|
SPLINT WRIST/HAND
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: AETNA Commercial |
$108.30
|
| Rate for Payer: AETNA Medicare |
$102.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$108.30
|
| Rate for Payer: BCBS Healthlink |
$102.60
|
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$102.60
|
| Rate for Payer: BCBS POS |
$108.30
|
| Rate for Payer: BCBS Traditional |
$114.00
|
| Rate for Payer: CASH_PRICE |
$91.20
|
| Rate for Payer: CIGNA Commercial |
$108.30
|
| Rate for Payer: CIGNA Medicare |
$102.60
|
| Rate for Payer: HUMANA Commercial |
$102.60
|
| Rate for Payer: MEDICAID Medicaid |
$104.88
|
| Rate for Payer: MEDICARE Medicare |
$79.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$108.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$110.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$108.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$108.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$91.20
|
|
|
.SPUTUM CULTURE REFLEX
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
.SPUTUM CULTURE REFLEX
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
SS-A/RO ANTIBODIES, IGG (012682)
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
SS-A/RO ANTIBODIES, IGG (012682)
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
SS-B/LA ANTIBODIES, IGG (012690)
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
SS-B/LA ANTIBODIES, IGG (012690)
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
ST ASSESS APHASIA W/REPORT
|
Facility
OP
|
$293.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: AETNA Commercial |
$278.35
|
| Rate for Payer: AETNA Medicare |
$263.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$278.35
|
| Rate for Payer: BCBS Healthlink |
$263.70
|
| Rate for Payer: BCBS HMK CHIP |
$263.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$263.70
|
| Rate for Payer: BCBS POS |
$278.35
|
| Rate for Payer: BCBS Traditional |
$293.00
|
| Rate for Payer: CASH_PRICE |
$234.40
|
| Rate for Payer: CIGNA Commercial |
$278.35
|
| Rate for Payer: CIGNA Medicare |
$263.70
|
| Rate for Payer: HUMANA Commercial |
$263.70
|
| Rate for Payer: MEDICAID Medicaid |
$269.56
|
| Rate for Payer: MEDICARE Medicare |
$205.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$278.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$284.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$278.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$278.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$249.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$234.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$234.40
|
|
|
ST ASSESS APHASIA W/REPORT
|
Facility
IP
|
$293.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$293.00 |
| Rate for Payer: AETNA Commercial |
$278.35
|
| Rate for Payer: AETNA Medicare |
$263.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$278.35
|
| Rate for Payer: BCBS Healthlink |
$263.70
|
| Rate for Payer: BCBS HMK CHIP |
$263.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$263.70
|
| Rate for Payer: BCBS POS |
$278.35
|
| Rate for Payer: BCBS Traditional |
$293.00
|
| Rate for Payer: CASH_PRICE |
$234.40
|
| Rate for Payer: CIGNA Commercial |
$278.35
|
| Rate for Payer: CIGNA Medicare |
$263.70
|
| Rate for Payer: HUMANA Commercial |
$263.70
|
| Rate for Payer: MEDICAID Medicaid |
$269.56
|
| Rate for Payer: MEDICARE Medicare |
$205.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$278.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$284.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$278.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$278.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$249.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$234.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$234.40
|
|
|
ST BEHAVIORAL AND QUALITATIVE ANALYSIS
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: AETNA Commercial |
$252.70
|
| Rate for Payer: AETNA Medicare |
$239.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$252.70
|
| Rate for Payer: BCBS Healthlink |
$239.40
|
| Rate for Payer: BCBS HMK CHIP |
$239.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$239.40
|
| Rate for Payer: BCBS POS |
$252.70
|
| Rate for Payer: BCBS Traditional |
$266.00
|
| Rate for Payer: CASH_PRICE |
$212.80
|
| Rate for Payer: CIGNA Commercial |
$252.70
|
| Rate for Payer: CIGNA Medicare |
$239.40
|
| Rate for Payer: HUMANA Commercial |
$239.40
|
| Rate for Payer: MEDICAID Medicaid |
$244.72
|
| Rate for Payer: MEDICARE Medicare |
$186.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$252.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$258.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$252.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$252.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$226.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$212.80
|
|
|
ST BEHAVIORAL AND QUALITATIVE ANALYSIS
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: AETNA Commercial |
$252.70
|
| Rate for Payer: AETNA Medicare |
$239.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$252.70
|
| Rate for Payer: BCBS Healthlink |
$239.40
|
| Rate for Payer: BCBS HMK CHIP |
$239.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$239.40
|
| Rate for Payer: BCBS POS |
$252.70
|
| Rate for Payer: BCBS Traditional |
$266.00
|
| Rate for Payer: CASH_PRICE |
$212.80
|
| Rate for Payer: CIGNA Commercial |
$252.70
|
| Rate for Payer: CIGNA Medicare |
$239.40
|
| Rate for Payer: HUMANA Commercial |
$239.40
|
| Rate for Payer: MEDICAID Medicaid |
$244.72
|
| Rate for Payer: MEDICARE Medicare |
$186.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$252.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$258.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$252.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$252.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$226.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$212.80
|
|
|
ST DEVELOPMENTAL TESTING LIMITED
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 96110 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
ST DEVELOPMENTAL TESTING LIMITED
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 96110 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
STERILE TOWEL DRAPE (FENESTRAT
|
Facility
IP
|
$20.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
STERILE TOWEL DRAPE (FENESTRAT
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
STERILE TOWEL DRAPE (PLAIN)
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
STERILE TOWEL DRAPE (PLAIN)
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
STERISTRIPS 1/4X4
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
STERISTRIPS 1/4X4
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
ST EVAL OF ORAL&PHARYNGEAL SWALLOWING F
|
Facility
OP
|
$677.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$473.90 |
| Max. Negotiated Rate |
$677.00 |
| Rate for Payer: AETNA Commercial |
$643.15
|
| Rate for Payer: AETNA Medicare |
$609.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$643.15
|
| Rate for Payer: BCBS Healthlink |
$609.30
|
| Rate for Payer: BCBS HMK CHIP |
$609.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$609.30
|
| Rate for Payer: BCBS POS |
$643.15
|
| Rate for Payer: BCBS Traditional |
$677.00
|
| Rate for Payer: CASH_PRICE |
$541.60
|
| Rate for Payer: CIGNA Commercial |
$643.15
|
| Rate for Payer: CIGNA Medicare |
$609.30
|
| Rate for Payer: HUMANA Commercial |
$609.30
|
| Rate for Payer: MEDICAID Medicaid |
$622.84
|
| Rate for Payer: MEDICARE Medicare |
$473.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$643.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$656.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$643.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$643.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$575.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$541.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$541.60
|
|
|
ST EVAL OF ORAL&PHARYNGEAL SWALLOWING F
|
Facility
IP
|
$677.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$473.90 |
| Max. Negotiated Rate |
$677.00 |
| Rate for Payer: AETNA Commercial |
$643.15
|
| Rate for Payer: AETNA Medicare |
$609.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$643.15
|
| Rate for Payer: BCBS Healthlink |
$609.30
|
| Rate for Payer: BCBS HMK CHIP |
$609.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$609.30
|
| Rate for Payer: BCBS POS |
$643.15
|
| Rate for Payer: BCBS Traditional |
$677.00
|
| Rate for Payer: CASH_PRICE |
$541.60
|
| Rate for Payer: CIGNA Commercial |
$643.15
|
| Rate for Payer: CIGNA Medicare |
$609.30
|
| Rate for Payer: HUMANA Commercial |
$609.30
|
| Rate for Payer: MEDICAID Medicaid |
$622.84
|
| Rate for Payer: MEDICARE Medicare |
$473.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$643.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$656.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$643.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$643.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$575.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$541.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$541.60
|
|
|
ST EVAL SPEECH FLUENCY(STUTTERING CLUTT
|
Facility
OP
|
$332.00
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: AETNA Commercial |
$315.40
|
| Rate for Payer: AETNA Medicare |
$298.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$315.40
|
| Rate for Payer: BCBS Healthlink |
$298.80
|
| Rate for Payer: BCBS HMK CHIP |
$298.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$298.80
|
| Rate for Payer: BCBS POS |
$315.40
|
| Rate for Payer: BCBS Traditional |
$332.00
|
| Rate for Payer: CASH_PRICE |
$265.60
|
| Rate for Payer: CIGNA Commercial |
$315.40
|
| Rate for Payer: CIGNA Medicare |
$298.80
|
| Rate for Payer: HUMANA Commercial |
$298.80
|
| Rate for Payer: MEDICAID Medicaid |
$305.44
|
| Rate for Payer: MEDICARE Medicare |
$232.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$315.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$322.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$315.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$315.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$282.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$265.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$265.60
|
|
|
ST EVAL SPEECH FLUENCY(STUTTERING CLUTT
|
Facility
IP
|
$332.00
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: AETNA Commercial |
$315.40
|
| Rate for Payer: AETNA Medicare |
$298.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$315.40
|
| Rate for Payer: BCBS Healthlink |
$298.80
|
| Rate for Payer: BCBS HMK CHIP |
$298.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$298.80
|
| Rate for Payer: BCBS POS |
$315.40
|
| Rate for Payer: BCBS Traditional |
$332.00
|
| Rate for Payer: CASH_PRICE |
$265.60
|
| Rate for Payer: CIGNA Commercial |
$315.40
|
| Rate for Payer: CIGNA Medicare |
$298.80
|
| Rate for Payer: HUMANA Commercial |
$298.80
|
| Rate for Payer: MEDICAID Medicaid |
$305.44
|
| Rate for Payer: MEDICARE Medicare |
$232.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$315.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$322.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$315.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$315.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$282.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$265.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$265.60
|
|
|
ST EVAL SPEECH SOUND PROD LANGUAGE
|
Facility
OP
|
$332.00
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: AETNA Commercial |
$315.40
|
| Rate for Payer: AETNA Medicare |
$298.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$315.40
|
| Rate for Payer: BCBS Healthlink |
$298.80
|
| Rate for Payer: BCBS HMK CHIP |
$298.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$298.80
|
| Rate for Payer: BCBS POS |
$315.40
|
| Rate for Payer: BCBS Traditional |
$332.00
|
| Rate for Payer: CASH_PRICE |
$265.60
|
| Rate for Payer: CIGNA Commercial |
$315.40
|
| Rate for Payer: CIGNA Medicare |
$298.80
|
| Rate for Payer: HUMANA Commercial |
$298.80
|
| Rate for Payer: MEDICAID Medicaid |
$305.44
|
| Rate for Payer: MEDICARE Medicare |
$232.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$315.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$322.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$315.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$315.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$282.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$265.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$265.60
|
|
|
ST EVAL SPEECH SOUND PROD LANGUAGE
|
Facility
IP
|
$332.00
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: AETNA Commercial |
$315.40
|
| Rate for Payer: AETNA Medicare |
$298.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$315.40
|
| Rate for Payer: BCBS Healthlink |
$298.80
|
| Rate for Payer: BCBS HMK CHIP |
$298.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$298.80
|
| Rate for Payer: BCBS POS |
$315.40
|
| Rate for Payer: BCBS Traditional |
$332.00
|
| Rate for Payer: CASH_PRICE |
$265.60
|
| Rate for Payer: CIGNA Commercial |
$315.40
|
| Rate for Payer: CIGNA Medicare |
$298.80
|
| Rate for Payer: HUMANA Commercial |
$298.80
|
| Rate for Payer: MEDICAID Medicaid |
$305.44
|
| Rate for Payer: MEDICARE Medicare |
$232.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$315.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$322.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$315.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$315.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$282.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$265.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$265.60
|
|
