|
IV - NITROGLYCERIN/D5W [25 MG/250 ML]
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
|
IV - POTASSIUM CL/NACL 0.9% [20 MEQ] 1L
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: AETNA Commercial |
$34.20
|
| Rate for Payer: AETNA Medicare |
$32.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.20
|
| Rate for Payer: BCBS Healthlink |
$32.40
|
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.40
|
| Rate for Payer: BCBS POS |
$34.20
|
| Rate for Payer: BCBS Traditional |
$36.00
|
| Rate for Payer: CASH_PRICE |
$28.80
|
| Rate for Payer: CIGNA Commercial |
$34.20
|
| Rate for Payer: CIGNA Medicare |
$32.40
|
| Rate for Payer: HUMANA Commercial |
$32.40
|
| Rate for Payer: MEDICAID Medicaid |
$33.12
|
| Rate for Payer: MEDICARE Medicare |
$25.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.80
|
|
|
IV - POTASSIUM CL/NACL 0.9% [20 MEQ] 1L
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| Rate for Payer: AETNA Commercial |
$34.20
|
| Rate for Payer: AETNA Medicare |
$32.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.20
|
| Rate for Payer: BCBS Healthlink |
$32.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.40
|
| Rate for Payer: BCBS POS |
$34.20
|
| Rate for Payer: BCBS Traditional |
$36.00
|
| Rate for Payer: CASH_PRICE |
$28.80
|
| Rate for Payer: CIGNA Commercial |
$34.20
|
| Rate for Payer: CIGNA Medicare |
$32.40
|
| Rate for Payer: HUMANA Commercial |
$32.40
|
| Rate for Payer: MEDICAID Medicaid |
$33.12
|
| Rate for Payer: MEDICARE Medicare |
$25.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.80
|
|
|
IV - POTASSIUM CL/NS [40 mEq] 1000ML
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
IV - POTASSIUM CL/NS [40 mEq] 1000ML
|
Facility
IP
|
$41.00
|
|
|
Service Code
|
CPT J3480
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
IV PUSH EA ADD'L DRUG
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
IV PUSH EA ADD'L DRUG
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: AETNA Commercial |
$139.65
|
| Rate for Payer: AETNA Medicare |
$132.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$139.65
|
| Rate for Payer: BCBS Healthlink |
$132.30
|
| Rate for Payer: BCBS HMK CHIP |
$132.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$132.30
|
| Rate for Payer: BCBS POS |
$139.65
|
| Rate for Payer: BCBS Traditional |
$147.00
|
| Rate for Payer: CASH_PRICE |
$117.60
|
| Rate for Payer: CIGNA Commercial |
$139.65
|
| Rate for Payer: CIGNA Medicare |
$132.30
|
| Rate for Payer: HUMANA Commercial |
$132.30
|
| Rate for Payer: MEDICAID Medicaid |
$135.24
|
| Rate for Payer: MEDICARE Medicare |
$102.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$139.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$142.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$139.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$139.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$124.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$117.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$117.60
|
|
|
IV PUSH;INITIAL
|
Facility
OP
|
$195.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: AETNA Commercial |
$185.25
|
| Rate for Payer: AETNA Medicare |
$175.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$185.25
|
| Rate for Payer: BCBS Healthlink |
$175.50
|
| Rate for Payer: BCBS HMK CHIP |
$175.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$175.50
|
| Rate for Payer: BCBS POS |
$185.25
|
| Rate for Payer: BCBS Traditional |
$195.00
|
| Rate for Payer: CASH_PRICE |
$156.00
|
| Rate for Payer: CIGNA Commercial |
$185.25
|
| Rate for Payer: CIGNA Medicare |
$175.50
|
| Rate for Payer: HUMANA Commercial |
$175.50
|
| Rate for Payer: MEDICAID Medicaid |
$179.40
|
| Rate for Payer: MEDICARE Medicare |
$136.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$185.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$189.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$185.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$185.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$165.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.00
|
|
|
IV PUSH;INITIAL
|
Facility
IP
|
$195.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: AETNA Commercial |
$185.25
|
| Rate for Payer: AETNA Medicare |
$175.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$185.25
|
| Rate for Payer: BCBS Healthlink |
$175.50
|
| Rate for Payer: BCBS HMK CHIP |
$175.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$175.50
|
| Rate for Payer: BCBS POS |
$185.25
|
| Rate for Payer: BCBS Traditional |
$195.00
|
| Rate for Payer: CASH_PRICE |
$156.00
|
| Rate for Payer: CIGNA Commercial |
$185.25
|
| Rate for Payer: CIGNA Medicare |
$175.50
|
| Rate for Payer: HUMANA Commercial |
$175.50
|
| Rate for Payer: MEDICAID Medicaid |
$179.40
|
| Rate for Payer: MEDICARE Medicare |
$136.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$185.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$189.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$185.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$185.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$165.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$156.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$156.00
|
|
|
IV PUSH SAME MED
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: AETNA Commercial |
$125.40
|
| Rate for Payer: AETNA Medicare |
$118.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$125.40
|
| Rate for Payer: BCBS Healthlink |
$118.80
|
| Rate for Payer: BCBS HMK CHIP |
$118.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$118.80
|
| Rate for Payer: BCBS POS |
$125.40
|
| Rate for Payer: BCBS Traditional |
$132.00
|
| Rate for Payer: CASH_PRICE |
$105.60
|
| Rate for Payer: CIGNA Commercial |
$125.40
|
| Rate for Payer: CIGNA Medicare |
$118.80
|
| Rate for Payer: HUMANA Commercial |
$118.80
|
| Rate for Payer: MEDICAID Medicaid |
$121.44
|
| Rate for Payer: MEDICARE Medicare |
$92.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$125.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$128.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$125.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$125.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$112.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$105.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$105.60
|
|
|
IV PUSH SAME MED
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: BCBS HMK CHIP |
$118.80
|
| Rate for Payer: AETNA Commercial |
$125.40
|
| Rate for Payer: AETNA Medicare |
$118.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$125.40
|
| Rate for Payer: BCBS Healthlink |
$118.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$118.80
|
| Rate for Payer: BCBS POS |
$125.40
|
| Rate for Payer: BCBS Traditional |
$132.00
|
| Rate for Payer: CASH_PRICE |
$105.60
|
| Rate for Payer: CIGNA Commercial |
$125.40
|
| Rate for Payer: CIGNA Medicare |
$118.80
|
| Rate for Payer: HUMANA Commercial |
$118.80
|
| Rate for Payer: MEDICAID Medicaid |
$121.44
|
| Rate for Payer: MEDICARE Medicare |
$92.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$125.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$128.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$125.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$125.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$112.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$105.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$105.60
|
|
|
JAK2V617F MUTATION DETECTION (489200)
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
|
JAK2V617F MUTATION DETECTION (489200)
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
|
KERLIX FLUFFS SUPER SPONGE
|
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: BCBS HMK CHIP |
$3.60
|
| 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 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
|
|
|
KERLIX FLUFFS SUPER SPONGE
|
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
|
|
|
KERLIX ROLLS 4.5X4YDS
|
Facility
IP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
KERLIX ROLLS 4.5X4YDS
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
KETAMINE INJ [500 MG/10 ML] MDV
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
KETAMINE INJ [500 MG/10 ML] MDV
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
KETOROLAC INJ [15 MG/ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
KETOROLAC INJ [15 MG/ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
KIDNEY STONE ANALYSIS (910180)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
KIDNEY STONE ANALYSIS (910180)
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
KING AIRWAY SIZE 3
|
Facility
IP
|
$167.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
|
KING AIRWAY SIZE 3
|
Facility
OP
|
$167.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: AETNA Commercial |
$158.65
|
| Rate for Payer: AETNA Medicare |
$150.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$158.65
|
| Rate for Payer: BCBS Healthlink |
$150.30
|
| Rate for Payer: BCBS HMK CHIP |
$150.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$150.30
|
| Rate for Payer: BCBS POS |
$158.65
|
| Rate for Payer: BCBS Traditional |
$167.00
|
| Rate for Payer: CASH_PRICE |
$133.60
|
| Rate for Payer: CIGNA Commercial |
$158.65
|
| Rate for Payer: CIGNA Medicare |
$150.30
|
| Rate for Payer: HUMANA Commercial |
$150.30
|
| Rate for Payer: MEDICAID Medicaid |
$153.64
|
| Rate for Payer: MEDICARE Medicare |
$116.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$158.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$161.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$158.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$158.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$141.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$133.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$133.60
|
|
