150.10
|
| Rate for Payer: CIGNA Medicare |
$142.20
|
| Rate for Payer: HUMANA Commercial |
$142.20
|
| Rate for Payer: MEDICAID Medicaid |
$145.36
|
| Rate for Payer: MEDICARE Medicare |
$110.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$150.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$153.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$150.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$150.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$134.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$126.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$126.40
|
|
|
BASIC METABOLIC PANEL
|
Facility
IP
|
$158.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: AETNA Commercial |
$150.10
|
| Rate for Payer: AETNA Medicare |
$142.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$150.10
|
| Rate for Payer: BCBS Healthlink |
$142.20
|
| Rate for Payer: BCBS HMK CHIP |
$142.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$142.20
|
| Rate for Payer: BCBS POS |
$150.10
|
| Rate for Payer: BCBS Traditional |
$158.00
|
| Rate for Payer: CASH_PRICE |
$126.40
|
| Rate for Payer: CIGNA Commercial |
$150.10
|
| Rate for Payer: CIGNA Medicare |
$142.20
|
| Rate for Payer: HUMANA Commercial |
$142.20
|
| Rate for Payer: MEDICAID Medicaid |
$145.36
|
| Rate for Payer: MEDICARE Medicare |
$110.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$150.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$153.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$150.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$150.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$134.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$126.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$126.40
|
|
|
BB ADMINISTRATION BLOOD/DAY
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: BCBS HMK CHIP |
$567.00
|
| Rate for Payer: AETNA Commercial |
$598.50
|
| Rate for Payer: AETNA Medicare |
$567.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$598.50
|
| Rate for Payer: BCBS Healthlink |
$567.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$567.00
|
| Rate for Payer: BCBS POS |
$598.50
|
| Rate for Payer: BCBS Traditional |
$630.00
|
| Rate for Payer: CASH_PRICE |
$504.00
|
| Rate for Payer: CIGNA Commercial |
$598.50
|
| Rate for Payer: CIGNA Medicare |
$567.00
|
| Rate for Payer: HUMANA Commercial |
$567.00
|
| Rate for Payer: MEDICAID Medicaid |
$579.60
|
| Rate for Payer: MEDICARE Medicare |
$441.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$598.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$611.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$598.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$598.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$535.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$504.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$504.00
|
|
|
BB ADMINISTRATION BLOOD/DAY
|
Facility
OP
|
$630.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: AETNA Commercial |
$598.50
|
| Rate for Payer: AETNA Medicare |
$567.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$598.50
|
| Rate for Payer: BCBS Healthlink |
$567.00
|
| Rate for Payer: BCBS HMK CHIP |
$567.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$567.00
|
| Rate for Payer: BCBS POS |
$598.50
|
| Rate for Payer: BCBS Traditional |
$630.00
|
| Rate for Payer: CASH_PRICE |
$504.00
|
| Rate for Payer: CIGNA Commercial |
$598.50
|
| Rate for Payer: CIGNA Medicare |
$567.00
|
| Rate for Payer: HUMANA Commercial |
$567.00
|
| Rate for Payer: MEDICAID Medicaid |
$579.60
|
| Rate for Payer: MEDICARE Medicare |
$441.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$598.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$611.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$598.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$598.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$535.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$504.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$504.00
|
|
|
BB BLOOD PACKED CELLS
|
Facility
OP
|
$659.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$461.30 |
| Max. Negotiated Rate |
$659.00 |
| Rate for Payer: AETNA Commercial |
$626.05
|
| Rate for Payer: AETNA Medicare |
$593.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$626.05
|
| Rate for Payer: BCBS Healthlink |
$593.10
|
| Rate for Payer: BCBS HMK CHIP |
$593.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$593.10
|
| Rate for Payer: BCBS POS |
$626.05
|
| Rate for Payer: BCBS Traditional |
$659.00
|
| Rate for Payer: CASH_PRICE |
$527.20
|
| Rate for Payer: CIGNA Commercial |
$626.05
|
| Rate for Payer: CIGNA Medicare |
$593.10
|
| Rate for Payer: HUMANA Commercial |
$593.10
|
| Rate for Payer: MEDICAID Medicaid |
$606.28
|
| Rate for Payer: MEDICARE Medicare |
$461.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$626.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$639.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$626.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$626.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$560.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$527.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$527.20
|
|
|
BB BLOOD PACKED CELLS
|
Facility
IP
|
$659.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$461.30 |
| Max. Negotiated Rate |
$659.00 |
| Rate for Payer: AETNA Commercial |
$626.05
|
| Rate for Payer: AETNA Medicare |
$593.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$626.05
|
| Rate for Payer: BCBS Healthlink |
$593.10
|
| Rate for Payer: BCBS HMK CHIP |
$593.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$593.10
|
| Rate for Payer: BCBS POS |
$626.05
|
| Rate for Payer: BCBS Traditional |
$659.00
|
| Rate for Payer: CASH_PRICE |
$527.20
|
| Rate for Payer: CIGNA Commercial |
$626.05
|
| Rate for Payer: CIGNA Medicare |
$593.10
|
| Rate for Payer: HUMANA Commercial |
$593.10
|
| Rate for Payer: MEDICAID Medicaid |
$606.28
|
| Rate for Payer: MEDICARE Medicare |
$461.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$626.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$639.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$626.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$626.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$560.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$527.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$527.20
|
|
|
.B CELLS, TOTAL COUNT
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
20220519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: AETNA Commercial |
$118.75
|
| Rate for Payer: AETNA Medicare |
$112.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$118.75
|
| Rate for Payer: BCBS Healthlink |
$112.50
|
| Rate for Payer: BCBS HMK CHIP |
$112.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$112.50
|
| Rate for Payer: BCBS POS |
$118.75
|
| Rate for Payer: BCBS Traditional |
$125.00
|
| Rate for Payer: CASH_PRICE |
$100.00
|
| Rate for Payer: CIGNA Commercial |
$118.75
|
| Rate for Payer: CIGNA Medicare |
$112.50
|
| Rate for Payer: HUMANA Commercial |
$112.50
|
| Rate for Payer: MEDICAID Medicaid |
$115.00
|
| Rate for Payer: MEDICARE Medicare |
$87.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$118.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$121.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$118.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$118.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$106.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.00
|
|
|
.B CELLS, TOTAL COUNT
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
20220519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: AETNA Commercial |
$118.75
|
| Rate for Payer: AETNA Medicare |
$112.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$118.75
|
| Rate for Payer: BCBS Healthlink |
$112.50
|
| Rate for Payer: BCBS HMK CHIP |
$112.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$112.50
|
| Rate for Payer: BCBS POS |
$118.75
|
| Rate for Payer: BCBS Traditional |
$125.00
|
| Rate for Payer: CASH_PRICE |
$100.00
|
| Rate for Payer: CIGNA Commercial |
$118.75
|
| Rate for Payer: CIGNA Medicare |
$112.50
|
| Rate for Payer: HUMANA Commercial |
$112.50
|
| Rate for Payer: MEDICAID Medicaid |
$115.00
|
| Rate for Payer: MEDICARE Medicare |
$87.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$118.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$121.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$118.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$118.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$106.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.00
|
|
|
.B CELLS, TOTAL COUNT (506049)
|
Facility
OP
|
$303.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
.B CELLS, TOTAL COUNT (506049)
|
Facility
IP
|
$303.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
BEBTELOVIMAB INTRAVENOUS INJ &MONITORING
|
Facility
IP
|
$368.00
|
|
|
Service Code
|
CPT M0222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: BCBS HMK CHIP |
$331.20
|
| Rate for Payer: AETNA Commercial |
$349.60
|
| Rate for Payer: AETNA Medicare |
$331.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$349.60
|
| Rate for Payer: BCBS Healthlink |
$331.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$331.20
|
| Rate for Payer: BCBS POS |
$349.60
|
| Rate for Payer: BCBS Traditional |
$368.00
|
| Rate for Payer: CASH_PRICE |
$294.40
|
| Rate for Payer: CIGNA Commercial |
$349.60
|
| Rate for Payer: CIGNA Medicare |
$331.20
|
| Rate for Payer: HUMANA Commercial |
$331.20
|
| Rate for Payer: MEDICAID Medicaid |
$338.56
|
| Rate for Payer: MEDICARE Medicare |
$257.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$349.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$356.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$349.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$294.40
|
|
|
BEBTELOVIMAB INTRAVENOUS INJ &MONITORING
|
Facility
OP
|
$368.00
|
|
|
Service Code
|
CPT M0222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: AETNA Commercial |
$349.60
|
| Rate for Payer: AETNA Medicare |
$331.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$349.60
|
| Rate for Payer: BCBS Healthlink |
$331.20
|
| Rate for Payer: BCBS HMK CHIP |
$331.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$331.20
|
| Rate for Payer: BCBS POS |
$349.60
|
| Rate for Payer: BCBS Traditional |
$368.00
|
| Rate for Payer: CASH_PRICE |
$294.40
|
| Rate for Payer: CIGNA Commercial |
$349.60
|
| Rate for Payer: CIGNA Medicare |
$331.20
|
| Rate for Payer: HUMANA Commercial |
$331.20
|
| Rate for Payer: MEDICAID Medicaid |
$338.56
|
| Rate for Payer: MEDICARE Medicare |
$257.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$349.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$356.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$349.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$294.40
|
|
|
BENZION SWAB
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
BENZION SWAB
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
BENZONATATE CAP [100 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
