|
CARDIOGRAPHY 1-3 LEAD INTREP&REPORT
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: AETNA Commercial |
$46.55
|
| Rate for Payer: AETNA Medicare |
$44.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$46.55
|
| Rate for Payer: BCBS Healthlink |
$44.10
|
| Rate for Payer: BCBS HMK CHIP |
$44.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$44.10
|
| Rate for Payer: BCBS POS |
$46.55
|
| Rate for Payer: BCBS Traditional |
$49.00
|
| Rate for Payer: CASH_PRICE |
$39.20
|
| Rate for Payer: CIGNA Commercial |
$46.55
|
| Rate for Payer: CIGNA Medicare |
$44.10
|
| Rate for Payer: HUMANA Commercial |
$44.10
|
| Rate for Payer: MEDICAID Medicaid |
$45.08
|
| Rate for Payer: MEDICARE Medicare |
$34.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$46.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$47.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$46.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$46.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$41.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$39.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$39.20
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$905.80 |
| Max. Negotiated Rate |
$1,294.00 |
| Rate for Payer: AETNA Commercial |
$1,229.30
|
| Rate for Payer: AETNA Medicare |
$1,164.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,229.30
|
| Rate for Payer: BCBS Healthlink |
$1,164.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,164.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,164.60
|
| Rate for Payer: BCBS POS |
$1,229.30
|
| Rate for Payer: BCBS Traditional |
$1,294.00
|
| Rate for Payer: CASH_PRICE |
$1,035.20
|
| Rate for Payer: CIGNA Commercial |
$1,229.30
|
| Rate for Payer: CIGNA Medicare |
$1,164.60
|
| Rate for Payer: HUMANA Commercial |
$1,164.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,190.48
|
| Rate for Payer: MEDICARE Medicare |
$905.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,255.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,229.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,099.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,035.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,035.20
|
|
|
CARDIOVASCULAR STRESS TEST
|
Facility
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$905.80 |
| Max. Negotiated Rate |
$1,294.00 |
| Rate for Payer: AETNA Commercial |
$1,229.30
|
| Rate for Payer: AETNA Medicare |
$1,164.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,229.30
|
| Rate for Payer: BCBS Healthlink |
$1,164.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,164.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,164.60
|
| Rate for Payer: BCBS POS |
$1,229.30
|
| Rate for Payer: BCBS Traditional |
$1,294.00
|
| Rate for Payer: CASH_PRICE |
$1,035.20
|
| Rate for Payer: CIGNA Commercial |
$1,229.30
|
| Rate for Payer: CIGNA Medicare |
$1,164.60
|
| Rate for Payer: HUMANA Commercial |
$1,164.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,190.48
|
| Rate for Payer: MEDICARE Medicare |
$905.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,255.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,229.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,229.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,099.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,035.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,035.20
|
|
|
CARDIOVASCULAR STRESS TEST W/OUT READ
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: AETNA Commercial |
$70.30
|
| Rate for Payer: AETNA Medicare |
$66.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$70.30
|
| Rate for Payer: BCBS Healthlink |
$66.60
|
| Rate for Payer: BCBS HMK CHIP |
$66.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$66.60
|
| Rate for Payer: BCBS POS |
$70.30
|
| Rate for Payer: BCBS Traditional |
$74.00
|
| Rate for Payer: CASH_PRICE |
$59.20
|
| Rate for Payer: CIGNA Commercial |
$70.30
|
| Rate for Payer: CIGNA Medicare |
$66.60
|
| Rate for Payer: HUMANA Commercial |
$66.60
|
| Rate for Payer: MEDICAID Medicaid |
$68.08
|
| Rate for Payer: MEDICARE Medicare |
$51.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$70.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$71.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$70.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$70.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$59.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$59.20
|
|
|
CARDIOVASCULAR STRESS TEST W/OUT READ
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$74.00 |
| Rate for Payer: BCBS HMK CHIP |
$66.60
|
| Rate for Payer: AETNA Commercial |
$70.30
|
| Rate for Payer: AETNA Medicare |
$66.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$70.30
|
| Rate for Payer: BCBS Healthlink |
$66.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$66.60
|
| Rate for Payer: BCBS POS |
$70.30
|
| Rate for Payer: BCBS Traditional |
$74.00
|
| Rate for Payer: CASH_PRICE |
$59.20
|
| Rate for Payer: CIGNA Commercial |
$70.30
|
| Rate for Payer: CIGNA Medicare |
$66.60
|
| Rate for Payer: HUMANA Commercial |
$66.60
|
| Rate for Payer: MEDICAID Medicaid |
$68.08
|
| Rate for Payer: MEDICARE Medicare |
$51.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$70.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$71.78
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$70.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$70.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$59.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$59.20
|
|
|
CARPEL TUNNEL SUPP LEFT LG
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP LEFT LG
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP LEFT MED
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP LEFT MED
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP LEFT XLG
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP LEFT XLG
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP R LG
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP R LG
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: BCBS HMK CHIP |
$24.30
|
| Rate for Payer: AETNA Commercial |
$25.65
|
| Rate for Payer: AETNA Medicare |
$24.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$25.65
|
| Rate for Payer: BCBS Healthlink |
$24.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$24.30
|
| Rate for Payer: BCBS POS |
$25.65
|
| Rate for Payer: BCBS Traditional |
$27.00
|
| Rate for Payer: CASH_PRICE |
$21.60
|
| Rate for Payer: CIGNA Commercial |
$25.65
|
| Rate for Payer: CIGNA Medicare |
$24.30
|
| Rate for Payer: HUMANA Commercial |
$24.30
|
| Rate for Payer: MEDICAID Medicaid |
$24.84
|
| Rate for Payer: MEDICARE Medicare |
$18.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$25.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$26.19
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$25.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$25.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$21.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$21.60
|
|
|
CARPEL TUNNEL SUPP R MED
|
Facility
OP
|
$33.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
CARPEL TUNNEL SUPP R MED
|
Facility
IP
|
$33.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
CARPEL TUNNEL SUPP UNIV LG
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
CARPEL TUNNEL SUPP UNIV LG
|
Facility
IP
|
$28.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
CARTRIDGE, TEST CHEM8+ I-STAT (25/BX)
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: AETNA Commercial |
$203.30
|
| Rate for Payer: AETNA Medicare |
$192.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$203.30
|
| Rate for Payer: BCBS Healthlink |
$192.60
|
| Rate for Payer: BCBS HMK CHIP |
$192.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$192.60
|
| Rate for Payer: BCBS POS |
$203.30
|
| Rate for Payer: BCBS Traditional |
$214.00
|
| Rate for Payer: CASH_PRICE |
$171.20
|
| Rate for Payer: CIGNA Commercial |
$203.30
|
| Rate for Payer: CIGNA Medicare |
$192.60
|
| Rate for Payer: HUMANA Commercial |
$192.60
|
| Rate for Payer: MEDICAID Medicaid |
$196.88
|
| Rate for Payer: MEDICARE Medicare |
$149.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$203.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$207.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$203.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$203.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$171.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$171.20
|
|
|
CARTRIDGE, TEST CHEM8+ I-STAT (25/BX)
|
Facility
IP
|
$214.00
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: AETNA Commercial |
$203.30
|
| Rate for Payer: AETNA Medicare |
$192.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$203.30
|
| Rate for Payer: BCBS Healthlink |
$192.60
|
| Rate for Payer: BCBS HMK CHIP |
$192.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$192.60
|
| Rate for Payer: BCBS POS |
$203.30
|
| Rate for Payer: BCBS Traditional |
$214.00
|
| Rate for Payer: CASH_PRICE |
$171.20
|
| Rate for Payer: CIGNA Commercial |
$203.30
|
| Rate for Payer: CIGNA Medicare |
$192.60
|
| Rate for Payer: HUMANA Commercial |
$192.60
|
| Rate for Payer: MEDICAID Medicaid |
$196.88
|
| Rate for Payer: MEDICARE Medicare |
$149.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$203.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$207.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$203.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$203.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$181.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$171.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$171.20
|
|
|
CARVEDILOL TAB [12.5 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CARVEDILOL TAB [12.5 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CARVEDILOL TAB [3.125 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CARVEDILOL TAB [3.125 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CA SCREEN; PELVIC/BREAST EXAM
|
Facility
IP
|
$156.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: AETNA Commercial |
$148.20
|
| Rate for Payer: AETNA Medicare |
$140.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$148.20
|
| Rate for Payer: BCBS Healthlink |
$140.40
|
| Rate for Payer: BCBS HMK CHIP |
$140.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$140.40
|
| Rate for Payer: BCBS POS |
$148.20
|
| Rate for Payer: BCBS Traditional |
$156.00
|
| Rate for Payer: CASH_PRICE |
$124.80
|
| Rate for Payer: CIGNA Commercial |
$148.20
|
| Rate for Payer: CIGNA Medicare |
$140.40
|
| Rate for Payer: HUMANA Commercial |
$140.40
|
| Rate for Payer: MEDICAID Medicaid |
$143.52
|
| Rate for Payer: MEDICARE Medicare |
$109.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$148.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$151.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$148.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$148.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$132.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.80
|
|
|
CA SCREEN; PELVIC/BREAST EXAM
|
Facility
OP
|
$156.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: AETNA Commercial |
$148.20
|
| Rate for Payer: AETNA Medicare |
$140.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$148.20
|
| Rate for Payer: BCBS Healthlink |
$140.40
|
| Rate for Payer: BCBS HMK CHIP |
$140.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$140.40
|
| Rate for Payer: BCBS POS |
$148.20
|
| Rate for Payer: BCBS Traditional |
$156.00
|
| Rate for Payer: CASH_PRICE |
$124.80
|
| Rate for Payer: CIGNA Commercial |
$148.20
|
| Rate for Payer: CIGNA Medicare |
$140.40
|
| Rate for Payer: HUMANA Commercial |
$140.40
|
| Rate for Payer: MEDICAID Medicaid |
$143.52
|
| Rate for Payer: MEDICARE Medicare |
$109.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$148.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$151.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$148.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$148.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$132.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.80
|
|
