|
.COPPER, URINE
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
CORTISOL (004051)
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
CORTISOL (004051)
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
CORTISOL, FREE, 24 HOUR URINE (004432)
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
CORTISOL, FREE, 24 HOUR URINE (004432)
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| 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 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
|
|
|
CORTISOL, SALIVA (500179)
|
Facility
OP
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: AETNA Commercial |
$114.95
|
| Rate for Payer: AETNA Medicare |
$108.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.95
|
| Rate for Payer: BCBS Healthlink |
$108.90
|
| Rate for Payer: BCBS HMK CHIP |
$108.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.90
|
| Rate for Payer: BCBS POS |
$114.95
|
| Rate for Payer: BCBS Traditional |
$121.00
|
| Rate for Payer: CASH_PRICE |
$96.80
|
| Rate for Payer: CIGNA Commercial |
$114.95
|
| Rate for Payer: CIGNA Medicare |
$108.90
|
| Rate for Payer: HUMANA Commercial |
$108.90
|
| Rate for Payer: MEDICAID Medicaid |
$111.32
|
| Rate for Payer: MEDICARE Medicare |
$84.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$117.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.80
|
|
|
CORTISOL, SALIVA (500179)
|
Facility
IP
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$121.00 |
| Rate for Payer: AETNA Commercial |
$114.95
|
| Rate for Payer: AETNA Medicare |
$108.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$114.95
|
| Rate for Payer: BCBS Healthlink |
$108.90
|
| Rate for Payer: BCBS HMK CHIP |
$108.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$108.90
|
| Rate for Payer: BCBS POS |
$114.95
|
| Rate for Payer: BCBS Traditional |
$121.00
|
| Rate for Payer: CASH_PRICE |
$96.80
|
| Rate for Payer: CIGNA Commercial |
$114.95
|
| Rate for Payer: CIGNA Medicare |
$108.90
|
| Rate for Payer: HUMANA Commercial |
$108.90
|
| Rate for Payer: MEDICAID Medicaid |
$111.32
|
| Rate for Payer: MEDICARE Medicare |
$84.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$114.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$117.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$114.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$114.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$102.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$96.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$96.80
|
|
|
COVID-19 ADMIN 1ST DOSE MODERNA
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 0011A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN 1ST DOSE MODERNA
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 0011A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN 2ND DOSE MODERNA
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 0012A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN 2ND DOSE MODERNA
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 0012A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN 3RD DOSE MODERNA
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 0013A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN 3RD DOSE MODERNA
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 0013A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN JANSSEN SINGLE DOSE
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 0031A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN JANSSEN SINGLE DOSE
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 0031A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN MODERNA BOOSTER
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 0134A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN MODERNA BOOSTER
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 0134A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN PFIZER BOOSTER
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 0124A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
COVID-19 ADMIN PFIZER BOOSTER
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 0124A
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
C-PEPTIDE (010108)
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
C-PEPTIDE (010108)
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
C-REACTIVE PROTEIN
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
|
C-REACTIVE PROTEIN
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
|
CREATINE KINASE, TOTAL
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
|
CREATINE KINASE, TOTAL
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: BCBS HMK CHIP |
$86.40
|
| Rate for Payer: AETNA Commercial |
$91.20
|
| Rate for Payer: AETNA Medicare |
$86.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$91.20
|
| Rate for Payer: BCBS Healthlink |
$86.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$86.40
|
| Rate for Payer: BCBS POS |
$91.20
|
| Rate for Payer: BCBS Traditional |
$96.00
|
| Rate for Payer: CASH_PRICE |
$76.80
|
| Rate for Payer: CIGNA Commercial |
$91.20
|
| Rate for Payer: CIGNA Medicare |
$86.40
|
| Rate for Payer: HUMANA Commercial |
$86.40
|
| Rate for Payer: MEDICAID Medicaid |
$88.32
|
| Rate for Payer: MEDICARE Medicare |
$67.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$91.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$93.12
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$91.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$81.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.80
|
|
