|
BLOOD CULTURE, SET 2 (008300)
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 87040 91
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
BLOOD DRAW-IMPLANTED VENOUS DEVICE
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: AETNA Commercial |
$119.70
|
| Rate for Payer: AETNA Medicare |
$113.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$119.70
|
| Rate for Payer: BCBS Healthlink |
$113.40
|
| Rate for Payer: BCBS HMK CHIP |
$113.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$113.40
|
| Rate for Payer: BCBS POS |
$119.70
|
| Rate for Payer: BCBS Traditional |
$126.00
|
| Rate for Payer: CASH_PRICE |
$100.80
|
| Rate for Payer: CIGNA Commercial |
$119.70
|
| Rate for Payer: CIGNA Medicare |
$113.40
|
| Rate for Payer: HUMANA Commercial |
$113.40
|
| Rate for Payer: MEDICAID Medicaid |
$115.92
|
| Rate for Payer: MEDICARE Medicare |
$88.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$119.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$122.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$119.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$119.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.80
|
|
|
BLOOD DRAW-IMPLANTED VENOUS DEVICE
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: AETNA Commercial |
$119.70
|
| Rate for Payer: AETNA Medicare |
$113.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$119.70
|
| Rate for Payer: BCBS Healthlink |
$113.40
|
| Rate for Payer: BCBS HMK CHIP |
$113.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$113.40
|
| Rate for Payer: BCBS POS |
$119.70
|
| Rate for Payer: BCBS Traditional |
$126.00
|
| Rate for Payer: CASH_PRICE |
$100.80
|
| Rate for Payer: CIGNA Commercial |
$119.70
|
| Rate for Payer: CIGNA Medicare |
$113.40
|
| Rate for Payer: HUMANA Commercial |
$113.40
|
| Rate for Payer: MEDICAID Medicaid |
$115.92
|
| Rate for Payer: MEDICARE Medicare |
$88.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$119.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$122.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$119.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$119.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$107.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$100.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$100.80
|
|
|
BLOOD DRAW-PICC LINE
|
Facility
OP
|
$117.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: AETNA Commercial |
$111.15
|
| Rate for Payer: AETNA Medicare |
$105.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$111.15
|
| Rate for Payer: BCBS Healthlink |
$105.30
|
| Rate for Payer: BCBS HMK CHIP |
$105.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$105.30
|
| Rate for Payer: BCBS POS |
$111.15
|
| Rate for Payer: BCBS Traditional |
$117.00
|
| Rate for Payer: CASH_PRICE |
$93.60
|
| Rate for Payer: CIGNA Commercial |
$111.15
|
| Rate for Payer: CIGNA Medicare |
$105.30
|
| Rate for Payer: HUMANA Commercial |
$105.30
|
| Rate for Payer: MEDICAID Medicaid |
$107.64
|
| Rate for Payer: MEDICARE Medicare |
$81.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$111.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$113.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$111.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$111.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$99.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$93.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$93.60
|
|
|
BLOOD DRAW-PICC LINE
|
Facility
IP
|
$117.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: BCBS HMK CHIP |
$105.30
|
| Rate for Payer: AETNA Commercial |
$111.15
|
| Rate for Payer: AETNA Medicare |
$105.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$111.15
|
| Rate for Payer: BCBS Healthlink |
$105.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$105.30
|
| Rate for Payer: BCBS POS |
$111.15
|
| Rate for Payer: BCBS Traditional |
$117.00
|
| Rate for Payer: CASH_PRICE |
$93.60
|
| Rate for Payer: CIGNA Commercial |
$111.15
|
| Rate for Payer: CIGNA Medicare |
$105.30
|
| Rate for Payer: HUMANA Commercial |
$105.30
|
| Rate for Payer: MEDICAID Medicaid |
$107.64
|
| Rate for Payer: MEDICARE Medicare |
$81.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$111.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$113.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$111.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$111.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$99.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$93.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$93.60
|
|
|
BLOOD GASES, ARTERIAL
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
BLOOD GASES, ARTERIAL
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
BLOOD GASES, VENOUS
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
BLOOD GASES, VENOUS
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: AETNA Commercial |
$262.20
|
| Rate for Payer: AETNA Medicare |
$248.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$262.20
|
| Rate for Payer: BCBS Healthlink |
$248.40
|
| Rate for Payer: BCBS HMK CHIP |
$248.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$248.40
|
| Rate for Payer: BCBS POS |
$262.20
|
| Rate for Payer: BCBS Traditional |
$276.00
|
| Rate for Payer: CASH_PRICE |
$220.80
|
| Rate for Payer: CIGNA Commercial |
$262.20
|
| Rate for Payer: CIGNA Medicare |
$248.40
|
| Rate for Payer: HUMANA Commercial |
$248.40
|
| Rate for Payer: MEDICAID Medicaid |
$253.92
|
| Rate for Payer: MEDICARE Medicare |
$193.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$262.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$267.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$262.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$262.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$234.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$220.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$220.80
|
|
|
BLOOD TRANSFER DEVICE (NURSING ONLY)
|
Facility
IP
|
$3.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: AETNA Commercial |
$2.85
|
| Rate for Payer: AETNA Medicare |
$2.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2.85
|
| Rate for Payer: BCBS Healthlink |
$2.70
|
| Rate for Payer: BCBS HMK CHIP |
$2.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2.70
|
| Rate for Payer: BCBS POS |
$2.85
|
| Rate for Payer: BCBS Traditional |
$3.00
|
| Rate for Payer: CASH_PRICE |
$2.40
|
| Rate for Payer: CIGNA Commercial |
$2.85
|
| Rate for Payer: CIGNA Medicare |
$2.70
|
| Rate for Payer: HUMANA Commercial |
$2.70
|
| Rate for Payer: MEDICAID Medicaid |
$2.76
|
| Rate for Payer: MEDICARE Medicare |
$2.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2.40
|
|
|
BLOOD TRANSFER DEVICE (NURSING ONLY)
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: AETNA Commercial |
$2.85
|
| Rate for Payer: AETNA Medicare |
$2.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2.85
|
| Rate for Payer: BCBS Healthlink |
$2.70
|
| Rate for Payer: BCBS HMK CHIP |
$2.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2.70
|
| Rate for Payer: BCBS POS |
$2.85
|
| Rate for Payer: BCBS Traditional |
$3.00
|
| Rate for Payer: CASH_PRICE |
$2.40
|
| Rate for Payer: CIGNA Commercial |
$2.85
|
| Rate for Payer: CIGNA Medicare |
$2.70
|
| Rate for Payer: HUMANA Commercial |
$2.70
|
| Rate for Payer: MEDICAID Medicaid |
$2.76
|
| Rate for Payer: MEDICARE Medicare |
$2.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2.40
|
|
|
BLOOD TRANSFER PACK BAG
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
BLOOD TRANSFER PACK BAG
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
BLOOD UREA NITROGEN (BUN)
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
BLOOD UREA NITROGEN (BUN)
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
BRIMONIDINE 0.2% (5ML) OPTH DROPS
|
Facility
IP
|
$42.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
BRIMONIDINE 0.2% (5ML) OPTH DROPS
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
BUDESONIDE/FORMOTEROL 160/4.5MCG-NF
|
Facility
IP
|
$719.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$503.30 |
| Max. Negotiated Rate |
$719.00 |
| Rate for Payer: AETNA Commercial |
$683.05
|
| Rate for Payer: AETNA Medicare |
$647.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$683.05
|
| Rate for Payer: BCBS Healthlink |
$647.10
|
| Rate for Payer: BCBS HMK CHIP |
$647.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$647.10
|
| Rate for Payer: BCBS POS |
$683.05
|
| Rate for Payer: BCBS Traditional |
$719.00
|
| Rate for Payer: CASH_PRICE |
$575.20
|
| Rate for Payer: CIGNA Commercial |
$683.05
|
| Rate for Payer: CIGNA Medicare |
$647.10
|
| Rate for Payer: HUMANA Commercial |
$647.10
|
| Rate for Payer: MEDICAID Medicaid |
$661.48
|
| Rate for Payer: MEDICARE Medicare |
$503.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$683.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$697.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$683.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$683.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$611.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$575.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$575.20
|
|
|
BUDESONIDE/FORMOTEROL 160/4.5MCG-NF
|
Facility
OP
|
$719.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$503.30 |
| Max. Negotiated Rate |
$719.00 |
| Rate for Payer: AETNA Commercial |
$683.05
|
| Rate for Payer: AETNA Medicare |
$647.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$683.05
|
| Rate for Payer: BCBS Healthlink |
$647.10
|
| Rate for Payer: BCBS HMK CHIP |
$647.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$647.10
|
| Rate for Payer: BCBS POS |
$683.05
|
| Rate for Payer: BCBS Traditional |
$719.00
|
| Rate for Payer: CASH_PRICE |
$575.20
|
| Rate for Payer: CIGNA Commercial |
$683.05
|
| Rate for Payer: CIGNA Medicare |
$647.10
|
| Rate for Payer: HUMANA Commercial |
$647.10
|
| Rate for Payer: MEDICAID Medicaid |
$661.48
|
| Rate for Payer: MEDICARE Medicare |
$503.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$683.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$697.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$683.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$683.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$611.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$575.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$575.20
|
|
|
BUDESONIDE FORMOTEROL 80/4.5 INH-NF
|
Facility
IP
|
$703.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$492.10 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: BCBS HMK CHIP |
$632.70
|
| Rate for Payer: AETNA Commercial |
$667.85
|
| Rate for Payer: AETNA Medicare |
$632.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$667.85
|
| Rate for Payer: BCBS Healthlink |
$632.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$632.70
|
| Rate for Payer: BCBS POS |
$667.85
|
| Rate for Payer: BCBS Traditional |
$703.00
|
| Rate for Payer: CASH_PRICE |
$562.40
|
| Rate for Payer: CIGNA Commercial |
$667.85
|
| Rate for Payer: CIGNA Medicare |
$632.70
|
| Rate for Payer: HUMANA Commercial |
$632.70
|
| Rate for Payer: MEDICAID Medicaid |
$646.76
|
| Rate for Payer: MEDICARE Medicare |
$492.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$667.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$681.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$667.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$667.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$597.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$562.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$562.40
|
|
|
BUDESONIDE FORMOTEROL 80/4.5 INH-NF
|
Facility
OP
|
$703.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$492.10 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: AETNA Commercial |
$667.85
|
| Rate for Payer: AETNA Medicare |
$632.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$667.85
|
| Rate for Payer: BCBS Healthlink |
$632.70
|
| Rate for Payer: BCBS HMK CHIP |
$632.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$632.70
|
| Rate for Payer: BCBS POS |
$667.85
|
| Rate for Payer: BCBS Traditional |
$703.00
|
| Rate for Payer: CASH_PRICE |
$562.40
|
| Rate for Payer: CIGNA Commercial |
$667.85
|
| Rate for Payer: CIGNA Medicare |
$632.70
|
| Rate for Payer: HUMANA Commercial |
$632.70
|
| Rate for Payer: MEDICAID Medicaid |
$646.76
|
| Rate for Payer: MEDICARE Medicare |
$492.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$667.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$681.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$667.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$667.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$597.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$562.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$562.40
|
|
|
BUDESONIDE INH [180MCG] 120 DOSES
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
CPT J7626
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: AETNA Commercial |
$584.25
|
| Rate for Payer: AETNA Medicare |
$553.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$584.25
|
| Rate for Payer: BCBS Healthlink |
$553.50
|
| Rate for Payer: BCBS HMK CHIP |
$553.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$553.50
|
| Rate for Payer: BCBS POS |
$584.25
|
| Rate for Payer: BCBS Traditional |
$615.00
|
| Rate for Payer: CASH_PRICE |
$492.00
|
| Rate for Payer: CIGNA Commercial |
$584.25
|
| Rate for Payer: CIGNA Medicare |
$553.50
|
| Rate for Payer: HUMANA Commercial |
$553.50
|
| Rate for Payer: MEDICAID Medicaid |
$565.80
|
| Rate for Payer: MEDICARE Medicare |
$430.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$584.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$596.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$584.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$584.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$522.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$492.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$492.00
|
|
|
BUDESONIDE INH [180MCG] 120 DOSES
|
Facility
OP
|
$615.00
|
|
|
Service Code
|
CPT J7626
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: AETNA Commercial |
$584.25
|
| Rate for Payer: AETNA Medicare |
$553.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$584.25
|
| Rate for Payer: BCBS Healthlink |
$553.50
|
| Rate for Payer: BCBS HMK CHIP |
$553.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$553.50
|
| Rate for Payer: BCBS POS |
$584.25
|
| Rate for Payer: BCBS Traditional |
$615.00
|
| Rate for Payer: CASH_PRICE |
$492.00
|
| Rate for Payer: CIGNA Commercial |
$584.25
|
| Rate for Payer: CIGNA Medicare |
$553.50
|
| Rate for Payer: HUMANA Commercial |
$553.50
|
| Rate for Payer: MEDICAID Medicaid |
$565.80
|
| Rate for Payer: MEDICARE Medicare |
$430.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$584.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$596.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$584.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$584.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$522.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$492.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$492.00
|
|
