|
INCISION OF RECTAL ABSCESS
|
Facility
IP
|
$983.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$688.10 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: AETNA Commercial |
$933.85
|
| Rate for Payer: AETNA Medicare |
$884.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$933.85
|
| Rate for Payer: BCBS Healthlink |
$884.70
|
| Rate for Payer: BCBS HMK CHIP |
$884.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$884.70
|
| Rate for Payer: BCBS POS |
$933.85
|
| Rate for Payer: BCBS Traditional |
$983.00
|
| Rate for Payer: CASH_PRICE |
$786.40
|
| Rate for Payer: CIGNA Commercial |
$933.85
|
| Rate for Payer: CIGNA Medicare |
$884.70
|
| Rate for Payer: HUMANA Commercial |
$884.70
|
| Rate for Payer: MEDICAID Medicaid |
$904.36
|
| Rate for Payer: MEDICARE Medicare |
$688.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$933.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$953.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$933.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$933.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$835.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$786.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$786.40
|
|
|
INCISION OF RECTAL ABSCESS
|
Facility
OP
|
$983.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$688.10 |
| Max. Negotiated Rate |
$983.00 |
| Rate for Payer: AETNA Commercial |
$933.85
|
| Rate for Payer: AETNA Medicare |
$884.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$933.85
|
| Rate for Payer: BCBS Healthlink |
$884.70
|
| Rate for Payer: BCBS HMK CHIP |
$884.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$884.70
|
| Rate for Payer: BCBS POS |
$933.85
|
| Rate for Payer: BCBS Traditional |
$983.00
|
| Rate for Payer: CASH_PRICE |
$786.40
|
| Rate for Payer: CIGNA Commercial |
$933.85
|
| Rate for Payer: CIGNA Medicare |
$884.70
|
| Rate for Payer: HUMANA Commercial |
$884.70
|
| Rate for Payer: MEDICAID Medicaid |
$904.36
|
| Rate for Payer: MEDICARE Medicare |
$688.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$933.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$953.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$933.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$933.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$835.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$786.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$786.40
|
|
|
INCISION OF THROMBOSED HEMORRHOID, EXTER
|
Facility
IP
|
$382.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: BCBS HMK CHIP |
$343.80
|
| Rate for Payer: AETNA Commercial |
$362.90
|
| Rate for Payer: AETNA Medicare |
$343.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$362.90
|
| Rate for Payer: BCBS Healthlink |
$343.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$343.80
|
| Rate for Payer: BCBS POS |
$362.90
|
| Rate for Payer: BCBS Traditional |
$382.00
|
| Rate for Payer: CASH_PRICE |
$305.60
|
| Rate for Payer: CIGNA Commercial |
$362.90
|
| Rate for Payer: CIGNA Medicare |
$343.80
|
| Rate for Payer: HUMANA Commercial |
$343.80
|
| Rate for Payer: MEDICAID Medicaid |
$351.44
|
| Rate for Payer: MEDICARE Medicare |
$267.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$362.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$370.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$362.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$362.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$324.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$305.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$305.60
|
|
|
INCISION OF THROMBOSED HEMORRHOID, EXTER
|
Facility
OP
|
$382.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: AETNA Commercial |
$362.90
|
| Rate for Payer: AETNA Medicare |
$343.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$362.90
|
| Rate for Payer: BCBS Healthlink |
$343.80
|
| Rate for Payer: BCBS HMK CHIP |
$343.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$343.80
|
| Rate for Payer: BCBS POS |
$362.90
|
| Rate for Payer: BCBS Traditional |
$382.00
|
| Rate for Payer: CASH_PRICE |
$305.60
|
| Rate for Payer: CIGNA Commercial |
$362.90
|
| Rate for Payer: CIGNA Medicare |
$343.80
|
| Rate for Payer: HUMANA Commercial |
$343.80
|
| Rate for Payer: MEDICAID Medicaid |
$351.44
|
| Rate for Payer: MEDICARE Medicare |
$267.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$362.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$370.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$362.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$362.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$324.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$305.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$305.60
|
|
|
INDOMETHACIN CAP[25 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
INDOMETHACIN CAP[25 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
INFANT CATH KIT
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
INFANT CATH KIT
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
INFECTIOUS MONONUCLEOSIS, RAPID TEST
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: AETNA Commercial |
$85.50
|
| Rate for Payer: AETNA Medicare |
$81.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$85.50
|
| Rate for Payer: BCBS Healthlink |
$81.00
|
| Rate for Payer: BCBS HMK CHIP |
$81.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.00
|
| Rate for Payer: BCBS POS |
$85.50
|
| Rate for Payer: BCBS Traditional |
$90.00
|
| Rate for Payer: CASH_PRICE |
$72.00
|
| Rate for Payer: CIGNA Commercial |
$85.50
|
| Rate for Payer: CIGNA Medicare |
$81.00
|
| Rate for Payer: HUMANA Commercial |
$81.00
|
| Rate for Payer: MEDICAID Medicaid |
$82.80
|
| Rate for Payer: MEDICARE Medicare |
$63.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$85.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$87.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$85.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$85.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$76.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.00
|
|
|
INFECTIOUS MONONUCLEOSIS, RAPID TEST
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: AETNA Commercial |
$85.50
|
| Rate for Payer: AETNA Medicare |
$81.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$85.50
|
| Rate for Payer: BCBS Healthlink |
$81.00
|
| Rate for Payer: BCBS HMK CHIP |
$81.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.00
|
| Rate for Payer: BCBS POS |
$85.50
|
| Rate for Payer: BCBS Traditional |
$90.00
|
| Rate for Payer: CASH_PRICE |
$72.00
|
| Rate for Payer: CIGNA Commercial |
$85.50
|
| Rate for Payer: CIGNA Medicare |
$81.00
|
| Rate for Payer: HUMANA Commercial |
$81.00
|
| Rate for Payer: MEDICAID Medicaid |
$82.80
|
| Rate for Payer: MEDICARE Medicare |
$63.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$85.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$87.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$85.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$85.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$76.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.00
|
|
|
.INFLUENZA A
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
.INFLUENZA A
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
.INFLUENZA B
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 87804 59
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
.INFLUENZA B
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 87804 59
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: AETNA Commercial |
$107.35
|
| Rate for Payer: AETNA Medicare |
$101.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$107.35
|
| Rate for Payer: BCBS Healthlink |
$101.70
|
| Rate for Payer: BCBS HMK CHIP |
$101.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$101.70
|
| Rate for Payer: BCBS POS |
$107.35
|
| Rate for Payer: BCBS Traditional |
$113.00
|
| Rate for Payer: CASH_PRICE |
$90.40
|
| Rate for Payer: CIGNA Commercial |
$107.35
|
| Rate for Payer: CIGNA Medicare |
$101.70
|
| Rate for Payer: HUMANA Commercial |
$101.70
|
| Rate for Payer: MEDICAID Medicaid |
$103.96
|
| Rate for Payer: MEDICARE Medicare |
$79.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$107.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$109.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$107.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$107.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$96.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$90.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$90.40
|
|
|
INFUSURG 1000CC
|
Facility
OP
|
$39.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
INFUSURG 1000CC
|
Facility
IP
|
$39.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
Initial E/M Normal Newborn <8days
|
Facility
OP
|
$218.00
|
|
|
Service Code
|
CPT 99461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
Initial E/M Normal Newborn <8days
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT 99461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
INITIAL HOUR OF CHEMO INFUSION
|
Facility
OP
|
$890.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$623.00 |
| Max. Negotiated Rate |
$890.00 |
| Rate for Payer: AETNA Commercial |
$845.50
|
| Rate for Payer: AETNA Medicare |
$801.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$845.50
|
| Rate for Payer: BCBS Healthlink |
$801.00
|
| Rate for Payer: BCBS HMK CHIP |
$801.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$801.00
|
| Rate for Payer: BCBS POS |
$845.50
|
| Rate for Payer: BCBS Traditional |
$890.00
|
| Rate for Payer: CASH_PRICE |
$712.00
|
| Rate for Payer: CIGNA Commercial |
$845.50
|
| Rate for Payer: CIGNA Medicare |
$801.00
|
| Rate for Payer: HUMANA Commercial |
$801.00
|
| Rate for Payer: MEDICAID Medicaid |
$818.80
|
| Rate for Payer: MEDICARE Medicare |
$623.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$845.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$863.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$845.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$845.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$756.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$712.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$712.00
|
|
|
INITIAL HOUR OF CHEMO INFUSION
|
Facility
IP
|
$890.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$623.00 |
| Max. Negotiated Rate |
$890.00 |
| Rate for Payer: BCBS HMK CHIP |
$801.00
|
| Rate for Payer: AETNA Commercial |
$845.50
|
| Rate for Payer: AETNA Medicare |
$801.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$845.50
|
| Rate for Payer: BCBS Healthlink |
$801.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$801.00
|
| Rate for Payer: BCBS POS |
$845.50
|
| Rate for Payer: BCBS Traditional |
$890.00
|
| Rate for Payer: CASH_PRICE |
$712.00
|
| Rate for Payer: CIGNA Commercial |
$845.50
|
| Rate for Payer: CIGNA Medicare |
$801.00
|
| Rate for Payer: HUMANA Commercial |
$801.00
|
| Rate for Payer: MEDICAID Medicaid |
$818.80
|
| Rate for Payer: MEDICARE Medicare |
$623.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$845.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$863.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$845.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$845.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$756.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$712.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$712.00
|
|
|
INITIAL PSYCH INTAKE
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
INITIAL PSYCH INTAKE
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: AETNA Commercial |
$285.00
|
| Rate for Payer: AETNA Medicare |
$270.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$285.00
|
| Rate for Payer: BCBS Healthlink |
$270.00
|
| Rate for Payer: BCBS HMK CHIP |
$270.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$270.00
|
| Rate for Payer: BCBS POS |
$285.00
|
| Rate for Payer: BCBS Traditional |
$300.00
|
| Rate for Payer: CASH_PRICE |
$240.00
|
| Rate for Payer: CIGNA Commercial |
$285.00
|
| Rate for Payer: CIGNA Medicare |
$270.00
|
| Rate for Payer: HUMANA Commercial |
$270.00
|
| Rate for Payer: MEDICAID Medicaid |
$276.00
|
| Rate for Payer: MEDICARE Medicare |
$210.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$285.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$291.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$285.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$285.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$255.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$240.00
|
|
|
INITIAL PSYCH INTAKE WITH MEDICAL SERVIC
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: AETNA Commercial |
$316.35
|
| Rate for Payer: AETNA Medicare |
$299.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$316.35
|
| Rate for Payer: BCBS Healthlink |
$299.70
|
| Rate for Payer: BCBS HMK CHIP |
$299.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$299.70
|
| Rate for Payer: BCBS POS |
$316.35
|
| Rate for Payer: BCBS Traditional |
$333.00
|
| Rate for Payer: CASH_PRICE |
$266.40
|
| Rate for Payer: CIGNA Commercial |
$316.35
|
| Rate for Payer: CIGNA Medicare |
$299.70
|
| Rate for Payer: HUMANA Commercial |
$299.70
|
| Rate for Payer: MEDICAID Medicaid |
$306.36
|
| Rate for Payer: MEDICARE Medicare |
$233.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$316.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$316.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$316.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$266.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$266.40
|
|
|
INITIAL PSYCH INTAKE WITH MEDICAL SERVIC
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: BCBS HMK CHIP |
$299.70
|
| Rate for Payer: AETNA Commercial |
$316.35
|
| Rate for Payer: AETNA Medicare |
$299.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$316.35
|
| Rate for Payer: BCBS Healthlink |
$299.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$299.70
|
| Rate for Payer: BCBS POS |
$316.35
|
| Rate for Payer: BCBS Traditional |
$333.00
|
| Rate for Payer: CASH_PRICE |
$266.40
|
| Rate for Payer: CIGNA Commercial |
$316.35
|
| Rate for Payer: CIGNA Medicare |
$299.70
|
| Rate for Payer: HUMANA Commercial |
$299.70
|
| Rate for Payer: MEDICAID Medicaid |
$306.36
|
| Rate for Payer: MEDICARE Medicare |
$233.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$316.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$323.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$316.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$316.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$283.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$266.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$266.40
|
|
|
INJ ADMIN ALLERGY/MULTI
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
