|
HEMOGLOBIN
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
HEMOGLOBIN
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: BCBS HMK CHIP |
$39.60
|
| 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 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
|
|
|
HEMOGLOBIN A1C
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 83036
|
| 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
|
|
|
HEMOGLOBIN A1C
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 83036
|
| 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
|
|
|
HEMOGLOBIN, BLOOD
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
HEMOGLOBIN, BLOOD
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
HEMOGLOBINOPATHY FRACTIONATION (121690)
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
HEMOGLOBINOPATHY FRACTIONATION (121690)
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
HEPARIN DRIP [25,000 UNITS]/D5W 250ML
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AETNA Commercial |
$32.30
|
| Rate for Payer: AETNA Medicare |
$30.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$32.30
|
| Rate for Payer: BCBS Healthlink |
$30.60
|
| Rate for Payer: BCBS HMK CHIP |
$30.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$30.60
|
| Rate for Payer: BCBS POS |
$32.30
|
| Rate for Payer: BCBS Traditional |
$34.00
|
| Rate for Payer: CASH_PRICE |
$27.20
|
| Rate for Payer: CIGNA Commercial |
$32.30
|
| Rate for Payer: CIGNA Medicare |
$30.60
|
| Rate for Payer: HUMANA Commercial |
$30.60
|
| Rate for Payer: MEDICAID Medicaid |
$31.28
|
| Rate for Payer: MEDICARE Medicare |
$23.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$32.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$32.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$27.20
|
|
|
HEPARIN DRIP [25,000 UNITS]/D5W 250ML
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: AETNA Commercial |
$32.30
|
| Rate for Payer: AETNA Medicare |
$30.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$32.30
|
| Rate for Payer: BCBS Healthlink |
$30.60
|
| Rate for Payer: BCBS HMK CHIP |
$30.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$30.60
|
| Rate for Payer: BCBS POS |
$32.30
|
| Rate for Payer: BCBS Traditional |
$34.00
|
| Rate for Payer: CASH_PRICE |
$27.20
|
| Rate for Payer: CIGNA Commercial |
$32.30
|
| Rate for Payer: CIGNA Medicare |
$30.60
|
| Rate for Payer: HUMANA Commercial |
$30.60
|
| Rate for Payer: MEDICAID Medicaid |
$31.28
|
| Rate for Payer: MEDICARE Medicare |
$23.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$32.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.98
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$32.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$27.20
|
|
|
HEPARIN INJ 5000 units/ML
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: AETNA Commercial |
$10.45
|
| Rate for Payer: AETNA Medicare |
$9.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10.45
|
| Rate for Payer: BCBS Healthlink |
$9.90
|
| Rate for Payer: BCBS HMK CHIP |
$9.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$9.90
|
| Rate for Payer: BCBS POS |
$10.45
|
| Rate for Payer: BCBS Traditional |
$11.00
|
| Rate for Payer: CASH_PRICE |
$8.80
|
| Rate for Payer: CIGNA Commercial |
$10.45
|
| Rate for Payer: CIGNA Medicare |
$9.90
|
| Rate for Payer: HUMANA Commercial |
$9.90
|
| Rate for Payer: MEDICAID Medicaid |
$10.12
|
| Rate for Payer: MEDICARE Medicare |
$7.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$10.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$8.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$8.80
|
|
|
HEPARIN INJ 5000 units/ML
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: BCBS HMK CHIP |
$9.90
|
| Rate for Payer: AETNA Commercial |
$10.45
|
| Rate for Payer: AETNA Medicare |
$9.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10.45
|
| Rate for Payer: BCBS Healthlink |
$9.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$9.90
|
| Rate for Payer: BCBS POS |
$10.45
|
| Rate for Payer: BCBS Traditional |
$11.00
|
| Rate for Payer: CASH_PRICE |
$8.80
|
| Rate for Payer: CIGNA Commercial |
$10.45
|
| Rate for Payer: CIGNA Medicare |
$9.90
|
| Rate for Payer: HUMANA Commercial |
$9.90
|
| Rate for Payer: MEDICAID Medicaid |
$10.12
|
| Rate for Payer: MEDICARE Medicare |
$7.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$10.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$8.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$8.80
|
|
|
HEPARIN LOCK FLUSH INJ [100 UNITS/ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
HEPARIN LOCK FLUSH INJ [100 UNITS/ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: BCBS HMK CHIP |
$147.60
|
| Rate for Payer: AETNA Commercial |
$155.80
|
| Rate for Payer: AETNA Medicare |
$147.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$155.80
|
| Rate for Payer: BCBS Healthlink |
$147.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$147.60
|
| Rate for Payer: BCBS POS |
$155.80
|
| Rate for Payer: BCBS Traditional |
$164.00
|
| Rate for Payer: CASH_PRICE |
$131.20
|
| Rate for Payer: CIGNA Commercial |
$155.80
|
| Rate for Payer: CIGNA Medicare |
$147.60
|
| Rate for Payer: HUMANA Commercial |
$147.60
|
| Rate for Payer: MEDICAID Medicaid |
$150.88
|
| Rate for Payer: MEDICARE Medicare |
$114.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$155.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$159.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$155.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$155.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$139.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$131.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$131.20
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
OP
|
$164.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: AETNA Commercial |
$155.80
|
| Rate for Payer: AETNA Medicare |
$147.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$155.80
|
| Rate for Payer: BCBS Healthlink |
$147.60
|
| Rate for Payer: BCBS HMK CHIP |
$147.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$147.60
|
| Rate for Payer: BCBS POS |
$155.80
|
| Rate for Payer: BCBS Traditional |
$164.00
|
| Rate for Payer: CASH_PRICE |
$131.20
|
| Rate for Payer: CIGNA Commercial |
$155.80
|
| Rate for Payer: CIGNA Medicare |
$147.60
|
| Rate for Payer: HUMANA Commercial |
$147.60
|
| Rate for Payer: MEDICAID Medicaid |
$150.88
|
| Rate for Payer: MEDICARE Medicare |
$114.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$155.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$159.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$155.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$155.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$139.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$131.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$131.20
|
|
|
HEPATITIS A ANTIBODY, IGM (006734)
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
HEPATITIS A ANTIBODY, IGM (006734)
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
HEPATITIS A VIRUS AB TOTAL (006726)
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: AETNA Commercial |
$18.05
|
| Rate for Payer: AETNA Medicare |
$17.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$18.05
|
| Rate for Payer: BCBS Healthlink |
$17.10
|
| Rate for Payer: BCBS HMK CHIP |
$17.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$17.10
|
| Rate for Payer: BCBS POS |
$18.05
|
| Rate for Payer: BCBS Traditional |
$19.00
|
| Rate for Payer: CASH_PRICE |
$15.20
|
| Rate for Payer: CIGNA Commercial |
$18.05
|
| Rate for Payer: CIGNA Medicare |
$17.10
|
| Rate for Payer: HUMANA Commercial |
$17.10
|
| Rate for Payer: MEDICAID Medicaid |
$17.48
|
| Rate for Payer: MEDICARE Medicare |
$13.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$18.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$18.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$18.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$18.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$15.20
|
|
|
HEPATITIS A VIRUS AB TOTAL (006726)
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: BCBS HMK CHIP |
$17.10
|
| Rate for Payer: AETNA Commercial |
$18.05
|
| Rate for Payer: AETNA Medicare |
$17.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$18.05
|
| Rate for Payer: BCBS Healthlink |
$17.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$17.10
|
| Rate for Payer: BCBS POS |
$18.05
|
| Rate for Payer: BCBS Traditional |
$19.00
|
| Rate for Payer: CASH_PRICE |
$15.20
|
| Rate for Payer: CIGNA Commercial |
$18.05
|
| Rate for Payer: CIGNA Medicare |
$17.10
|
| Rate for Payer: HUMANA Commercial |
$17.10
|
| Rate for Payer: MEDICAID Medicaid |
$17.48
|
| Rate for Payer: MEDICARE Medicare |
$13.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$18.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$18.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$18.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$18.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$15.20
|
|
|
HEPATITIS B CORE AB, IGM (016881)
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
HEPATITIS B CORE AB, IGM (016881)
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
HEPATITIS B CORE AB, TOTAL (006718)
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
HEPATITIS B CORE AB, TOTAL (006718)
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
HEPATITIS B SURFACE AG SCREEN (006510)
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
