|
INS - NOVOLIN NPH [1 UNITS/0.01 ML]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
INS - NOVOLIN REGULAR [1 UNITS/0.01 ML]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
INS - NOVOLIN REGULAR [1 UNITS/0.01 ML]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
INS - REGULAR [HUMULIN] 100UN/ML 3ML
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
INS - REGULAR [HUMULIN] 100UN/ML 3ML
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
INSULIN LEVEL (004333)
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
INSULIN LEVEL (004333)
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
INSULIN-LIKE GROWTH FACTOR-1 (010363)
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
INSULIN-LIKE GROWTH FACTOR-1 (010363)
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$118.00 |
| Rate for Payer: AETNA Commercial |
$112.10
|
| Rate for Payer: AETNA Medicare |
$106.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$112.10
|
| Rate for Payer: BCBS Healthlink |
$106.20
|
| Rate for Payer: BCBS HMK CHIP |
$106.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$106.20
|
| Rate for Payer: BCBS POS |
$112.10
|
| Rate for Payer: BCBS Traditional |
$118.00
|
| Rate for Payer: CASH_PRICE |
$94.40
|
| Rate for Payer: CIGNA Commercial |
$112.10
|
| Rate for Payer: CIGNA Medicare |
$106.20
|
| Rate for Payer: HUMANA Commercial |
$106.20
|
| Rate for Payer: MEDICAID Medicaid |
$108.56
|
| Rate for Payer: MEDICARE Medicare |
$82.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$112.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$114.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$112.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$112.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$100.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$94.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$94.40
|
|
|
INTERACTIVE COMPLEXITY
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
INTERACTIVE COMPLEXITY
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
INTRA LESION CHEMO ADMIN MORE THAT 7 LES
|
Facility
IP
|
$455.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: BCBS HMK CHIP |
$409.50
|
| Rate for Payer: AETNA Commercial |
$432.25
|
| Rate for Payer: AETNA Medicare |
$409.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$432.25
|
| Rate for Payer: BCBS Healthlink |
$409.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$409.50
|
| Rate for Payer: BCBS POS |
$432.25
|
| Rate for Payer: BCBS Traditional |
$455.00
|
| Rate for Payer: CASH_PRICE |
$364.00
|
| Rate for Payer: CIGNA Commercial |
$432.25
|
| Rate for Payer: CIGNA Medicare |
$409.50
|
| Rate for Payer: HUMANA Commercial |
$409.50
|
| Rate for Payer: MEDICAID Medicaid |
$418.60
|
| Rate for Payer: MEDICARE Medicare |
$318.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$432.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$441.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$432.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$432.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$386.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$364.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$364.00
|
|
|
INTRA LESION CHEMO ADMIN MORE THAT 7 LES
|
Facility
OP
|
$455.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: AETNA Commercial |
$432.25
|
| Rate for Payer: AETNA Medicare |
$409.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$432.25
|
| Rate for Payer: BCBS Healthlink |
$409.50
|
| Rate for Payer: BCBS HMK CHIP |
$409.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$409.50
|
| Rate for Payer: BCBS POS |
$432.25
|
| Rate for Payer: BCBS Traditional |
$455.00
|
| Rate for Payer: CASH_PRICE |
$364.00
|
| Rate for Payer: CIGNA Commercial |
$432.25
|
| Rate for Payer: CIGNA Medicare |
$409.50
|
| Rate for Payer: HUMANA Commercial |
$409.50
|
| Rate for Payer: MEDICAID Medicaid |
$418.60
|
| Rate for Payer: MEDICARE Medicare |
$318.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$432.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$441.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$432.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$432.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$386.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$364.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$364.00
|
|
|
INTRA LESION CHEMO ADMIN UP TO 7 LES
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
INTRA LESION CHEMO ADMIN UP TO 7 LES
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
INTREPID INITIAL EVAL/DISCHARGE
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
CPT G0151
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: BCBS HMK CHIP |
$158.40
|
| Rate for Payer: AETNA Commercial |
$167.20
|
| Rate for Payer: AETNA Medicare |
$158.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$167.20
|
| Rate for Payer: BCBS Healthlink |
$158.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$158.40
|
| Rate for Payer: BCBS POS |
$167.20
|
| Rate for Payer: BCBS Traditional |
$176.00
|
| Rate for Payer: CASH_PRICE |
$140.80
|
| Rate for Payer: CIGNA Commercial |
$167.20
|
| Rate for Payer: CIGNA Medicare |
$158.40
|
| Rate for Payer: HUMANA Commercial |
$158.40
|
| Rate for Payer: MEDICAID Medicaid |
$161.92
|
| Rate for Payer: MEDICARE Medicare |
$123.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$167.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$170.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$167.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$167.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$140.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$140.80
|
|
|
INTREPID INITIAL EVAL/DISCHARGE
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
CPT G0151
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: AETNA Commercial |
$167.20
|
| Rate for Payer: AETNA Medicare |
$158.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$167.20
|
| Rate for Payer: BCBS Healthlink |
$158.40
|
| Rate for Payer: BCBS HMK CHIP |
$158.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$158.40
|
| Rate for Payer: BCBS POS |
$167.20
|
| Rate for Payer: BCBS Traditional |
$176.00
|
| Rate for Payer: CASH_PRICE |
$140.80
|
| Rate for Payer: CIGNA Commercial |
$167.20
|
| Rate for Payer: CIGNA Medicare |
$158.40
|
| Rate for Payer: HUMANA Commercial |
$158.40
|
| Rate for Payer: MEDICAID Medicaid |
$161.92
|
| Rate for Payer: MEDICARE Medicare |
$123.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$167.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$170.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$167.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$167.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$140.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$140.80
|
|
|
INTREPID ORIENTATION OF STAFF
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
INTREPID ORIENTATION OF STAFF
|
Facility
IP
|
$45.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
INTREPID TRAVEL TIME/HR
|
Facility
OP
|
$64.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
429
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: AETNA Commercial |
$60.80
|
| Rate for Payer: AETNA Medicare |
$57.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$60.80
|
| Rate for Payer: BCBS Healthlink |
$57.60
|
| Rate for Payer: BCBS HMK CHIP |
$57.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$57.60
|
| Rate for Payer: BCBS POS |
$60.80
|
| Rate for Payer: BCBS Traditional |
$64.00
|
| Rate for Payer: CASH_PRICE |
$51.20
|
| Rate for Payer: CIGNA Commercial |
$60.80
|
| Rate for Payer: CIGNA Medicare |
$57.60
|
| Rate for Payer: HUMANA Commercial |
$57.60
|
| Rate for Payer: MEDICAID Medicaid |
$58.88
|
| Rate for Payer: MEDICARE Medicare |
$44.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$60.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$62.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$60.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$51.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$51.20
|
|
|
INTREPID TRAVEL TIME/HR
|
Facility
IP
|
$64.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
429
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: BCBS HMK CHIP |
$57.60
|
| Rate for Payer: AETNA Commercial |
$60.80
|
| Rate for Payer: AETNA Medicare |
$57.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$60.80
|
| Rate for Payer: BCBS Healthlink |
$57.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$57.60
|
| Rate for Payer: BCBS POS |
$60.80
|
| Rate for Payer: BCBS Traditional |
$64.00
|
| Rate for Payer: CASH_PRICE |
$51.20
|
| Rate for Payer: CIGNA Commercial |
$60.80
|
| Rate for Payer: CIGNA Medicare |
$57.60
|
| Rate for Payer: HUMANA Commercial |
$57.60
|
| Rate for Payer: MEDICAID Medicaid |
$58.88
|
| Rate for Payer: MEDICARE Medicare |
$44.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$60.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$62.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$60.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$51.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$51.20
|
|
|
INTREPID VISIT
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT G0151
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
INTREPID VISIT
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT G0151
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
INVALID RING
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
INVALID RING
|
Facility
IP
|
$9.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
