|
WV CHILD ESTAB PATIENT 1-4 YEARS OLD
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
WV CHILD ESTAB PATIENT 1-4 YEARS OLD
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
WV CHILD ESTAB PATIENT 5-11 YEARS OLD
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
WV CHILD ESTAB PATIENT 5-11 YEARS OLD
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: AETNA Commercial |
$217.55
|
| Rate for Payer: AETNA Medicare |
$206.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$217.55
|
| Rate for Payer: BCBS Healthlink |
$206.10
|
| Rate for Payer: BCBS HMK CHIP |
$206.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$206.10
|
| Rate for Payer: BCBS POS |
$217.55
|
| Rate for Payer: BCBS Traditional |
$229.00
|
| Rate for Payer: CASH_PRICE |
$183.20
|
| Rate for Payer: CIGNA Commercial |
$217.55
|
| Rate for Payer: CIGNA Medicare |
$206.10
|
| Rate for Payer: HUMANA Commercial |
$206.10
|
| Rate for Payer: MEDICAID Medicaid |
$210.68
|
| Rate for Payer: MEDICARE Medicare |
$160.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$217.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$222.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$217.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$217.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$194.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$183.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$183.20
|
|
|
WV CHILD NEW PATIENT 12-17YEARS OLD
|
Facility
OP
|
$295.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: AETNA Commercial |
$280.25
|
| Rate for Payer: AETNA Medicare |
$265.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$280.25
|
| Rate for Payer: BCBS Healthlink |
$265.50
|
| Rate for Payer: BCBS HMK CHIP |
$265.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$265.50
|
| Rate for Payer: BCBS POS |
$280.25
|
| Rate for Payer: BCBS Traditional |
$295.00
|
| Rate for Payer: CASH_PRICE |
$236.00
|
| Rate for Payer: CIGNA Commercial |
$280.25
|
| Rate for Payer: CIGNA Medicare |
$265.50
|
| Rate for Payer: HUMANA Commercial |
$265.50
|
| Rate for Payer: MEDICAID Medicaid |
$271.40
|
| Rate for Payer: MEDICARE Medicare |
$206.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$280.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$286.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$280.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$280.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$250.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$236.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$236.00
|
|
|
WV CHILD NEW PATIENT 12-17YEARS OLD
|
Facility
IP
|
$295.00
|
|
|
Service Code
|
CPT 99384
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$280.25
|
| Rate for Payer: AETNA Commercial |
$280.25
|
| Rate for Payer: AETNA Medicare |
$265.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$280.25
|
| Rate for Payer: BCBS Healthlink |
$265.50
|
| Rate for Payer: BCBS HMK CHIP |
$265.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$265.50
|
| Rate for Payer: BCBS POS |
$280.25
|
| Rate for Payer: BCBS Traditional |
$295.00
|
| Rate for Payer: CASH_PRICE |
$236.00
|
| Rate for Payer: CIGNA Commercial |
$280.25
|
| Rate for Payer: CIGNA Medicare |
$265.50
|
| Rate for Payer: HUMANA Commercial |
$265.50
|
| Rate for Payer: MEDICAID Medicaid |
$271.40
|
| Rate for Payer: MEDICARE Medicare |
$206.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$286.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$280.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$280.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$250.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$236.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$236.00
|
|
|
WV CHILD NEW PATIENT 1-4YEARS OLD
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
WV CHILD NEW PATIENT 1-4YEARS OLD
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 99382
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$175.70 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: AETNA Commercial |
$238.45
|
| Rate for Payer: AETNA Medicare |
$225.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$238.45
|
| Rate for Payer: BCBS Healthlink |
$225.90
|
| Rate for Payer: BCBS HMK CHIP |
$225.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$225.90
|
| Rate for Payer: BCBS POS |
$238.45
|
| Rate for Payer: BCBS Traditional |
$251.00
|
| Rate for Payer: CASH_PRICE |
$200.80
|
| Rate for Payer: CIGNA Commercial |
$238.45
|
| Rate for Payer: CIGNA Medicare |
$225.90
|
| Rate for Payer: HUMANA Commercial |
$225.90
|
| Rate for Payer: MEDICAID Medicaid |
$230.92
|
| Rate for Payer: MEDICARE Medicare |
$175.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$238.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$243.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$238.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$238.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$213.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$200.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$200.80
|
|
|
WV CHILD NEW PATIENTS 5-11YEARS OLD
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
WV CHILD NEW PATIENTS 5-11YEARS OLD
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 99383
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: AETNA Commercial |
$249.85
|
| Rate for Payer: AETNA Medicare |
$236.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$249.85
|
| Rate for Payer: BCBS Healthlink |
$236.70
|
| Rate for Payer: BCBS HMK CHIP |
$236.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$236.70
|
| Rate for Payer: BCBS POS |
$249.85
|
| Rate for Payer: BCBS Traditional |
$263.00
|
| Rate for Payer: CASH_PRICE |
$210.40
|
| Rate for Payer: CIGNA Commercial |
$249.85
|
| Rate for Payer: CIGNA Medicare |
$236.70
|
| Rate for Payer: HUMANA Commercial |
$236.70
|
| Rate for Payer: MEDICAID Medicaid |
$241.96
|
| Rate for Payer: MEDICARE Medicare |
$184.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$249.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$255.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$249.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$249.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$223.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$210.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$210.40
|
|
|
WV ESTAB PATIENT 18-39 YEARS OLD
|
Facility
OP
|
$256.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: AETNA Commercial |
$243.20
|
| Rate for Payer: AETNA Medicare |
$230.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$243.20
|
| Rate for Payer: BCBS Healthlink |
$230.40
|
| Rate for Payer: BCBS HMK CHIP |
$230.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$230.40
|
| Rate for Payer: BCBS POS |
$243.20
|
| Rate for Payer: BCBS Traditional |
$256.00
|
| Rate for Payer: CASH_PRICE |
$204.80
|
| Rate for Payer: CIGNA Commercial |
$243.20
|
| Rate for Payer: CIGNA Medicare |
$230.40
|
| Rate for Payer: HUMANA Commercial |
$230.40
|
| Rate for Payer: MEDICAID Medicaid |
$235.52
|
| Rate for Payer: MEDICARE Medicare |
$179.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$243.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$248.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$243.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$243.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$217.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$204.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$204.80
|
|
|
WV ESTAB PATIENT 18-39 YEARS OLD
|
Facility
IP
|
$256.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: AETNA Commercial |
$243.20
|
| Rate for Payer: AETNA Medicare |
$230.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$243.20
|
| Rate for Payer: BCBS Healthlink |
$230.40
|
| Rate for Payer: BCBS HMK CHIP |
$230.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$230.40
|
| Rate for Payer: BCBS POS |
$243.20
|
| Rate for Payer: BCBS Traditional |
$256.00
|
| Rate for Payer: CASH_PRICE |
$204.80
|
| Rate for Payer: CIGNA Commercial |
$243.20
|
| Rate for Payer: CIGNA Medicare |
$230.40
|
| Rate for Payer: HUMANA Commercial |
$230.40
|
| Rate for Payer: MEDICAID Medicaid |
$235.52
|
| Rate for Payer: MEDICARE Medicare |
$179.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$243.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$248.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$243.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$243.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$217.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$204.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$204.80
|
|
|
WV OCCUPATIONAL PE (WINSTON)
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 99499
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
WV OCCUPATIONAL PE (WINSTON)
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 99499
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
XEROFORM 1X8
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
XEROFORM 1X8
|
Facility
IP
|
$5.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
XEROFORM 5X9
|
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
|
|
|
XEROFORM 5X9
|
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
|
|
|
XR ABDOMEN 1 VIEW
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
XR ABDOMEN 1 VIEW
|
Facility
OP
|
$233.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.10 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: AETNA Commercial |
$221.35
|
| Rate for Payer: AETNA Medicare |
$209.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$221.35
|
| Rate for Payer: BCBS Healthlink |
$209.70
|
| Rate for Payer: BCBS HMK CHIP |
$209.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$209.70
|
| Rate for Payer: BCBS POS |
$221.35
|
| Rate for Payer: BCBS Traditional |
$233.00
|
| Rate for Payer: CASH_PRICE |
$186.40
|
| Rate for Payer: CIGNA Commercial |
$221.35
|
| Rate for Payer: CIGNA Medicare |
$209.70
|
| Rate for Payer: HUMANA Commercial |
$209.70
|
| Rate for Payer: MEDICAID Medicaid |
$214.36
|
| Rate for Payer: MEDICARE Medicare |
$163.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$221.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$226.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$221.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$221.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$198.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$186.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$186.40
|
|
|
XR ABDOMEN 2 VIEWS
|
Facility
IP
|
$281.00
|
|
|
Service Code
|
CPT 74019 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: AETNA Commercial |
$266.95
|
| Rate for Payer: AETNA Medicare |
$252.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$266.95
|
| Rate for Payer: BCBS Healthlink |
$252.90
|
| Rate for Payer: BCBS HMK CHIP |
$252.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$252.90
|
| Rate for Payer: BCBS POS |
$266.95
|
| Rate for Payer: BCBS Traditional |
$281.00
|
| Rate for Payer: CASH_PRICE |
$224.80
|
| Rate for Payer: CIGNA Commercial |
$266.95
|
| Rate for Payer: CIGNA Medicare |
$252.90
|
| Rate for Payer: HUMANA Commercial |
$252.90
|
| Rate for Payer: MEDICAID Medicaid |
$258.52
|
| Rate for Payer: MEDICARE Medicare |
$196.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$266.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$272.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$266.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$266.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$238.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$224.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$224.80
|
|
|
XR ABDOMEN 2 VIEWS
|
Facility
OP
|
$281.00
|
|
|
Service Code
|
CPT 74019 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: AETNA Commercial |
$266.95
|
| Rate for Payer: AETNA Medicare |
$252.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$266.95
|
| Rate for Payer: BCBS Healthlink |
$252.90
|
| Rate for Payer: BCBS HMK CHIP |
$252.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$252.90
|
| Rate for Payer: BCBS POS |
$266.95
|
| Rate for Payer: BCBS Traditional |
$281.00
|
| Rate for Payer: CASH_PRICE |
$224.80
|
| Rate for Payer: CIGNA Commercial |
$266.95
|
| Rate for Payer: CIGNA Medicare |
$252.90
|
| Rate for Payer: HUMANA Commercial |
$252.90
|
| Rate for Payer: MEDICAID Medicaid |
$258.52
|
| Rate for Payer: MEDICARE Medicare |
$196.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$266.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$272.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$266.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$266.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$238.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$224.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$224.80
|
|
|
XR ABDOMEN ACUTE
|
Facility
OP
|
$442.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AETNA Commercial |
$419.90
|
| Rate for Payer: AETNA Medicare |
$397.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$419.90
|
| Rate for Payer: BCBS Healthlink |
$397.80
|
| Rate for Payer: BCBS HMK CHIP |
$397.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$397.80
|
| Rate for Payer: BCBS POS |
$419.90
|
| Rate for Payer: BCBS Traditional |
$442.00
|
| Rate for Payer: CASH_PRICE |
$353.60
|
| Rate for Payer: CIGNA Commercial |
$419.90
|
| Rate for Payer: CIGNA Medicare |
$397.80
|
| Rate for Payer: HUMANA Commercial |
$397.80
|
| Rate for Payer: MEDICAID Medicaid |
$406.64
|
| Rate for Payer: MEDICARE Medicare |
$309.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$419.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$428.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$419.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$419.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$375.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$353.60
|
|
|
XR ABDOMEN ACUTE
|
Facility
IP
|
$442.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AETNA Commercial |
$419.90
|
| Rate for Payer: AETNA Medicare |
$397.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$419.90
|
| Rate for Payer: BCBS Healthlink |
$397.80
|
| Rate for Payer: BCBS HMK CHIP |
$397.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$397.80
|
| Rate for Payer: BCBS POS |
$419.90
|
| Rate for Payer: BCBS Traditional |
$442.00
|
| Rate for Payer: CASH_PRICE |
$353.60
|
| Rate for Payer: CIGNA Commercial |
$419.90
|
| Rate for Payer: CIGNA Medicare |
$397.80
|
| Rate for Payer: HUMANA Commercial |
$397.80
|
| Rate for Payer: MEDICAID Medicaid |
$406.64
|
| Rate for Payer: MEDICARE Medicare |
$309.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$419.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$428.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$419.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$419.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$375.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$353.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$353.60
|
|
|
XR AC JOINTS W WO WEIGHTS
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
