|
STRETCH BANDAGE 2'' STERILE
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: AETNA Commercial |
$10.45
|
| Rate for Payer: AETNA Medicare |
$9.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10.45
|
| Rate for Payer: BCBS Healthlink |
$9.90
|
| Rate for Payer: BCBS HMK CHIP |
$9.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$9.90
|
| Rate for Payer: BCBS POS |
$10.45
|
| Rate for Payer: BCBS Traditional |
$11.00
|
| Rate for Payer: CASH_PRICE |
$8.80
|
| Rate for Payer: CIGNA Commercial |
$10.45
|
| Rate for Payer: CIGNA Medicare |
$9.90
|
| Rate for Payer: HUMANA Commercial |
$9.90
|
| Rate for Payer: MEDICAID Medicaid |
$10.12
|
| Rate for Payer: MEDICARE Medicare |
$7.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$10.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$8.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$8.80
|
|
|
STRETCH BANDAGE 3''
|
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
|
|
|
STRETCH BANDAGE 3''
|
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
|
|
|
STRETCH BANDAGE 3'' STERILE
|
Facility
IP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
STRETCH BANDAGE 3'' STERILE
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
ST SELF CARE HOME MGMT ADL EA 15 MIN
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 97535 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
ST SELF CARE HOME MGMT ADL EA 15 MIN
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 97535 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
ST SGD EVAL 1ST HR
|
Facility
IP
|
$444.00
|
|
|
Service Code
|
CPT 92607 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$310.80 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: AETNA Commercial |
$421.80
|
| Rate for Payer: AETNA Medicare |
$399.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$421.80
|
| Rate for Payer: BCBS Healthlink |
$399.60
|
| Rate for Payer: BCBS HMK CHIP |
$399.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$399.60
|
| Rate for Payer: BCBS POS |
$421.80
|
| Rate for Payer: BCBS Traditional |
$444.00
|
| Rate for Payer: CASH_PRICE |
$355.20
|
| Rate for Payer: CIGNA Commercial |
$421.80
|
| Rate for Payer: CIGNA Medicare |
$399.60
|
| Rate for Payer: HUMANA Commercial |
$399.60
|
| Rate for Payer: MEDICAID Medicaid |
$408.48
|
| Rate for Payer: MEDICARE Medicare |
$310.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$421.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$430.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$421.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$421.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$377.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$355.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$355.20
|
|
|
ST SGD EVAL 1ST HR
|
Facility
OP
|
$444.00
|
|
|
Service Code
|
CPT 92607 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$310.80 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: AETNA Commercial |
$421.80
|
| Rate for Payer: AETNA Medicare |
$399.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$421.80
|
| Rate for Payer: BCBS Healthlink |
$399.60
|
| Rate for Payer: BCBS HMK CHIP |
$399.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$399.60
|
| Rate for Payer: BCBS POS |
$421.80
|
| Rate for Payer: BCBS Traditional |
$444.00
|
| Rate for Payer: CASH_PRICE |
$355.20
|
| Rate for Payer: CIGNA Commercial |
$421.80
|
| Rate for Payer: CIGNA Medicare |
$399.60
|
| Rate for Payer: HUMANA Commercial |
$399.60
|
| Rate for Payer: MEDICAID Medicaid |
$408.48
|
| Rate for Payer: MEDICARE Medicare |
$310.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$421.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$430.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$421.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$421.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$377.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$355.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$355.20
|
|
|
ST SGD EVAL ADD 1/2 HR
|
Facility
IP
|
$193.00
|
|
|
Service Code
|
CPT 92608 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
ST SGD EVAL ADD 1/2 HR
|
Facility
OP
|
$193.00
|
|
|
Service Code
|
CPT 92608 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$135.10 |
| Max. Negotiated Rate |
$193.00 |
| Rate for Payer: AETNA Commercial |
$183.35
|
| Rate for Payer: AETNA Medicare |
$173.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$183.35
|
| Rate for Payer: BCBS Healthlink |
$173.70
|
| Rate for Payer: BCBS HMK CHIP |
$173.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$173.70
|
| Rate for Payer: BCBS POS |
$183.35
|
| Rate for Payer: BCBS Traditional |
$193.00
|
| Rate for Payer: CASH_PRICE |
$154.40
|
| Rate for Payer: CIGNA Commercial |
$183.35
|
| Rate for Payer: CIGNA Medicare |
$173.70
|
| Rate for Payer: HUMANA Commercial |
$173.70
|
| Rate for Payer: MEDICAID Medicaid |
$177.56
|
| Rate for Payer: MEDICARE Medicare |
$135.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$183.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$187.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$183.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$183.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$164.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$154.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$154.40
|
|
|
ST SGD THERAPY, PRGM MOD
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: AETNA Commercial |
$171.00
|
| Rate for Payer: AETNA Medicare |
$162.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$171.00
|
| Rate for Payer: BCBS Healthlink |
$162.00
|
| Rate for Payer: BCBS HMK CHIP |
$162.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$162.00
|
| Rate for Payer: BCBS POS |
$171.00
|
| Rate for Payer: BCBS Traditional |
$180.00
|
| Rate for Payer: CASH_PRICE |
$144.00
|
| Rate for Payer: CIGNA Commercial |
$171.00
|
| Rate for Payer: CIGNA Medicare |
$162.00
|
| Rate for Payer: HUMANA Commercial |
$162.00
|
| Rate for Payer: MEDICAID Medicaid |
$165.60
|
| Rate for Payer: MEDICARE Medicare |
$126.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$171.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$174.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$171.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$171.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$153.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$144.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$144.00
|
|
|
ST SGD THERAPY, PRGM MOD
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: AETNA Commercial |
$171.00
|
| Rate for Payer: AETNA Medicare |
$162.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$171.00
|
| Rate for Payer: BCBS Healthlink |
$162.00
|
| Rate for Payer: BCBS HMK CHIP |
$162.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$162.00
|
| Rate for Payer: BCBS POS |
$171.00
|
| Rate for Payer: BCBS Traditional |
$180.00
|
| Rate for Payer: CASH_PRICE |
$144.00
|
| Rate for Payer: CIGNA Commercial |
$171.00
|
| Rate for Payer: CIGNA Medicare |
$162.00
|
| Rate for Payer: HUMANA Commercial |
$162.00
|
| Rate for Payer: MEDICAID Medicaid |
$165.60
|
| Rate for Payer: MEDICARE Medicare |
$126.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$171.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$174.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$171.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$171.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$153.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$144.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$144.00
|
|
|
ST STD CONGNITIVE PERFORMANCE TEST PER H
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 96125 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 STD CONGNITIVE PERFORMANCE TEST PER H
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 96125 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 THERAPEUTIC ACTIVITIES
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
ST THERAPEUTIC ACTIVITIES
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 97530 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
ST THERAPEUTIC EXERCISE
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
ST THERAPEUTIC EXERCISE
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 97110 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
ST THER INTVENTION COGNI FUNCT 1ST 15MIN
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
ST THER INTVENTION COGNI FUNCT 1ST 15MIN
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
ST THERP INTERVENT EA ADDL 15 MIN
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: AETNA Commercial |
$61.75
|
| Rate for Payer: AETNA Medicare |
$58.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$61.75
|
| Rate for Payer: BCBS Healthlink |
$58.50
|
| Rate for Payer: BCBS HMK CHIP |
$58.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$58.50
|
| Rate for Payer: BCBS POS |
$61.75
|
| Rate for Payer: BCBS Traditional |
$65.00
|
| Rate for Payer: CASH_PRICE |
$52.00
|
| Rate for Payer: CIGNA Commercial |
$61.75
|
| Rate for Payer: CIGNA Medicare |
$58.50
|
| Rate for Payer: HUMANA Commercial |
$58.50
|
| Rate for Payer: MEDICAID Medicaid |
$59.80
|
| Rate for Payer: MEDICARE Medicare |
$45.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$61.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$63.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$61.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$61.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$55.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.00
|
|
|
ST THERP INTERVENT EA ADDL 15 MIN
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: AETNA Commercial |
$61.75
|
| Rate for Payer: AETNA Medicare |
$58.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$61.75
|
| Rate for Payer: BCBS Healthlink |
$58.50
|
| Rate for Payer: BCBS HMK CHIP |
$58.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$58.50
|
| Rate for Payer: BCBS POS |
$61.75
|
| Rate for Payer: BCBS Traditional |
$65.00
|
| Rate for Payer: CASH_PRICE |
$52.00
|
| Rate for Payer: CIGNA Commercial |
$61.75
|
| Rate for Payer: CIGNA Medicare |
$58.50
|
| Rate for Payer: HUMANA Commercial |
$58.50
|
| Rate for Payer: MEDICAID Medicaid |
$59.80
|
| Rate for Payer: MEDICARE Medicare |
$45.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$61.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$63.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$61.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$61.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$55.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.00
|
|
|
ST TREATMENT OF SPEECH/LANG (GROUP)
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 92508 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: AETNA Commercial |
$152.95
|
| Rate for Payer: AETNA Medicare |
$144.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$152.95
|
| Rate for Payer: BCBS Healthlink |
$144.90
|
| Rate for Payer: BCBS HMK CHIP |
$144.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$144.90
|
| Rate for Payer: BCBS POS |
$152.95
|
| Rate for Payer: BCBS Traditional |
$161.00
|
| Rate for Payer: CASH_PRICE |
$128.80
|
| Rate for Payer: CIGNA Commercial |
$152.95
|
| Rate for Payer: CIGNA Medicare |
$144.90
|
| Rate for Payer: HUMANA Commercial |
$144.90
|
| Rate for Payer: MEDICAID Medicaid |
$148.12
|
| Rate for Payer: MEDICARE Medicare |
$112.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$152.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$156.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$152.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$152.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$136.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$128.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$128.80
|
|
|
ST TREATMENT OF SPEECH/LANG (GROUP)
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 92508 GN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: AETNA Commercial |
$152.95
|
| Rate for Payer: AETNA Medicare |
$144.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$152.95
|
| Rate for Payer: BCBS Healthlink |
$144.90
|
| Rate for Payer: BCBS HMK CHIP |
$144.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$144.90
|
| Rate for Payer: BCBS POS |
$152.95
|
| Rate for Payer: BCBS Traditional |
$161.00
|
| Rate for Payer: CASH_PRICE |
$128.80
|
| Rate for Payer: CIGNA Commercial |
$152.95
|
| Rate for Payer: CIGNA Medicare |
$144.90
|
| Rate for Payer: HUMANA Commercial |
$144.90
|
| Rate for Payer: MEDICAID Medicaid |
$148.12
|
| Rate for Payer: MEDICARE Medicare |
$112.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$152.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$156.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$152.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$152.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$136.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$128.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$128.80
|
|
