|
HANDLING FEE SPECIMEN (CLINIC)
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
HANTAVIRUS ANTIBODIES, ELISA (835027)
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: AETNA Commercial |
$201.40
|
| Rate for Payer: AETNA Medicare |
$190.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$201.40
|
| Rate for Payer: BCBS Healthlink |
$190.80
|
| Rate for Payer: BCBS HMK CHIP |
$190.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$190.80
|
| Rate for Payer: BCBS POS |
$201.40
|
| Rate for Payer: BCBS Traditional |
$212.00
|
| Rate for Payer: CASH_PRICE |
$169.60
|
| Rate for Payer: CIGNA Commercial |
$201.40
|
| Rate for Payer: CIGNA Medicare |
$190.80
|
| Rate for Payer: HUMANA Commercial |
$190.80
|
| Rate for Payer: MEDICAID Medicaid |
$195.04
|
| Rate for Payer: MEDICARE Medicare |
$148.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$201.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$205.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$201.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$201.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$180.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$169.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$169.60
|
|
|
HANTAVIRUS ANTIBODIES, ELISA (835027)
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: AETNA Commercial |
$201.40
|
| Rate for Payer: AETNA Medicare |
$190.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$201.40
|
| Rate for Payer: BCBS Healthlink |
$190.80
|
| Rate for Payer: BCBS HMK CHIP |
$190.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$190.80
|
| Rate for Payer: BCBS POS |
$201.40
|
| Rate for Payer: BCBS Traditional |
$212.00
|
| Rate for Payer: CASH_PRICE |
$169.60
|
| Rate for Payer: CIGNA Commercial |
$201.40
|
| Rate for Payer: CIGNA Medicare |
$190.80
|
| Rate for Payer: HUMANA Commercial |
$190.80
|
| Rate for Payer: MEDICAID Medicaid |
$195.04
|
| Rate for Payer: MEDICARE Medicare |
$148.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$201.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$205.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$201.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$201.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$180.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$169.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$169.60
|
|
|
HAPTOGLOBIN (001628)
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
HAPTOGLOBIN (001628)
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
HCG, BETA, QUANTITATIVE (004416)
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HCG, BETA, QUANTITATIVE (004416)
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HCG, QUALITATIVE, URINE
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: AETNA Commercial |
$97.85
|
| Rate for Payer: AETNA Medicare |
$92.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$97.85
|
| Rate for Payer: BCBS Healthlink |
$92.70
|
| Rate for Payer: BCBS HMK CHIP |
$92.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$92.70
|
| Rate for Payer: BCBS POS |
$97.85
|
| Rate for Payer: BCBS Traditional |
$103.00
|
| Rate for Payer: CASH_PRICE |
$82.40
|
| Rate for Payer: CIGNA Commercial |
$97.85
|
| Rate for Payer: CIGNA Medicare |
$92.70
|
| Rate for Payer: HUMANA Commercial |
$92.70
|
| Rate for Payer: MEDICAID Medicaid |
$94.76
|
| Rate for Payer: MEDICARE Medicare |
$72.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$97.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$99.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$97.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$97.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$87.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$82.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$82.40
|
|
|
HCG, QUALITATIVE, URINE
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: BCBS HMK CHIP |
$92.70
|
| Rate for Payer: AETNA Commercial |
$97.85
|
| Rate for Payer: AETNA Medicare |
$92.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$97.85
|
| Rate for Payer: BCBS Healthlink |
$92.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$92.70
|
| Rate for Payer: BCBS POS |
$97.85
|
| Rate for Payer: BCBS Traditional |
$103.00
|
| Rate for Payer: CASH_PRICE |
$82.40
|
| Rate for Payer: CIGNA Commercial |
$97.85
|
| Rate for Payer: CIGNA Medicare |
$92.70
|
| Rate for Payer: HUMANA Commercial |
$92.70
|
| Rate for Payer: MEDICAID Medicaid |
$94.76
|
| Rate for Payer: MEDICARE Medicare |
$72.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$97.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$99.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$97.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$97.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$87.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$82.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$82.40
|
|
|
HCG, TUMOR MARKER (140450)
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HCG, TUMOR MARKER (140450)
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HCV AB W/ RELEX TO QUANT RT-PCR (144050)
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
HCV AB W/ RELEX TO QUANT RT-PCR (144050)
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
.HCV RT-PCR, QUANT
|
Facility
OP
|
$339.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$237.30 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: AETNA Commercial |
$322.05
|
| Rate for Payer: AETNA Medicare |
$305.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$322.05
|
| Rate for Payer: BCBS Healthlink |
$305.10
|
| Rate for Payer: BCBS HMK CHIP |
$305.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$305.10
|
| Rate for Payer: BCBS POS |
$322.05
|
| Rate for Payer: BCBS Traditional |
$339.00
|
| Rate for Payer: CASH_PRICE |
$271.20
|
| Rate for Payer: CIGNA Commercial |
$322.05
|
| Rate for Payer: CIGNA Medicare |
$305.10
|
| Rate for Payer: HUMANA Commercial |
$305.10
|
| Rate for Payer: MEDICAID Medicaid |
$311.88
|
| Rate for Payer: MEDICARE Medicare |
$237.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$322.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$328.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$322.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$322.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$288.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$271.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$271.20
|
|
|
.HCV RT-PCR, QUANT
|
Facility
IP
|
$339.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$237.30 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: BCBS HMK CHIP |
$305.10
|
| Rate for Payer: AETNA Commercial |
$322.05
|
| Rate for Payer: AETNA Medicare |
$305.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$322.05
|
| Rate for Payer: BCBS Healthlink |
$305.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$305.10
|
| Rate for Payer: BCBS POS |
$322.05
|
| Rate for Payer: BCBS Traditional |
$339.00
|
| Rate for Payer: CASH_PRICE |
$271.20
|
| Rate for Payer: CIGNA Commercial |
$322.05
|
| Rate for Payer: CIGNA Medicare |
$305.10
|
| Rate for Payer: HUMANA Commercial |
$305.10
|
| Rate for Payer: MEDICAID Medicaid |
$311.88
|
| Rate for Payer: MEDICARE Medicare |
$237.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$322.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$328.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$322.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$322.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$288.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$271.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$271.20
|
|
|
HEMATOCRIT, BLOOD
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: AETNA Commercial |
$41.80
|
| Rate for Payer: AETNA Medicare |
$39.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$41.80
|
| Rate for Payer: BCBS Healthlink |
$39.60
|
| Rate for Payer: BCBS HMK CHIP |
$39.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.60
|
| Rate for Payer: BCBS POS |
$41.80
|
| Rate for Payer: BCBS Traditional |
$44.00
|
| Rate for Payer: CASH_PRICE |
$35.20
|
| Rate for Payer: CIGNA Commercial |
$41.80
|
| Rate for Payer: CIGNA Medicare |
$39.60
|
| Rate for Payer: HUMANA Commercial |
$39.60
|
| Rate for Payer: MEDICAID Medicaid |
$40.48
|
| Rate for Payer: MEDICARE Medicare |
$30.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$41.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$42.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$41.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$41.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.20
|
|
|
HEMATOCRIT, BLOOD
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: AETNA Commercial |
$41.80
|
| Rate for Payer: AETNA Medicare |
$39.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$41.80
|
| Rate for Payer: BCBS Healthlink |
$39.60
|
| Rate for Payer: BCBS HMK CHIP |
$39.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$39.60
|
| Rate for Payer: BCBS POS |
$41.80
|
| Rate for Payer: BCBS Traditional |
$44.00
|
| Rate for Payer: CASH_PRICE |
$35.20
|
| Rate for Payer: CIGNA Commercial |
$41.80
|
| Rate for Payer: CIGNA Medicare |
$39.60
|
| Rate for Payer: HUMANA Commercial |
$39.60
|
| Rate for Payer: MEDICAID Medicaid |
$40.48
|
| Rate for Payer: MEDICARE Medicare |
$30.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$41.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$42.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$41.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$41.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$37.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$35.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$35.20
|
|
|
HEMOCCULT BLOOD CARD SCREENING - RVMC
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| 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 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
|
|
|
HEMOCCULT BLOOD CARD SCREENING - RVMC
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT 82270
|
| 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
|
|
|
HEMOCCULT BLOOD CARD SCREEN-TWIN BRIDGES
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT 82270
|
| 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
|
|
|
HEMOCCULT BLOOD CARD SCREEN-TWIN BRIDGES
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT 82270
|
| 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
|
|
|
HEMOCCULT SINGLE SLIDES
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
HEMOCCULT SINGLE SLIDES
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
HEMOCHROMATOSIS HFE GENE (511345)
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: AETNA Commercial |
$213.75
|
| Rate for Payer: AETNA Medicare |
$202.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$213.75
|
| Rate for Payer: BCBS Healthlink |
$202.50
|
| Rate for Payer: BCBS HMK CHIP |
$202.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$202.50
|
| Rate for Payer: BCBS POS |
$213.75
|
| Rate for Payer: BCBS Traditional |
$225.00
|
| Rate for Payer: CASH_PRICE |
$180.00
|
| Rate for Payer: CIGNA Commercial |
$213.75
|
| Rate for Payer: CIGNA Medicare |
$202.50
|
| Rate for Payer: HUMANA Commercial |
$202.50
|
| Rate for Payer: MEDICAID Medicaid |
$207.00
|
| Rate for Payer: MEDICARE Medicare |
$157.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$213.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$218.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$213.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$213.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$191.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.00
|
|
|
HEMOCHROMATOSIS HFE GENE (511345)
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: AETNA Commercial |
$213.75
|
| Rate for Payer: AETNA Medicare |
$202.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$213.75
|
| Rate for Payer: BCBS Healthlink |
$202.50
|
| Rate for Payer: BCBS HMK CHIP |
$202.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$202.50
|
| Rate for Payer: BCBS POS |
$213.75
|
| Rate for Payer: BCBS Traditional |
$225.00
|
| Rate for Payer: CASH_PRICE |
$180.00
|
| Rate for Payer: CIGNA Commercial |
$213.75
|
| Rate for Payer: CIGNA Medicare |
$202.50
|
| Rate for Payer: HUMANA Commercial |
$202.50
|
| Rate for Payer: MEDICAID Medicaid |
$207.00
|
| Rate for Payer: MEDICARE Medicare |
$157.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$213.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$218.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$213.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$213.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$191.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.00
|
|
