|
PT WHEELCHAIR MGMT
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
PT WHEELCHAIR MGMT
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$96.90
|
| Rate for Payer: AETNA Commercial |
$96.90
|
| Rate for Payer: AETNA Medicare |
$91.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$96.90
|
| Rate for Payer: BCBS Healthlink |
$91.80
|
| Rate for Payer: BCBS HMK CHIP |
$91.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$91.80
|
| Rate for Payer: BCBS POS |
$96.90
|
| Rate for Payer: BCBS Traditional |
$102.00
|
| Rate for Payer: CASH_PRICE |
$81.60
|
| Rate for Payer: CIGNA Commercial |
$96.90
|
| Rate for Payer: CIGNA Medicare |
$91.80
|
| Rate for Payer: HUMANA Commercial |
$91.80
|
| Rate for Payer: MEDICAID Medicaid |
$93.84
|
| Rate for Payer: MEDICARE Medicare |
$71.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$98.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$96.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$86.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$81.60
|
|
|
PT WHIRLPOOL
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
PT WHIRLPOOL
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
PT WORK HARDENING EA ADD HR
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
PT WORK HARDENING EA ADD HR
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
PT WORK HARDENING INITIAL 2 HRS
|
Facility
OP
|
$330.00
|
|
|
Service Code
|
CPT 97545 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: AETNA Commercial |
$313.50
|
| Rate for Payer: AETNA Medicare |
$297.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$313.50
|
| Rate for Payer: BCBS Healthlink |
$297.00
|
| Rate for Payer: BCBS HMK CHIP |
$297.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$297.00
|
| Rate for Payer: BCBS POS |
$313.50
|
| Rate for Payer: BCBS Traditional |
$330.00
|
| Rate for Payer: CASH_PRICE |
$264.00
|
| Rate for Payer: CIGNA Commercial |
$313.50
|
| Rate for Payer: CIGNA Medicare |
$297.00
|
| Rate for Payer: HUMANA Commercial |
$297.00
|
| Rate for Payer: MEDICAID Medicaid |
$303.60
|
| Rate for Payer: MEDICARE Medicare |
$231.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$313.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$320.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$313.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$313.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$280.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$264.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$264.00
|
|
|
PT WORK HARDENING INITIAL 2 HRS
|
Facility
IP
|
$330.00
|
|
|
Service Code
|
CPT 97545 GP
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: AETNA Commercial |
$313.50
|
| Rate for Payer: AETNA Medicare |
$297.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$313.50
|
| Rate for Payer: BCBS Healthlink |
$297.00
|
| Rate for Payer: BCBS HMK CHIP |
$297.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$297.00
|
| Rate for Payer: BCBS POS |
$313.50
|
| Rate for Payer: BCBS Traditional |
$330.00
|
| Rate for Payer: CASH_PRICE |
$264.00
|
| Rate for Payer: CIGNA Commercial |
$313.50
|
| Rate for Payer: CIGNA Medicare |
$297.00
|
| Rate for Payer: HUMANA Commercial |
$297.00
|
| Rate for Payer: MEDICAID Medicaid |
$303.60
|
| Rate for Payer: MEDICARE Medicare |
$231.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$313.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$320.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$313.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$313.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$280.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$264.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$264.00
|
|
|
PULMONARY FUNCTION INTERPRETATION
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 94016
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
PULMONARY FUNCTION INTERPRETATION
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 94016
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
PUNCH BX SKIN EA ADDITIONAL-11105
|
Facility
OP
|
$196.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
PUNCH BX SKIN EA ADDITIONAL-11105
|
Facility
IP
|
$196.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
OP
|
$196.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: AETNA Commercial |
$186.20
|
| Rate for Payer: AETNA Medicare |
$176.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$186.20
|
| Rate for Payer: BCBS Healthlink |
$176.40
|
| Rate for Payer: BCBS HMK CHIP |
$176.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$176.40
|
| Rate for Payer: BCBS POS |
$186.20
|
| Rate for Payer: BCBS Traditional |
$196.00
|
| Rate for Payer: CASH_PRICE |
$156.80
|
| Rate for Payer: CIGNA Commercial |
$186.20
|
| Rate for Payer: CIGNA Medicare |
$176.40
|
| Rate for Payer: HUMANA Commercial |
$176.40
|
| Rate for Payer: MEDICAID Medicaid |
$180.32
|
| Rate for Payer: MEDICARE Medicare |
$137.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$186.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$190.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$186.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$186.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$166.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.80
|
|
|
PURE PAK NASAL TAMPON SM 8/BX
|
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: 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
|
|
|
PURE PAK NASAL TAMPON SM 8/BX
|
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
|
|
|
PVB THORACIC SECOND AND ANY ADD ON
|
Facility
IP
|
$920.00
|
|
|
Service Code
|
CPT 64462
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$644.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: AETNA Commercial |
$874.00
|
| Rate for Payer: AETNA Medicare |
$828.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$874.00
|
| Rate for Payer: BCBS Healthlink |
$828.00
|
| Rate for Payer: BCBS HMK CHIP |
$828.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$828.00
|
| Rate for Payer: BCBS POS |
$874.00
|
| Rate for Payer: BCBS Traditional |
$920.00
|
| Rate for Payer: CASH_PRICE |
$736.00
|
| Rate for Payer: CIGNA Commercial |
$874.00
|
| Rate for Payer: CIGNA Medicare |
$828.00
|
| Rate for Payer: HUMANA Commercial |
$828.00
|
| Rate for Payer: MEDICAID Medicaid |
$846.40
|
| Rate for Payer: MEDICARE Medicare |
$644.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$874.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$892.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$874.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$874.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$782.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$736.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$736.00
|
|
|
PVB THORACIC SECOND AND ANY ADD ON
|
Facility
OP
|
$920.00
|
|
|
Service Code
|
CPT 64462
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$644.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: AETNA Commercial |
$874.00
|
| Rate for Payer: AETNA Medicare |
$828.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$874.00
|
| Rate for Payer: BCBS Healthlink |
$828.00
|
| Rate for Payer: BCBS HMK CHIP |
$828.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$828.00
|
| Rate for Payer: BCBS POS |
$874.00
|
| Rate for Payer: BCBS Traditional |
$920.00
|
| Rate for Payer: CASH_PRICE |
$736.00
|
| Rate for Payer: CIGNA Commercial |
$874.00
|
| Rate for Payer: CIGNA Medicare |
$828.00
|
| Rate for Payer: HUMANA Commercial |
$828.00
|
| Rate for Payer: MEDICAID Medicaid |
$846.40
|
| Rate for Payer: MEDICARE Medicare |
$644.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$874.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$892.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$874.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$874.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$782.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$736.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$736.00
|
|
|
PVB THORACIC SINGLE
|
Facility
OP
|
$1,747.00
|
|
|
Service Code
|
CPT 64461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$1,222.90 |
| Max. Negotiated Rate |
$1,747.00 |
| Rate for Payer: AETNA Commercial |
$1,659.65
|
| Rate for Payer: AETNA Medicare |
$1,572.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,659.65
|
| Rate for Payer: BCBS Healthlink |
$1,572.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,572.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,572.30
|
| Rate for Payer: BCBS POS |
$1,659.65
|
| Rate for Payer: BCBS Traditional |
$1,747.00
|
| Rate for Payer: CASH_PRICE |
$1,397.60
|
| Rate for Payer: CIGNA Commercial |
$1,659.65
|
| Rate for Payer: CIGNA Medicare |
$1,572.30
|
| Rate for Payer: HUMANA Commercial |
$1,572.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,607.24
|
| Rate for Payer: MEDICARE Medicare |
$1,222.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,659.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,694.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,659.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,659.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,484.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,397.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,397.60
|
|
|
PVB THORACIC SINGLE
|
Facility
IP
|
$1,747.00
|
|
|
Service Code
|
CPT 64461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$1,222.90 |
| Max. Negotiated Rate |
$1,747.00 |
| Rate for Payer: AETNA Commercial |
$1,659.65
|
| Rate for Payer: AETNA Medicare |
$1,572.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,659.65
|
| Rate for Payer: BCBS Healthlink |
$1,572.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,572.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,572.30
|
| Rate for Payer: BCBS POS |
$1,659.65
|
| Rate for Payer: BCBS Traditional |
$1,747.00
|
| Rate for Payer: CASH_PRICE |
$1,397.60
|
| Rate for Payer: CIGNA Commercial |
$1,659.65
|
| Rate for Payer: CIGNA Medicare |
$1,572.30
|
| Rate for Payer: HUMANA Commercial |
$1,572.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,607.24
|
| Rate for Payer: MEDICARE Medicare |
$1,222.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,659.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,694.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,659.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,659.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,484.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,397.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,397.60
|
|
|
QUANTIFERON-TB GOLD PLUS (182893)
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
QUANTIFERON-TB GOLD PLUS (182893)
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
QUETIAPINE TAB [100 MG]
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
QUETIAPINE TAB [100 MG]
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
QUETIAPINE TAB [25 MG]
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
