|
HOT PACK 5 X 8
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: AETNA Commercial |
$0.95
|
| Rate for Payer: AETNA Medicare |
$0.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$0.95
|
| Rate for Payer: BCBS Healthlink |
$0.90
|
| Rate for Payer: BCBS HMK CHIP |
$0.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$0.90
|
| Rate for Payer: BCBS POS |
$0.95
|
| Rate for Payer: BCBS Traditional |
$1.00
|
| Rate for Payer: CASH_PRICE |
$0.80
|
| Rate for Payer: CIGNA Commercial |
$0.95
|
| Rate for Payer: CIGNA Medicare |
$0.90
|
| Rate for Payer: HUMANA Commercial |
$0.90
|
| Rate for Payer: MEDICAID Medicaid |
$0.92
|
| Rate for Payer: MEDICARE Medicare |
$0.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$0.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$0.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$0.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$0.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$0.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$0.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$0.80
|
|
|
HOV HOME VISI NP INTERMEDIATE
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT 99343
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
HOV HOME VISI NP INTERMEDIATE
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT 99343
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
HOV HOME VISIT EST BRIEF
|
Facility
IP
|
$116.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: AETNA Commercial |
$110.20
|
| Rate for Payer: AETNA Medicare |
$104.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$110.20
|
| Rate for Payer: BCBS Healthlink |
$104.40
|
| Rate for Payer: BCBS HMK CHIP |
$104.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$104.40
|
| Rate for Payer: BCBS POS |
$110.20
|
| Rate for Payer: BCBS Traditional |
$116.00
|
| Rate for Payer: CASH_PRICE |
$92.80
|
| Rate for Payer: CIGNA Commercial |
$110.20
|
| Rate for Payer: CIGNA Medicare |
$104.40
|
| Rate for Payer: HUMANA Commercial |
$104.40
|
| Rate for Payer: MEDICAID Medicaid |
$106.72
|
| Rate for Payer: MEDICARE Medicare |
$81.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$110.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$112.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$110.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$110.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$98.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$92.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$92.80
|
|
|
HOV HOME VISIT EST BRIEF
|
Facility
OP
|
$116.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: AETNA Commercial |
$110.20
|
| Rate for Payer: AETNA Medicare |
$104.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$110.20
|
| Rate for Payer: BCBS Healthlink |
$104.40
|
| Rate for Payer: BCBS HMK CHIP |
$104.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$104.40
|
| Rate for Payer: BCBS POS |
$110.20
|
| Rate for Payer: BCBS Traditional |
$116.00
|
| Rate for Payer: CASH_PRICE |
$92.80
|
| Rate for Payer: CIGNA Commercial |
$110.20
|
| Rate for Payer: CIGNA Medicare |
$104.40
|
| Rate for Payer: HUMANA Commercial |
$104.40
|
| Rate for Payer: MEDICAID Medicaid |
$106.72
|
| Rate for Payer: MEDICARE Medicare |
$81.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$110.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$112.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$110.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$110.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$98.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$92.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$92.80
|
|
|
HOV HOME VISIT EST EXTENDED
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
HOV HOME VISIT EST EXTENDED
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
HOV HOME VISIT EST INTERMEDIATE
|
Facility
IP
|
$179.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: AETNA Commercial |
$170.05
|
| Rate for Payer: AETNA Medicare |
$161.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$170.05
|
| Rate for Payer: BCBS Healthlink |
$161.10
|
| Rate for Payer: BCBS HMK CHIP |
$161.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$161.10
|
| Rate for Payer: BCBS POS |
$170.05
|
| Rate for Payer: BCBS Traditional |
$179.00
|
| Rate for Payer: CASH_PRICE |
$143.20
|
| Rate for Payer: CIGNA Commercial |
$170.05
|
| Rate for Payer: CIGNA Medicare |
$161.10
|
| Rate for Payer: HUMANA Commercial |
$161.10
|
| Rate for Payer: MEDICAID Medicaid |
$164.68
|
| Rate for Payer: MEDICARE Medicare |
$125.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$170.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$173.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$170.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$170.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$152.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$143.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$143.20
|
|
|
HOV HOME VISIT EST INTERMEDIATE
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
CPT 99348
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: AETNA Commercial |
$170.05
|
| Rate for Payer: AETNA Medicare |
$161.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$170.05
|
| Rate for Payer: BCBS Healthlink |
$161.10
|
| Rate for Payer: BCBS HMK CHIP |
$161.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$161.10
|
| Rate for Payer: BCBS POS |
$170.05
|
| Rate for Payer: BCBS Traditional |
$179.00
|
| Rate for Payer: CASH_PRICE |
$143.20
|
| Rate for Payer: CIGNA Commercial |
$170.05
|
| Rate for Payer: CIGNA Medicare |
$161.10
|
| Rate for Payer: HUMANA Commercial |
$161.10
|
| Rate for Payer: MEDICAID Medicaid |
$164.68
|
| Rate for Payer: MEDICARE Medicare |
$125.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$170.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$173.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$170.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$170.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$152.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$143.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$143.20
|
|
|
HPV COMBO ASSAY CA SCREEN
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT G0476
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
HPV COMBO ASSAY CA SCREEN
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT G0476
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
HPV GARDASIL 9
|
Facility
OP
|
$687.00
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$480.90 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: AETNA Commercial |
$652.65
|
| Rate for Payer: AETNA Medicare |
$618.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$652.65
|
| Rate for Payer: BCBS Healthlink |
$618.30
|
| Rate for Payer: BCBS HMK CHIP |
$618.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$618.30
|
| Rate for Payer: BCBS POS |
$652.65
|
| Rate for Payer: BCBS Traditional |
$687.00
|
| Rate for Payer: CASH_PRICE |
$549.60
|
| Rate for Payer: CIGNA Commercial |
$652.65
|
| Rate for Payer: CIGNA Medicare |
$618.30
|
| Rate for Payer: HUMANA Commercial |
$618.30
|
| Rate for Payer: MEDICAID Medicaid |
$632.04
|
| Rate for Payer: MEDICARE Medicare |
$480.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$652.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$666.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$652.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$652.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$583.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$549.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$549.60
|
|
|
HPV GARDASIL 9
|
Facility
IP
|
$687.00
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$480.90 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: AETNA Commercial |
$652.65
|
| Rate for Payer: AETNA Medicare |
$618.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$652.65
|
| Rate for Payer: BCBS Healthlink |
$618.30
|
| Rate for Payer: BCBS HMK CHIP |
$618.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$618.30
|
| Rate for Payer: BCBS POS |
$652.65
|
| Rate for Payer: BCBS Traditional |
$687.00
|
| Rate for Payer: CASH_PRICE |
$549.60
|
| Rate for Payer: CIGNA Commercial |
$652.65
|
| Rate for Payer: CIGNA Medicare |
$618.30
|
| Rate for Payer: HUMANA Commercial |
$618.30
|
| Rate for Payer: MEDICAID Medicaid |
$632.04
|
| Rate for Payer: MEDICARE Medicare |
$480.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$652.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$666.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$652.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$652.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$583.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$549.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$549.60
|
|
|
HPV GUARDASIL (19-27 YRS)
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: BCBS HMK CHIP |
$165.60
|
| Rate for Payer: AETNA Commercial |
$174.80
|
| Rate for Payer: AETNA Medicare |
$165.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$174.80
|
| Rate for Payer: BCBS Healthlink |
$165.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$165.60
|
| Rate for Payer: BCBS POS |
$174.80
|
| Rate for Payer: BCBS Traditional |
$184.00
|
| Rate for Payer: CASH_PRICE |
$147.20
|
| Rate for Payer: CIGNA Commercial |
$174.80
|
| Rate for Payer: CIGNA Medicare |
$165.60
|
| Rate for Payer: HUMANA Commercial |
$165.60
|
| Rate for Payer: MEDICAID Medicaid |
$169.28
|
| Rate for Payer: MEDICARE Medicare |
$128.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$174.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$178.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$174.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$174.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$156.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$147.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$147.20
|
|
|
HPV GUARDASIL (19-27 YRS)
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: AETNA Commercial |
$174.80
|
| Rate for Payer: AETNA Medicare |
$165.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$174.80
|
| Rate for Payer: BCBS Healthlink |
$165.60
|
| Rate for Payer: BCBS HMK CHIP |
$165.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$165.60
|
| Rate for Payer: BCBS POS |
$174.80
|
| Rate for Payer: BCBS Traditional |
$184.00
|
| Rate for Payer: CASH_PRICE |
$147.20
|
| Rate for Payer: CIGNA Commercial |
$174.80
|
| Rate for Payer: CIGNA Medicare |
$165.60
|
| Rate for Payer: HUMANA Commercial |
$165.60
|
| Rate for Payer: MEDICAID Medicaid |
$169.28
|
| Rate for Payer: MEDICARE Medicare |
$128.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$174.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$178.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$174.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$174.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$156.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$147.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$147.20
|
|
|
HPV HIGH-RISK TYPES
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
HPV HIGH-RISK TYPES
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
H PYLORI ANTIGEN, STOOL (180764)
|
Facility
OP
|
$171.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: AETNA Commercial |
$162.45
|
| Rate for Payer: AETNA Medicare |
$153.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$162.45
|
| Rate for Payer: BCBS Healthlink |
$153.90
|
| Rate for Payer: BCBS HMK CHIP |
$153.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$153.90
|
| Rate for Payer: BCBS POS |
$162.45
|
| Rate for Payer: BCBS Traditional |
$171.00
|
| Rate for Payer: CASH_PRICE |
$136.80
|
| Rate for Payer: CIGNA Commercial |
$162.45
|
| Rate for Payer: CIGNA Medicare |
$153.90
|
| Rate for Payer: HUMANA Commercial |
$153.90
|
| Rate for Payer: MEDICAID Medicaid |
$157.32
|
| Rate for Payer: MEDICARE Medicare |
$119.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$162.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$165.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$162.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$162.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$136.80
|
|
|
H PYLORI ANTIGEN, STOOL (180764)
|
Facility
IP
|
$171.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: BCBS HMK CHIP |
$153.90
|
| Rate for Payer: AETNA Commercial |
$162.45
|
| Rate for Payer: AETNA Medicare |
$153.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$162.45
|
| Rate for Payer: BCBS Healthlink |
$153.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$153.90
|
| Rate for Payer: BCBS POS |
$162.45
|
| Rate for Payer: BCBS Traditional |
$171.00
|
| Rate for Payer: CASH_PRICE |
$136.80
|
| Rate for Payer: CIGNA Commercial |
$162.45
|
| Rate for Payer: CIGNA Medicare |
$153.90
|
| Rate for Payer: HUMANA Commercial |
$153.90
|
| Rate for Payer: MEDICAID Medicaid |
$157.32
|
| Rate for Payer: MEDICARE Medicare |
$119.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$162.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$165.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$162.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$162.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$145.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$136.80
|
|
|
H PYLORI BREATH TEST (180836)
|
Facility
OP
|
$236.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: AETNA Commercial |
$224.20
|
| Rate for Payer: AETNA Medicare |
$212.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$224.20
|
| Rate for Payer: BCBS Healthlink |
$212.40
|
| Rate for Payer: BCBS HMK CHIP |
$212.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$212.40
|
| Rate for Payer: BCBS POS |
$224.20
|
| Rate for Payer: BCBS Traditional |
$236.00
|
| Rate for Payer: CASH_PRICE |
$188.80
|
| Rate for Payer: CIGNA Commercial |
$224.20
|
| Rate for Payer: CIGNA Medicare |
$212.40
|
| Rate for Payer: HUMANA Commercial |
$212.40
|
| Rate for Payer: MEDICAID Medicaid |
$217.12
|
| Rate for Payer: MEDICARE Medicare |
$165.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$224.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$228.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$224.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$224.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$200.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.80
|
|
|
H PYLORI BREATH TEST (180836)
|
Facility
IP
|
$236.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: AETNA Commercial |
$224.20
|
| Rate for Payer: AETNA Medicare |
$212.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$224.20
|
| Rate for Payer: BCBS Healthlink |
$212.40
|
| Rate for Payer: BCBS HMK CHIP |
$212.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$212.40
|
| Rate for Payer: BCBS POS |
$224.20
|
| Rate for Payer: BCBS Traditional |
$236.00
|
| Rate for Payer: CASH_PRICE |
$188.80
|
| Rate for Payer: CIGNA Commercial |
$224.20
|
| Rate for Payer: CIGNA Medicare |
$212.40
|
| Rate for Payer: HUMANA Commercial |
$212.40
|
| Rate for Payer: MEDICAID Medicaid |
$217.12
|
| Rate for Payer: MEDICARE Medicare |
$165.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$224.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$228.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$224.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$224.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$200.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.80
|
|
|
HSV TYPE 1 ANTIBODIES, IGG (164897)
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
HSV TYPE 1 ANTIBODIES, IGG (164897)
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: AETNA Commercial |
$44.65
|
| Rate for Payer: AETNA Medicare |
$42.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$44.65
|
| Rate for Payer: BCBS Healthlink |
$42.30
|
| Rate for Payer: BCBS HMK CHIP |
$42.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$42.30
|
| Rate for Payer: BCBS POS |
$44.65
|
| Rate for Payer: BCBS Traditional |
$47.00
|
| Rate for Payer: CASH_PRICE |
$37.60
|
| Rate for Payer: CIGNA Commercial |
$44.65
|
| Rate for Payer: CIGNA Medicare |
$42.30
|
| Rate for Payer: HUMANA Commercial |
$42.30
|
| Rate for Payer: MEDICAID Medicaid |
$43.24
|
| Rate for Payer: MEDICARE Medicare |
$32.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$44.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$45.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$44.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$44.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$37.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$37.60
|
|
|
HSV TYPE 2 ANTIBODIES, IGG (163033)
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
HSV TYPE 2 ANTIBODIES, IGG (163033)
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
