|
SUPPLIES AIRCAST ANKLE
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: AETNA Commercial |
$167.20
|
| Rate for Payer: AETNA Medicare |
$158.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$167.20
|
| Rate for Payer: BCBS Healthlink |
$158.40
|
| Rate for Payer: BCBS HMK CHIP |
$158.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$158.40
|
| Rate for Payer: BCBS POS |
$167.20
|
| Rate for Payer: BCBS Traditional |
$176.00
|
| Rate for Payer: CASH_PRICE |
$140.80
|
| Rate for Payer: CIGNA Commercial |
$167.20
|
| Rate for Payer: CIGNA Medicare |
$158.40
|
| Rate for Payer: HUMANA Commercial |
$158.40
|
| Rate for Payer: MEDICAID Medicaid |
$161.92
|
| Rate for Payer: MEDICARE Medicare |
$123.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$167.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$170.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$167.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$167.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$140.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$140.80
|
|
|
SUPPLIES-CERVICAL FOAM COLLAR
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
SUPPLIES-CERVICAL FOAM COLLAR
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT L0120
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
SUPPLIES CRUTCHES ALL SIZES
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT E0114
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
SUPPLIES CRUTCHES ALL SIZES
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT E0114
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
SUPPLIES FRACTURE BOOT SM-MED-LG
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
SUPPLIES FRACTURE BOOT SM-MED-LG
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
SUPPLIES HANDIVENT NEBULIZER
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT A7003
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
SUPPLIES HANDIVENT NEBULIZER
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT A7003
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
SUPPLIES - KNEE ORTHOTIC
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: AETNA Commercial |
$191.90
|
| Rate for Payer: AETNA Medicare |
$181.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$191.90
|
| Rate for Payer: BCBS Healthlink |
$181.80
|
| Rate for Payer: BCBS HMK CHIP |
$181.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$181.80
|
| Rate for Payer: BCBS POS |
$191.90
|
| Rate for Payer: BCBS Traditional |
$202.00
|
| Rate for Payer: CASH_PRICE |
$161.60
|
| Rate for Payer: CIGNA Commercial |
$191.90
|
| Rate for Payer: CIGNA Medicare |
$181.80
|
| Rate for Payer: HUMANA Commercial |
$181.80
|
| Rate for Payer: MEDICAID Medicaid |
$185.84
|
| Rate for Payer: MEDICARE Medicare |
$141.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$191.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$195.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$191.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$191.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$171.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$161.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$161.60
|
|
|
SUPPLIES - KNEE ORTHOTIC
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: AETNA Commercial |
$191.90
|
| Rate for Payer: AETNA Medicare |
$181.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$191.90
|
| Rate for Payer: BCBS Healthlink |
$181.80
|
| Rate for Payer: BCBS HMK CHIP |
$181.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$181.80
|
| Rate for Payer: BCBS POS |
$191.90
|
| Rate for Payer: BCBS Traditional |
$202.00
|
| Rate for Payer: CASH_PRICE |
$161.60
|
| Rate for Payer: CIGNA Commercial |
$191.90
|
| Rate for Payer: CIGNA Medicare |
$181.80
|
| Rate for Payer: HUMANA Commercial |
$181.80
|
| Rate for Payer: MEDICAID Medicaid |
$185.84
|
| Rate for Payer: MEDICARE Medicare |
$141.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$191.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$195.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$191.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$191.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$171.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$161.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$161.60
|
|
|
SUPPLIES POSTOP SHOE SM MED-L34.75
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT L3265
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$61.75
|
| 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 - 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
|
|
|
SUPPLIES POSTOP SHOE SM MED-L34.75
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT L3265
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
SUPPLIES SHOE FOR DIABETICS
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
SUPPLIES SHOE FOR DIABETICS
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT A5500
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
SUPPLIES SHORT LEG WALKER ALL SIZES
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
SUPPLIES SHORT LEG WALKER ALL SIZES
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
SUPPLIES SLING
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
SUPPLIES SLING
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
SUPPLIES SPLINT
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
SUPPLIES SPLINT
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT A4570
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| 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
|
|
|
SUTURE 0 SILK
|
Facility
IP
|
$42.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
SUTURE 0 SILK
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
SUTURE 3-0 ETHILON PS-1
|
Facility
OP
|
$56.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
SUTURE 3-0 ETHILON PS-1
|
Facility
IP
|
$56.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
