|
PROTEIN ELECTROPHORESIS, SERUM (001487)
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
.PROTEIN ELECTROPHORESIS, URINE
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
307
|
| 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
|
|
|
.PROTEIN ELECTROPHORESIS, URINE
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
307
|
| 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
|
|
|
PROTEIN ELECTRO W/ REFLEX IFE (123100)
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
PROTEIN ELECTRO W/ REFLEX IFE (123100)
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
PROTEIN S ANTIGEN (164517)
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
PROTEIN S ANTIGEN (164517)
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
.PROTEIN S, TOTAL
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
.PROTEIN S, TOTAL
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
PROTEIN, TOTAL
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
PROTEIN, TOTAL
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
PROTEIN, TOTAL, URINE, RANDOM (013664)
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.40
|
| Rate for Payer: AETNA Commercial |
$11.40
|
| Rate for Payer: AETNA Medicare |
$10.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.40
|
| Rate for Payer: BCBS Healthlink |
$10.80
|
| Rate for Payer: BCBS HMK CHIP |
$10.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10.80
|
| Rate for Payer: BCBS POS |
$11.40
|
| Rate for Payer: BCBS Traditional |
$12.00
|
| Rate for Payer: CASH_PRICE |
$9.60
|
| Rate for Payer: CIGNA Commercial |
$11.40
|
| Rate for Payer: CIGNA Medicare |
$10.80
|
| Rate for Payer: HUMANA Commercial |
$10.80
|
| Rate for Payer: MEDICAID Medicaid |
$11.04
|
| Rate for Payer: MEDICARE Medicare |
$8.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.60
|
|
|
PROTEIN, TOTAL, URINE, RANDOM (013664)
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: AETNA Commercial |
$11.40
|
| Rate for Payer: AETNA Medicare |
$10.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.40
|
| Rate for Payer: BCBS Healthlink |
$10.80
|
| Rate for Payer: BCBS HMK CHIP |
$10.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10.80
|
| Rate for Payer: BCBS POS |
$11.40
|
| Rate for Payer: BCBS Traditional |
$12.00
|
| Rate for Payer: CASH_PRICE |
$9.60
|
| Rate for Payer: CIGNA Commercial |
$11.40
|
| Rate for Payer: CIGNA Medicare |
$10.80
|
| Rate for Payer: HUMANA Commercial |
$10.80
|
| Rate for Payer: MEDICAID Medicaid |
$11.04
|
| Rate for Payer: MEDICARE Medicare |
$8.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.60
|
|
|
PROTHROMBIN GENE ANALYSIS (511162)
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AETNA Commercial |
$256.50
|
| Rate for Payer: AETNA Medicare |
$243.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$256.50
|
| Rate for Payer: BCBS Healthlink |
$243.00
|
| Rate for Payer: BCBS HMK CHIP |
$243.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.00
|
| Rate for Payer: BCBS POS |
$256.50
|
| Rate for Payer: BCBS Traditional |
$270.00
|
| Rate for Payer: CASH_PRICE |
$216.00
|
| Rate for Payer: CIGNA Commercial |
$256.50
|
| Rate for Payer: CIGNA Medicare |
$243.00
|
| Rate for Payer: HUMANA Commercial |
$243.00
|
| Rate for Payer: MEDICAID Medicaid |
$248.40
|
| Rate for Payer: MEDICARE Medicare |
$189.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$256.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$261.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$256.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$256.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$229.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.00
|
|
|
PROTHROMBIN GENE ANALYSIS (511162)
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AETNA Commercial |
$256.50
|
| Rate for Payer: AETNA Medicare |
$243.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$256.50
|
| Rate for Payer: BCBS Healthlink |
$243.00
|
| Rate for Payer: BCBS HMK CHIP |
$243.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$243.00
|
| Rate for Payer: BCBS POS |
$256.50
|
| Rate for Payer: BCBS Traditional |
$270.00
|
| Rate for Payer: CASH_PRICE |
$216.00
|
| Rate for Payer: CIGNA Commercial |
$256.50
|
| Rate for Payer: CIGNA Medicare |
$243.00
|
| Rate for Payer: HUMANA Commercial |
$243.00
|
| Rate for Payer: MEDICAID Medicaid |
$248.40
|
| Rate for Payer: MEDICARE Medicare |
$189.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$256.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$261.90
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$256.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$256.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$229.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$216.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$216.00
|
|
|
PROTHROMBIN TIME (005199)
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: AETNA Commercial |
$6.65
|
| Rate for Payer: AETNA Medicare |
$6.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6.65
|
| Rate for Payer: BCBS Healthlink |
$6.30
|
| Rate for Payer: BCBS HMK CHIP |
$6.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6.30
|
| Rate for Payer: BCBS POS |
$6.65
|
| Rate for Payer: BCBS Traditional |
$7.00
|
| Rate for Payer: CASH_PRICE |
$5.60
|
| Rate for Payer: CIGNA Commercial |
$6.65
|
| Rate for Payer: CIGNA Medicare |
$6.30
|
| Rate for Payer: HUMANA Commercial |
$6.30
|
| Rate for Payer: MEDICAID Medicaid |
$6.44
|
| Rate for Payer: MEDICARE Medicare |
$4.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5.60
|
|
|
PROTHROMBIN TIME (005199)
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6.65
|
| Rate for Payer: AETNA Commercial |
$6.65
|
| Rate for Payer: AETNA Medicare |
$6.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6.65
|
| Rate for Payer: BCBS Healthlink |
$6.30
|
| Rate for Payer: BCBS HMK CHIP |
$6.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6.30
|
| Rate for Payer: BCBS POS |
$6.65
|
| Rate for Payer: BCBS Traditional |
$7.00
|
| Rate for Payer: CASH_PRICE |
$5.60
|
| Rate for Payer: CIGNA Commercial |
$6.65
|
| Rate for Payer: CIGNA Medicare |
$6.30
|
| Rate for Payer: HUMANA Commercial |
$6.30
|
| Rate for Payer: MEDICAID Medicaid |
$6.44
|
| Rate for Payer: MEDICARE Medicare |
$4.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5.60
|
|
|
PROTIME/INR
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: AETNA Commercial |
$63.65
|
| Rate for Payer: AETNA Medicare |
$60.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$63.65
|
| Rate for Payer: BCBS Healthlink |
$60.30
|
| Rate for Payer: BCBS HMK CHIP |
$60.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$60.30
|
| Rate for Payer: BCBS POS |
$63.65
|
| Rate for Payer: BCBS Traditional |
$67.00
|
| Rate for Payer: CASH_PRICE |
$53.60
|
| Rate for Payer: CIGNA Commercial |
$63.65
|
| Rate for Payer: CIGNA Medicare |
$60.30
|
| Rate for Payer: HUMANA Commercial |
$60.30
|
| Rate for Payer: MEDICAID Medicaid |
$61.64
|
| Rate for Payer: MEDICARE Medicare |
$46.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$63.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$63.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$63.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$53.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$53.60
|
|
|
PROTIME/INR
|
Facility
IP
|
$67.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: AETNA Commercial |
$63.65
|
| Rate for Payer: AETNA Medicare |
$60.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$63.65
|
| Rate for Payer: BCBS Healthlink |
$60.30
|
| Rate for Payer: BCBS HMK CHIP |
$60.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$60.30
|
| Rate for Payer: BCBS POS |
$63.65
|
| Rate for Payer: BCBS Traditional |
$67.00
|
| Rate for Payer: CASH_PRICE |
$53.60
|
| Rate for Payer: CIGNA Commercial |
$63.65
|
| Rate for Payer: CIGNA Medicare |
$60.30
|
| Rate for Payer: HUMANA Commercial |
$60.30
|
| Rate for Payer: MEDICAID Medicaid |
$61.64
|
| Rate for Payer: MEDICARE Medicare |
$46.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$63.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$63.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$63.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$53.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$53.60
|
|
|
.PSA FREE (480772)
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
.PSA FREE (480772)
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
PSA TOTAL W/ REFLEX TO PSA FREE (480772)
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
PSA TOTAL W/ REFLEX TO PSA FREE (480772)
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
PSYCHOTHERAPY W/ PT 45 W/ E/M
|
Facility
OP
|
$190.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: AETNA Commercial |
$180.50
|
| Rate for Payer: AETNA Medicare |
$171.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$180.50
|
| Rate for Payer: BCBS Healthlink |
$171.00
|
| Rate for Payer: BCBS HMK CHIP |
$171.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.00
|
| Rate for Payer: BCBS POS |
$180.50
|
| Rate for Payer: BCBS Traditional |
$190.00
|
| Rate for Payer: CASH_PRICE |
$152.00
|
| Rate for Payer: CIGNA Commercial |
$180.50
|
| Rate for Payer: CIGNA Medicare |
$171.00
|
| Rate for Payer: HUMANA Commercial |
$171.00
|
| Rate for Payer: MEDICAID Medicaid |
$174.80
|
| Rate for Payer: MEDICARE Medicare |
$133.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$180.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$184.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$180.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$180.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$161.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.00
|
|
|
PSYCHOTHERAPY W/ PT 45 W/ E/M
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT 90836
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: AETNA Commercial |
$180.50
|
| Rate for Payer: AETNA Medicare |
$171.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$180.50
|
| Rate for Payer: BCBS Healthlink |
$171.00
|
| Rate for Payer: BCBS HMK CHIP |
$171.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.00
|
| Rate for Payer: BCBS POS |
$180.50
|
| Rate for Payer: BCBS Traditional |
$190.00
|
| Rate for Payer: CASH_PRICE |
$152.00
|
| Rate for Payer: CIGNA Commercial |
$180.50
|
| Rate for Payer: CIGNA Medicare |
$171.00
|
| Rate for Payer: HUMANA Commercial |
$171.00
|
| Rate for Payer: MEDICAID Medicaid |
$174.80
|
| Rate for Payer: MEDICARE Medicare |
$133.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$180.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$184.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$180.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$180.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$161.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.00
|
|
