|
LAB ALLERGY TEST: SESAME SEED
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST: SHRIMP
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST: SHRIMP
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST:SOYBEAN
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST:SOYBEAN
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST: TUNA
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST: TUNA
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST: WALNUT
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST: WALNUT
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST:WHEAT
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALLERGY TEST:WHEAT
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
LAB ALPHA FETORPTEIN L3
|
Facility
OP
|
$156.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: AETNA Commercial |
$148.20
|
| Rate for Payer: AETNA Medicare |
$140.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$148.20
|
| Rate for Payer: BCBS Healthlink |
$140.40
|
| Rate for Payer: BCBS HMK CHIP |
$140.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$140.40
|
| Rate for Payer: BCBS POS |
$148.20
|
| Rate for Payer: BCBS Traditional |
$156.00
|
| Rate for Payer: CASH_PRICE |
$124.80
|
| Rate for Payer: CIGNA Commercial |
$148.20
|
| Rate for Payer: CIGNA Medicare |
$140.40
|
| Rate for Payer: HUMANA Commercial |
$140.40
|
| Rate for Payer: MEDICAID Medicaid |
$143.52
|
| Rate for Payer: MEDICARE Medicare |
$109.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$148.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$151.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$148.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$148.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$132.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.80
|
|
|
LAB ALPHA FETORPTEIN L3
|
Facility
IP
|
$156.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: AETNA Commercial |
$148.20
|
| Rate for Payer: AETNA Medicare |
$140.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$148.20
|
| Rate for Payer: BCBS Healthlink |
$140.40
|
| Rate for Payer: BCBS HMK CHIP |
$140.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$140.40
|
| Rate for Payer: BCBS POS |
$148.20
|
| Rate for Payer: BCBS Traditional |
$156.00
|
| Rate for Payer: CASH_PRICE |
$124.80
|
| Rate for Payer: CIGNA Commercial |
$148.20
|
| Rate for Payer: CIGNA Medicare |
$140.40
|
| Rate for Payer: HUMANA Commercial |
$140.40
|
| Rate for Payer: MEDICAID Medicaid |
$143.52
|
| Rate for Payer: MEDICARE Medicare |
$109.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$148.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$151.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$148.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$148.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$132.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.80
|
|
|
LAB AMINO ACID DISORDER
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: BCBS HMK CHIP |
$117.00
|
| Rate for Payer: AETNA Commercial |
$123.50
|
| Rate for Payer: AETNA Medicare |
$117.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$123.50
|
| Rate for Payer: BCBS Healthlink |
$117.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.00
|
| Rate for Payer: BCBS POS |
$123.50
|
| Rate for Payer: BCBS Traditional |
$130.00
|
| Rate for Payer: CASH_PRICE |
$104.00
|
| Rate for Payer: CIGNA Commercial |
$123.50
|
| Rate for Payer: CIGNA Medicare |
$117.00
|
| Rate for Payer: HUMANA Commercial |
$117.00
|
| Rate for Payer: MEDICAID Medicaid |
$119.60
|
| Rate for Payer: MEDICARE Medicare |
$91.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$123.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$126.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$123.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$123.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$110.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.00
|
|
|
LAB AMINO ACID DISORDER
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: AETNA Commercial |
$123.50
|
| Rate for Payer: AETNA Medicare |
$117.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$123.50
|
| Rate for Payer: BCBS Healthlink |
$117.00
|
| Rate for Payer: BCBS HMK CHIP |
$117.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.00
|
| Rate for Payer: BCBS POS |
$123.50
|
| Rate for Payer: BCBS Traditional |
$130.00
|
| Rate for Payer: CASH_PRICE |
$104.00
|
| Rate for Payer: CIGNA Commercial |
$123.50
|
| Rate for Payer: CIGNA Medicare |
$117.00
|
| Rate for Payer: HUMANA Commercial |
$117.00
|
| Rate for Payer: MEDICAID Medicaid |
$119.60
|
| Rate for Payer: MEDICARE Medicare |
$91.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$123.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$126.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$123.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$123.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$110.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.00
|
|
|
LAB ANAEROBIC IDENTIFICATION
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: AETNA Commercial |
$63.65
|
| Rate for Payer: AETNA Medicare |
$60.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$63.65
|
| Rate for Payer: BCBS Healthlink |
$60.30
|
| Rate for Payer: BCBS HMK CHIP |
$60.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$60.30
|
| Rate for Payer: BCBS POS |
$63.65
|
| Rate for Payer: BCBS Traditional |
$67.00
|
| Rate for Payer: CASH_PRICE |
$53.60
|
| Rate for Payer: CIGNA Commercial |
$63.65
|
| Rate for Payer: CIGNA Medicare |
$60.30
|
| Rate for Payer: HUMANA Commercial |
$60.30
|
| Rate for Payer: MEDICAID Medicaid |
$61.64
|
| Rate for Payer: MEDICARE Medicare |
$46.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$63.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$63.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$63.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$53.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$53.60
|
|
|
LAB ANAEROBIC IDENTIFICATION
|
Facility
IP
|
$67.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: AETNA Commercial |
$63.65
|
| Rate for Payer: AETNA Medicare |
$60.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$63.65
|
| Rate for Payer: BCBS Healthlink |
$60.30
|
| Rate for Payer: BCBS HMK CHIP |
$60.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$60.30
|
| Rate for Payer: BCBS POS |
$63.65
|
| Rate for Payer: BCBS Traditional |
$67.00
|
| Rate for Payer: CASH_PRICE |
$53.60
|
| Rate for Payer: CIGNA Commercial |
$63.65
|
| Rate for Payer: CIGNA Medicare |
$60.30
|
| Rate for Payer: HUMANA Commercial |
$60.30
|
| Rate for Payer: MEDICAID Medicaid |
$61.64
|
| Rate for Payer: MEDICARE Medicare |
$46.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$63.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$63.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$63.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$53.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$53.60
|
|
|
LAB ANCA ANTIBODY IDENTIFICATION
|
Facility
IP
|
$145.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: BCBS HMK CHIP |
$130.50
|
| Rate for Payer: AETNA Commercial |
$137.75
|
| Rate for Payer: AETNA Medicare |
$130.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$137.75
|
| Rate for Payer: BCBS Healthlink |
$130.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$130.50
|
| Rate for Payer: BCBS POS |
$137.75
|
| Rate for Payer: BCBS Traditional |
$145.00
|
| Rate for Payer: CASH_PRICE |
$116.00
|
| Rate for Payer: CIGNA Commercial |
$137.75
|
| Rate for Payer: CIGNA Medicare |
$130.50
|
| Rate for Payer: HUMANA Commercial |
$130.50
|
| Rate for Payer: MEDICAID Medicaid |
$133.40
|
| Rate for Payer: MEDICARE Medicare |
$101.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$137.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$140.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$137.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$137.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$123.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$116.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$116.00
|
|
|
LAB ANCA ANTIBODY IDENTIFICATION
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: AETNA Commercial |
$137.75
|
| Rate for Payer: AETNA Medicare |
$130.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$137.75
|
| Rate for Payer: BCBS Healthlink |
$130.50
|
| Rate for Payer: BCBS HMK CHIP |
$130.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$130.50
|
| Rate for Payer: BCBS POS |
$137.75
|
| Rate for Payer: BCBS Traditional |
$145.00
|
| Rate for Payer: CASH_PRICE |
$116.00
|
| Rate for Payer: CIGNA Commercial |
$137.75
|
| Rate for Payer: CIGNA Medicare |
$130.50
|
| Rate for Payer: HUMANA Commercial |
$130.50
|
| Rate for Payer: MEDICAID Medicaid |
$133.40
|
| Rate for Payer: MEDICARE Medicare |
$101.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$137.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$140.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$137.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$137.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$123.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$116.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$116.00
|
|
|
LAB ANDROSTENEDIONE
|
Facility
IP
|
$390.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: AETNA Commercial |
$370.50
|
| Rate for Payer: AETNA Medicare |
$351.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$370.50
|
| Rate for Payer: BCBS Healthlink |
$351.00
|
| Rate for Payer: BCBS HMK CHIP |
$351.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$351.00
|
| Rate for Payer: BCBS POS |
$370.50
|
| Rate for Payer: BCBS Traditional |
$390.00
|
| Rate for Payer: CASH_PRICE |
$312.00
|
| Rate for Payer: CIGNA Commercial |
$370.50
|
| Rate for Payer: CIGNA Medicare |
$351.00
|
| Rate for Payer: HUMANA Commercial |
$351.00
|
| Rate for Payer: MEDICAID Medicaid |
$358.80
|
| Rate for Payer: MEDICARE Medicare |
$273.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$370.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$378.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$370.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$370.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$331.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$312.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$312.00
|
|
|
LAB ANDROSTENEDIONE
|
Facility
OP
|
$390.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: AETNA Commercial |
$370.50
|
| Rate for Payer: AETNA Medicare |
$351.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$370.50
|
| Rate for Payer: BCBS Healthlink |
$351.00
|
| Rate for Payer: BCBS HMK CHIP |
$351.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$351.00
|
| Rate for Payer: BCBS POS |
$370.50
|
| Rate for Payer: BCBS Traditional |
$390.00
|
| Rate for Payer: CASH_PRICE |
$312.00
|
| Rate for Payer: CIGNA Commercial |
$370.50
|
| Rate for Payer: CIGNA Medicare |
$351.00
|
| Rate for Payer: HUMANA Commercial |
$351.00
|
| Rate for Payer: MEDICAID Medicaid |
$358.80
|
| Rate for Payer: MEDICARE Medicare |
$273.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$370.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$378.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$370.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$370.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$331.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$312.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$312.00
|
|
|
LAB ANTIBODY IDENTIFICATION
|
Facility
IP
|
$187.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
LAB ANTIBODY IDENTIFICATION
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
LAB ANTI IGE
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: BCBS HMK CHIP |
$141.30
|
| Rate for Payer: AETNA Commercial |
$149.15
|
| Rate for Payer: AETNA Medicare |
$141.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$149.15
|
| Rate for Payer: BCBS Healthlink |
$141.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$141.30
|
| Rate for Payer: BCBS POS |
$149.15
|
| Rate for Payer: BCBS Traditional |
$157.00
|
| Rate for Payer: CASH_PRICE |
$125.60
|
| Rate for Payer: CIGNA Commercial |
$149.15
|
| Rate for Payer: CIGNA Medicare |
$141.30
|
| Rate for Payer: HUMANA Commercial |
$141.30
|
| Rate for Payer: MEDICAID Medicaid |
$144.44
|
| Rate for Payer: MEDICARE Medicare |
$109.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$149.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$152.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$149.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$149.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$133.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$125.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$125.60
|
|
|
LAB ANTI IGE
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$157.00 |
| Rate for Payer: AETNA Commercial |
$149.15
|
| Rate for Payer: AETNA Medicare |
$141.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$149.15
|
| Rate for Payer: BCBS Healthlink |
$141.30
|
| Rate for Payer: BCBS HMK CHIP |
$141.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$141.30
|
| Rate for Payer: BCBS POS |
$149.15
|
| Rate for Payer: BCBS Traditional |
$157.00
|
| Rate for Payer: CASH_PRICE |
$125.60
|
| Rate for Payer: CIGNA Commercial |
$149.15
|
| Rate for Payer: CIGNA Medicare |
$141.30
|
| Rate for Payer: HUMANA Commercial |
$141.30
|
| Rate for Payer: MEDICAID Medicaid |
$144.44
|
| Rate for Payer: MEDICARE Medicare |
$109.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$149.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$152.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$149.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$149.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$133.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$125.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$125.60
|
|
