|
IODOFORM PACKING 1/4 "
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
IODOFORM PACKING 1/4 "
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: AETNA Commercial |
$3.80
|
| Rate for Payer: AETNA Medicare |
$3.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3.80
|
| Rate for Payer: BCBS Healthlink |
$3.60
|
| Rate for Payer: BCBS HMK CHIP |
$3.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3.60
|
| Rate for Payer: BCBS POS |
$3.80
|
| Rate for Payer: BCBS Traditional |
$4.00
|
| Rate for Payer: CASH_PRICE |
$3.20
|
| Rate for Payer: CIGNA Commercial |
$3.80
|
| Rate for Payer: CIGNA Medicare |
$3.60
|
| Rate for Payer: HUMANA Commercial |
$3.60
|
| Rate for Payer: MEDICAID Medicaid |
$3.68
|
| Rate for Payer: MEDICARE Medicare |
$2.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$3.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$3.20
|
|
|
IP/OBS DAY DISCHARGE 30 MIN OR LESS
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
IP/OBS DAY DISCHARGE 30 MIN OR LESS
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 99238
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
IP/OBS SEP DISCHARGE >30 MIN
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: AETNA Commercial |
$214.70
|
| Rate for Payer: AETNA Medicare |
$203.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$214.70
|
| Rate for Payer: BCBS Healthlink |
$203.40
|
| Rate for Payer: BCBS HMK CHIP |
$203.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$203.40
|
| Rate for Payer: BCBS POS |
$214.70
|
| Rate for Payer: BCBS Traditional |
$226.00
|
| Rate for Payer: CASH_PRICE |
$180.80
|
| Rate for Payer: CIGNA Commercial |
$214.70
|
| Rate for Payer: CIGNA Medicare |
$203.40
|
| Rate for Payer: HUMANA Commercial |
$203.40
|
| Rate for Payer: MEDICAID Medicaid |
$207.92
|
| Rate for Payer: MEDICARE Medicare |
$158.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$214.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$219.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$214.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$214.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.80
|
|
|
IP/OBS SEP DISCHARGE >30 MIN
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
CPT 99239
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: AETNA Commercial |
$214.70
|
| Rate for Payer: AETNA Medicare |
$203.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$214.70
|
| Rate for Payer: BCBS Healthlink |
$203.40
|
| Rate for Payer: BCBS HMK CHIP |
$203.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$203.40
|
| Rate for Payer: BCBS POS |
$214.70
|
| Rate for Payer: BCBS Traditional |
$226.00
|
| Rate for Payer: CASH_PRICE |
$180.80
|
| Rate for Payer: CIGNA Commercial |
$214.70
|
| Rate for Payer: CIGNA Medicare |
$203.40
|
| Rate for Payer: HUMANA Commercial |
$203.40
|
| Rate for Payer: MEDICAID Medicaid |
$207.92
|
| Rate for Payer: MEDICARE Medicare |
$158.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$214.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$219.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$214.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$214.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.80
|
|
|
IPRATROP/ALBUTEROL MDI [20 MCG/100 MCG]
|
Facility
IP
|
$988.00
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: BCBS HMK CHIP |
$889.20
|
| Rate for Payer: AETNA Commercial |
$938.60
|
| Rate for Payer: AETNA Medicare |
$889.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$938.60
|
| Rate for Payer: BCBS Healthlink |
$889.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$889.20
|
| Rate for Payer: BCBS POS |
$938.60
|
| Rate for Payer: BCBS Traditional |
$988.00
|
| Rate for Payer: CASH_PRICE |
$790.40
|
| Rate for Payer: CIGNA Commercial |
$938.60
|
| Rate for Payer: CIGNA Medicare |
$889.20
|
| Rate for Payer: HUMANA Commercial |
$889.20
|
| Rate for Payer: MEDICAID Medicaid |
$908.96
|
| Rate for Payer: MEDICARE Medicare |
$691.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$938.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$958.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$938.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$938.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$839.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$790.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$790.40
|
|
|
IPRATROP/ALBUTEROL MDI [20 MCG/100 MCG]
|
Facility
OP
|
$988.00
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: AETNA Commercial |
$938.60
|
| Rate for Payer: AETNA Medicare |
$889.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$938.60
|
| Rate for Payer: BCBS Healthlink |
$889.20
|
| Rate for Payer: BCBS HMK CHIP |
$889.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$889.20
|
| Rate for Payer: BCBS POS |
$938.60
|
| Rate for Payer: BCBS Traditional |
$988.00
|
| Rate for Payer: CASH_PRICE |
$790.40
|
| Rate for Payer: CIGNA Commercial |
$938.60
|
| Rate for Payer: CIGNA Medicare |
$889.20
|
| Rate for Payer: HUMANA Commercial |
$889.20
|
| Rate for Payer: MEDICAID Medicaid |
$908.96
|
| Rate for Payer: MEDICARE Medicare |
$691.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$938.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$958.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$938.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$938.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$839.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$790.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$790.40
|
|
|
IPRATROPIUM NEB SOLN 0.02%
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
IPRATROPIUM NEB SOLN 0.02%
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J7644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
IPV INITIAL CARE BRIEF ADMIT 99221
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: AETNA Commercial |
$204.25
|
| Rate for Payer: AETNA Medicare |
$193.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$204.25
|
| Rate for Payer: BCBS Healthlink |
$193.50
|
| Rate for Payer: BCBS HMK CHIP |
$193.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$193.50
|
| Rate for Payer: BCBS POS |
$204.25
|
| Rate for Payer: BCBS Traditional |
$215.00
|
| Rate for Payer: CASH_PRICE |
$172.00
|
| Rate for Payer: CIGNA Commercial |
$204.25
|
| Rate for Payer: CIGNA Medicare |
$193.50
|
| Rate for Payer: HUMANA Commercial |
$193.50
|
| Rate for Payer: MEDICAID Medicaid |
$197.80
|
| Rate for Payer: MEDICARE Medicare |
$150.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$204.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$208.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$204.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$204.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$182.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$172.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$172.00
|
|
|
IPV INITIAL CARE BRIEF ADMIT 99221
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$215.00 |
| Rate for Payer: BCBS HMK CHIP |
$193.50
|
| Rate for Payer: AETNA Commercial |
$204.25
|
| Rate for Payer: AETNA Medicare |
$193.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$204.25
|
| Rate for Payer: BCBS Healthlink |
$193.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$193.50
|
| Rate for Payer: BCBS POS |
$204.25
|
| Rate for Payer: BCBS Traditional |
$215.00
|
| Rate for Payer: CASH_PRICE |
$172.00
|
| Rate for Payer: CIGNA Commercial |
$204.25
|
| Rate for Payer: CIGNA Medicare |
$193.50
|
| Rate for Payer: HUMANA Commercial |
$193.50
|
| Rate for Payer: MEDICAID Medicaid |
$197.80
|
| Rate for Payer: MEDICARE Medicare |
$150.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$204.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$208.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$204.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$204.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$182.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$172.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$172.00
|
|
|
IPV INITIAL CARE COMPLEX ADMIT
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
IPV INITIAL CARE COMPLEX ADMIT
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: AETNA Commercial |
$399.00
|
| Rate for Payer: AETNA Medicare |
$378.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$399.00
|
| Rate for Payer: BCBS Healthlink |
$378.00
|
| Rate for Payer: BCBS HMK CHIP |
$378.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$378.00
|
| Rate for Payer: BCBS POS |
$399.00
|
| Rate for Payer: BCBS Traditional |
$420.00
|
| Rate for Payer: CASH_PRICE |
$336.00
|
| Rate for Payer: CIGNA Commercial |
$399.00
|
| Rate for Payer: CIGNA Medicare |
$378.00
|
| Rate for Payer: HUMANA Commercial |
$378.00
|
| Rate for Payer: MEDICAID Medicaid |
$386.40
|
| Rate for Payer: MEDICARE Medicare |
$294.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$399.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$407.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$399.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$399.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$357.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$336.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$336.00
|
|
|
IPV INITIAL CARE INTERM ADMI
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
IPV INITIAL CARE INTERM ADMI
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
IPV SUBSEQUENT CARE EXTENDED
|
Facility
IP
|
$221.00
|
|
|
Service Code
|
CPT 99233
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AETNA Commercial |
$209.95
|
| Rate for Payer: AETNA Medicare |
$198.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$209.95
|
| Rate for Payer: BCBS Healthlink |
$198.90
|
| Rate for Payer: BCBS HMK CHIP |
$198.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$198.90
|
| Rate for Payer: BCBS POS |
$209.95
|
| Rate for Payer: BCBS Traditional |
$221.00
|
| Rate for Payer: CASH_PRICE |
$176.80
|
| Rate for Payer: CIGNA Commercial |
$209.95
|
| Rate for Payer: CIGNA Medicare |
$198.90
|
| Rate for Payer: HUMANA Commercial |
$198.90
|
| Rate for Payer: MEDICAID Medicaid |
$203.32
|
| Rate for Payer: MEDICARE Medicare |
$154.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$209.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$214.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$209.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$209.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$187.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$176.80
|
|
|
IPV SUBSEQUENT CARE EXTENDED
|
Facility
OP
|
$221.00
|
|
|
Service Code
|
CPT 99233
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AETNA Commercial |
$209.95
|
| Rate for Payer: AETNA Medicare |
$198.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$209.95
|
| Rate for Payer: BCBS Healthlink |
$198.90
|
| Rate for Payer: BCBS HMK CHIP |
$198.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$198.90
|
| Rate for Payer: BCBS POS |
$209.95
|
| Rate for Payer: BCBS Traditional |
$221.00
|
| Rate for Payer: CASH_PRICE |
$176.80
|
| Rate for Payer: CIGNA Commercial |
$209.95
|
| Rate for Payer: CIGNA Medicare |
$198.90
|
| Rate for Payer: HUMANA Commercial |
$198.90
|
| Rate for Payer: MEDICAID Medicaid |
$203.32
|
| Rate for Payer: MEDICARE Medicare |
$154.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$209.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$214.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$209.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$209.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$187.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$176.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$176.80
|
|
|
IPV SUBSEQUENT CARE INTERM
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
IPV SUBSEQUENT CARE INTERM
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: BCBS HMK CHIP |
$136.80
|
| Rate for Payer: AETNA Commercial |
$144.40
|
| Rate for Payer: AETNA Medicare |
$136.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$144.40
|
| Rate for Payer: BCBS Healthlink |
$136.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$136.80
|
| Rate for Payer: BCBS POS |
$144.40
|
| Rate for Payer: BCBS Traditional |
$152.00
|
| Rate for Payer: CASH_PRICE |
$121.60
|
| Rate for Payer: CIGNA Commercial |
$144.40
|
| Rate for Payer: CIGNA Medicare |
$136.80
|
| Rate for Payer: HUMANA Commercial |
$136.80
|
| Rate for Payer: MEDICAID Medicaid |
$139.84
|
| Rate for Payer: MEDICARE Medicare |
$106.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$144.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$147.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$144.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$144.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$129.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$121.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$121.60
|
|
|
IPV SUBSEQUENT CARE LIMITED
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 99231
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
IPV SUBSEQUENT CARE LIMITED
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 99231
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
IRON SUCROSE INJ 20MG/ML (10ML VIAL)
|
Facility
OP
|
$443.60
|
|
| Hospital Charge Code |
20230105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$310.52 |
| Max. Negotiated Rate |
$443.60 |
| Rate for Payer: AETNA Commercial |
$421.42
|
| Rate for Payer: AETNA Medicare |
$399.24
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$421.42
|
| Rate for Payer: BCBS Healthlink |
$399.24
|
| Rate for Payer: BCBS HMK CHIP |
$399.24
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$399.24
|
| Rate for Payer: BCBS POS |
$421.42
|
| Rate for Payer: BCBS Traditional |
$443.60
|
| Rate for Payer: CASH_PRICE |
$354.88
|
| Rate for Payer: CIGNA Commercial |
$421.42
|
| Rate for Payer: CIGNA Medicare |
$399.24
|
| Rate for Payer: HUMANA Commercial |
$399.24
|
| Rate for Payer: MEDICAID Medicaid |
$408.11
|
| Rate for Payer: MEDICARE Medicare |
$310.52
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$421.42
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$430.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$421.42
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$421.42
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$377.06
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$354.88
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$354.88
|
|
|
IRON SUCROSE INJ 20MG/ML (10ML VIAL)
|
Facility
IP
|
$443.60
|
|
| Hospital Charge Code |
20230105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$310.52 |
| Max. Negotiated Rate |
$443.60 |
| Rate for Payer: BCBS HMK CHIP |
$399.24
|
| Rate for Payer: AETNA Commercial |
$421.42
|
| Rate for Payer: AETNA Medicare |
$399.24
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$421.42
|
| Rate for Payer: BCBS Healthlink |
$399.24
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$399.24
|
| Rate for Payer: BCBS POS |
$421.42
|
| Rate for Payer: BCBS Traditional |
$443.60
|
| Rate for Payer: CASH_PRICE |
$354.88
|
| Rate for Payer: CIGNA Commercial |
$421.42
|
| Rate for Payer: CIGNA Medicare |
$399.24
|
| Rate for Payer: HUMANA Commercial |
$399.24
|
| Rate for Payer: MEDICAID Medicaid |
$408.11
|
| Rate for Payer: MEDICARE Medicare |
$310.52
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$421.42
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$430.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$421.42
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$421.42
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$377.06
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$354.88
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$354.88
|
|
|
.IRON, TOTAL
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
