|
EKG - OP/HOSPITAL
|
Facility
OP
|
$186.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: AETNA Commercial |
$176.70
|
| Rate for Payer: AETNA Medicare |
$167.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$176.70
|
| Rate for Payer: BCBS Healthlink |
$167.40
|
| Rate for Payer: BCBS HMK CHIP |
$167.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$167.40
|
| Rate for Payer: BCBS POS |
$176.70
|
| Rate for Payer: BCBS Traditional |
$186.00
|
| Rate for Payer: CASH_PRICE |
$148.80
|
| Rate for Payer: CIGNA Commercial |
$176.70
|
| Rate for Payer: CIGNA Medicare |
$167.40
|
| Rate for Payer: HUMANA Commercial |
$167.40
|
| Rate for Payer: MEDICAID Medicaid |
$171.12
|
| Rate for Payer: MEDICARE Medicare |
$130.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$176.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$180.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$176.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$176.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.80
|
|
|
EKG - OP/HOSPITAL
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: BCBS HMK CHIP |
$167.40
|
| Rate for Payer: AETNA Commercial |
$176.70
|
| Rate for Payer: AETNA Medicare |
$167.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$176.70
|
| Rate for Payer: BCBS Healthlink |
$167.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$167.40
|
| Rate for Payer: BCBS POS |
$176.70
|
| Rate for Payer: BCBS Traditional |
$186.00
|
| Rate for Payer: CASH_PRICE |
$148.80
|
| Rate for Payer: CIGNA Commercial |
$176.70
|
| Rate for Payer: CIGNA Medicare |
$167.40
|
| Rate for Payer: HUMANA Commercial |
$167.40
|
| Rate for Payer: MEDICAID Medicaid |
$171.12
|
| Rate for Payer: MEDICARE Medicare |
$130.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$176.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$180.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$176.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$176.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.80
|
|
|
EKG WELCOME TO MEDICARE
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT G0404
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: AETNA Commercial |
$176.70
|
| Rate for Payer: AETNA Medicare |
$167.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$176.70
|
| Rate for Payer: BCBS Healthlink |
$167.40
|
| Rate for Payer: BCBS HMK CHIP |
$167.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$167.40
|
| Rate for Payer: BCBS POS |
$176.70
|
| Rate for Payer: BCBS Traditional |
$186.00
|
| Rate for Payer: CASH_PRICE |
$148.80
|
| Rate for Payer: CIGNA Commercial |
$176.70
|
| Rate for Payer: CIGNA Medicare |
$167.40
|
| Rate for Payer: HUMANA Commercial |
$167.40
|
| Rate for Payer: MEDICAID Medicaid |
$171.12
|
| Rate for Payer: MEDICARE Medicare |
$130.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$176.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$180.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$176.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$176.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.80
|
|
|
EKG WELCOME TO MEDICARE
|
Facility
OP
|
$186.00
|
|
|
Service Code
|
CPT G0404
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: AETNA Commercial |
$176.70
|
| Rate for Payer: AETNA Medicare |
$167.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$176.70
|
| Rate for Payer: BCBS Healthlink |
$167.40
|
| Rate for Payer: BCBS HMK CHIP |
$167.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$167.40
|
| Rate for Payer: BCBS POS |
$176.70
|
| Rate for Payer: BCBS Traditional |
$186.00
|
| Rate for Payer: CASH_PRICE |
$148.80
|
| Rate for Payer: CIGNA Commercial |
$176.70
|
| Rate for Payer: CIGNA Medicare |
$167.40
|
| Rate for Payer: HUMANA Commercial |
$167.40
|
| Rate for Payer: MEDICAID Medicaid |
$171.12
|
| Rate for Payer: MEDICARE Medicare |
$130.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$176.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$180.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$176.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$176.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.80
|
|
|
ELASTIC SHLDR IMMOB
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| Rate for Payer: AETNA Commercial |
$108.30
|
| Rate for Payer: AETNA Medicare |
$102.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$108.30
|
| Rate for Payer: BCBS Healthlink |
$102.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$102.60
|
| Rate for Payer: BCBS POS |
$108.30
|
| Rate for Payer: BCBS Traditional |
$114.00
|
| Rate for Payer: CASH_PRICE |
$91.20
|
| Rate for Payer: CIGNA Commercial |
$108.30
|
| Rate for Payer: CIGNA Medicare |
$102.60
|
| Rate for Payer: HUMANA Commercial |
$102.60
|
| Rate for Payer: MEDICAID Medicaid |
$104.88
|
| Rate for Payer: MEDICARE Medicare |
$79.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$108.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$110.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$108.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$108.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$91.20
|
|
|
ELASTIC SHLDR IMMOB
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: AETNA Commercial |
$108.30
|
| Rate for Payer: AETNA Medicare |
$102.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$108.30
|
| Rate for Payer: BCBS Healthlink |
$102.60
|
| Rate for Payer: BCBS HMK CHIP |
$102.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$102.60
|
| Rate for Payer: BCBS POS |
$108.30
|
| Rate for Payer: BCBS Traditional |
$114.00
|
| Rate for Payer: CASH_PRICE |
$91.20
|
| Rate for Payer: CIGNA Commercial |
$108.30
|
| Rate for Payer: CIGNA Medicare |
$102.60
|
| Rate for Payer: HUMANA Commercial |
$102.60
|
| Rate for Payer: MEDICAID Medicaid |
$104.88
|
| Rate for Payer: MEDICARE Medicare |
$79.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$108.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$110.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$108.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$108.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$91.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$91.20
|
|
|
ELBOW ORTHOTIC W/O JOINTS
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
ELBOW ORTHOTIC W/O JOINTS
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
ELECTRICAL MUSCULAR STIMULATION
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| 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 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
|
|
|
ELECTRICAL MUSCULAR STIMULATION
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
ELECTRICAL MUSCULAR STIMULATION PER 15MI
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
ELECTRICAL MUSCULAR STIMULATION PER 15MI
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
ELECTRIC STIMULATION THERAPY UNATTENDED
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
ELECTRIC STIMULATION THERAPY UNATTENDED
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
ELECTRIC STIMULATION THERAPY UNATTENDED
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
ELECTRIC STIMULATION THERAPY UNATTENDED
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
ELECTROLYTES PANEL
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
ELECTROLYTES PANEL
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
EMPAGLIFLOZIN (JARDIANCE) 10MG TAB NF
|
Facility
IP
|
$77.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
EMPAGLIFLOZIN (JARDIANCE) 10MG TAB NF
|
Facility
OP
|
$77.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
ENDOMYSIAL ANTIBODY, IGA (164996)
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
ENDOMYSIAL ANTIBODY, IGA (164996)
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
ENEMA BUCKET
|
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
|
|
|
ENEMA BUCKET
|
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
|
|
|
ENOXAPARIN INJ [100 MG/1 ML] - NONFORM
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
