|
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
|
|
|
.BETA-2 GLYCOPROTEIN 1 AB, IGA
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
.BETA-2 GLYCOPROTEIN 1 AB, IGA
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
BETA-2 GLYCOPROTEIN 1 AB, IGG (163882)
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
BETA-2 GLYCOPROTEIN 1 AB, IGG (163882)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
BETA-2 GLYCOPROTEIN 1 AB, IGM (163908)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
BETA-2 GLYCOPROTEIN 1 AB, IGM (163908)
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
BETA 2 MICROGLOBULIN (010181)
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
BETA 2 MICROGLOBULIN (010181)
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
BETA-2 TRANSFERRIN (829030)
|
Facility
OP
|
$361.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$252.70 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: AETNA Commercial |
$342.95
|
| Rate for Payer: AETNA Medicare |
$324.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$342.95
|
| Rate for Payer: BCBS Healthlink |
$324.90
|
| Rate for Payer: BCBS HMK CHIP |
$324.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$324.90
|
| Rate for Payer: BCBS POS |
$342.95
|
| Rate for Payer: BCBS Traditional |
$361.00
|
| Rate for Payer: CASH_PRICE |
$288.80
|
| Rate for Payer: CIGNA Commercial |
$342.95
|
| Rate for Payer: CIGNA Medicare |
$324.90
|
| Rate for Payer: HUMANA Commercial |
$324.90
|
| Rate for Payer: MEDICAID Medicaid |
$332.12
|
| Rate for Payer: MEDICARE Medicare |
$252.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$342.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$350.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$342.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$342.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$306.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$288.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$288.80
|
|
|
BETA-2 TRANSFERRIN (829030)
|
Facility
IP
|
$361.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$252.70 |
| Max. Negotiated Rate |
$361.00 |
| Rate for Payer: BCBS HMK CHIP |
$324.90
|
| Rate for Payer: AETNA Commercial |
$342.95
|
| Rate for Payer: AETNA Medicare |
$324.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$342.95
|
| Rate for Payer: BCBS Healthlink |
$324.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$324.90
|
| Rate for Payer: BCBS POS |
$342.95
|
| Rate for Payer: BCBS Traditional |
$361.00
|
| Rate for Payer: CASH_PRICE |
$288.80
|
| Rate for Payer: CIGNA Commercial |
$342.95
|
| Rate for Payer: CIGNA Medicare |
$324.90
|
| Rate for Payer: HUMANA Commercial |
$324.90
|
| Rate for Payer: MEDICAID Medicaid |
$332.12
|
| Rate for Payer: MEDICARE Medicare |
$252.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$342.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$350.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$342.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$342.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$306.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$288.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$288.80
|
|
|
BETADINE SWAB STICKS
|
Facility
IP
|
$5.00
|
|
| 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
|
|
|
BETADINE SWAB STICKS
|
Facility
OP
|
$5.00
|
|
| 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
|
|
|
BETA-HYDROXYBUTYRATE (503610)
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: BCBS HMK CHIP |
$193.50
|
| Rate for Payer: AETNA Commercial |
$204.25
|
| Rate for Payer: AETNA Medicare |
$193.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$204.25
|
| Rate for Payer: BCBS Healthlink |
$193.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$193.50
|
| Rate for Payer: BCBS POS |
$204.25
|
| Rate for Payer: BCBS Traditional |
$215.00
|
| Rate for Payer: CASH_PRICE |
$172.00
|
| Rate for Payer: CIGNA Commercial |
$204.25
|
| Rate for Payer: CIGNA Medicare |
$193.50
|
| Rate for Payer: HUMANA Commercial |
$193.50
|
| Rate for Payer: MEDICAID Medicaid |
$197.80
|
| Rate for Payer: MEDICARE Medicare |
$150.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$204.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$208.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$204.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$204.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$182.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$172.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$172.00
|
|
|
BETA-HYDROXYBUTYRATE (503610)
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: AETNA Commercial |
$204.25
|
| Rate for Payer: AETNA Medicare |
$193.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$204.25
|
| Rate for Payer: BCBS Healthlink |
$193.50
|
| Rate for Payer: BCBS HMK CHIP |
$193.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$193.50
|
| Rate for Payer: BCBS POS |
$204.25
|
| Rate for Payer: BCBS Traditional |
$215.00
|
| Rate for Payer: CASH_PRICE |
$172.00
|
| Rate for Payer: CIGNA Commercial |
$204.25
|
| Rate for Payer: CIGNA Medicare |
$193.50
|
| Rate for Payer: HUMANA Commercial |
$193.50
|
| Rate for Payer: MEDICAID Medicaid |
$197.80
|
| Rate for Payer: MEDICARE Medicare |
$150.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$204.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$208.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$204.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$204.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$182.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$172.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$172.00
|
|
|
BETAMETHASONE INJ [6 MG/ML]
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
BETAMETHASONE INJ [6 MG/ML]
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
BILIRUBIN, TOTAL
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
BILIRUBIN, TOTAL
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
BIOPSY-INCISION SNGL LESION-11106
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: AETNA Commercial |
$167.20
|
| Rate for Payer: AETNA Medicare |
$158.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$167.20
|
| Rate for Payer: BCBS Healthlink |
$158.40
|
| Rate for Payer: BCBS HMK CHIP |
$158.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$158.40
|
| Rate for Payer: BCBS POS |
$167.20
|
| Rate for Payer: BCBS Traditional |
$176.00
|
| Rate for Payer: CASH_PRICE |
$140.80
|
| Rate for Payer: CIGNA Commercial |
$167.20
|
| Rate for Payer: CIGNA Medicare |
$158.40
|
| Rate for Payer: HUMANA Commercial |
$158.40
|
| Rate for Payer: MEDICAID Medicaid |
$161.92
|
| Rate for Payer: MEDICARE Medicare |
$123.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$167.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$170.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$167.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$167.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$140.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$140.80
|
|
|
BIOPSY-INCISION SNGL LESION-11106
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: BCBS HMK CHIP |
$158.40
|
| Rate for Payer: AETNA Commercial |
$167.20
|
| Rate for Payer: AETNA Medicare |
$158.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$167.20
|
| Rate for Payer: BCBS Healthlink |
$158.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$158.40
|
| Rate for Payer: BCBS POS |
$167.20
|
| Rate for Payer: BCBS Traditional |
$176.00
|
| Rate for Payer: CASH_PRICE |
$140.80
|
| Rate for Payer: CIGNA Commercial |
$167.20
|
| Rate for Payer: CIGNA Medicare |
$158.40
|
| Rate for Payer: HUMANA Commercial |
$158.40
|
| Rate for Payer: MEDICAID Medicaid |
$161.92
|
| Rate for Payer: MEDICARE Medicare |
$123.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$167.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$170.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$167.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$167.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$140.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$140.80
|
|
|
BIOPSY LIP
|
Facility
IP
|
$336.00
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: AETNA Commercial |
$319.20
|
| Rate for Payer: AETNA Medicare |
$302.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$319.20
|
| Rate for Payer: BCBS Healthlink |
$302.40
|
| Rate for Payer: BCBS HMK CHIP |
$302.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$302.40
|
| Rate for Payer: BCBS POS |
$319.20
|
| Rate for Payer: BCBS Traditional |
$336.00
|
| Rate for Payer: CASH_PRICE |
$268.80
|
| Rate for Payer: CIGNA Commercial |
$319.20
|
| Rate for Payer: CIGNA Medicare |
$302.40
|
| Rate for Payer: HUMANA Commercial |
$302.40
|
| Rate for Payer: MEDICAID Medicaid |
$309.12
|
| Rate for Payer: MEDICARE Medicare |
$235.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$319.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$325.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$319.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$319.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$285.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$268.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$268.80
|
|
|
BIOPSY LIP
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
CPT 40490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: AETNA Commercial |
$319.20
|
| Rate for Payer: AETNA Medicare |
$302.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$319.20
|
| Rate for Payer: BCBS Healthlink |
$302.40
|
| Rate for Payer: BCBS HMK CHIP |
$302.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$302.40
|
| Rate for Payer: BCBS POS |
$319.20
|
| Rate for Payer: BCBS Traditional |
$336.00
|
| Rate for Payer: CASH_PRICE |
$268.80
|
| Rate for Payer: CIGNA Commercial |
$319.20
|
| Rate for Payer: CIGNA Medicare |
$302.40
|
| Rate for Payer: HUMANA Commercial |
$302.40
|
| Rate for Payer: MEDICAID Medicaid |
$309.12
|
| Rate for Payer: MEDICARE Medicare |
$235.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$319.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$325.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$319.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$319.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$285.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$268.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$268.80
|
|
|
BIOPSY LYMPH NODE
|
Facility
IP
|
$594.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: BCBS HMK CHIP |
$534.60
|
| Rate for Payer: AETNA Commercial |
$564.30
|
| Rate for Payer: AETNA Medicare |
$534.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$564.30
|
| Rate for Payer: BCBS Healthlink |
$534.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$534.60
|
| Rate for Payer: BCBS POS |
$564.30
|
| Rate for Payer: BCBS Traditional |
$594.00
|
| Rate for Payer: CASH_PRICE |
$475.20
|
| Rate for Payer: CIGNA Commercial |
$564.30
|
| Rate for Payer: CIGNA Medicare |
$534.60
|
| Rate for Payer: HUMANA Commercial |
$534.60
|
| Rate for Payer: MEDICAID Medicaid |
$546.48
|
| Rate for Payer: MEDICARE Medicare |
$415.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$564.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$576.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$564.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$564.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$504.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$475.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$475.20
|
|
|
BIOPSY LYMPH NODE
|
Facility
OP
|
$594.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: AETNA Commercial |
$564.30
|
| Rate for Payer: AETNA Medicare |
$534.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$564.30
|
| Rate for Payer: BCBS Healthlink |
$534.60
|
| Rate for Payer: BCBS HMK CHIP |
$534.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$534.60
|
| Rate for Payer: BCBS POS |
$564.30
|
| Rate for Payer: BCBS Traditional |
$594.00
|
| Rate for Payer: CASH_PRICE |
$475.20
|
| Rate for Payer: CIGNA Commercial |
$564.30
|
| Rate for Payer: CIGNA Medicare |
$534.60
|
| Rate for Payer: HUMANA Commercial |
$534.60
|
| Rate for Payer: MEDICAID Medicaid |
$546.48
|
| Rate for Payer: MEDICARE Medicare |
$415.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$564.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$576.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$564.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$564.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$504.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$475.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$475.20
|
|
