|
LAB CREATINE URINE
|
Facility
OP
|
$154.00
|
|
|
Service Code
|
CPT 82540
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: AETNA Commercial |
$146.30
|
| Rate for Payer: AETNA Medicare |
$138.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$146.30
|
| Rate for Payer: BCBS Healthlink |
$138.60
|
| Rate for Payer: BCBS HMK CHIP |
$138.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$138.60
|
| Rate for Payer: BCBS POS |
$146.30
|
| Rate for Payer: BCBS Traditional |
$154.00
|
| Rate for Payer: CASH_PRICE |
$123.20
|
| Rate for Payer: CIGNA Commercial |
$146.30
|
| Rate for Payer: CIGNA Medicare |
$138.60
|
| Rate for Payer: HUMANA Commercial |
$138.60
|
| Rate for Payer: MEDICAID Medicaid |
$141.68
|
| Rate for Payer: MEDICARE Medicare |
$107.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$146.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$149.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$146.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$146.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$130.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$123.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$123.20
|
|
|
LAB CRYOFIBRINOGEN
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
LAB CRYOFIBRINOGEN
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: BCBS HMK CHIP |
$29.70
|
| Rate for Payer: AETNA Commercial |
$31.35
|
| Rate for Payer: AETNA Medicare |
$29.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$31.35
|
| Rate for Payer: BCBS Healthlink |
$29.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$29.70
|
| Rate for Payer: BCBS POS |
$31.35
|
| Rate for Payer: BCBS Traditional |
$33.00
|
| Rate for Payer: CASH_PRICE |
$26.40
|
| Rate for Payer: CIGNA Commercial |
$31.35
|
| Rate for Payer: CIGNA Medicare |
$29.70
|
| Rate for Payer: HUMANA Commercial |
$29.70
|
| Rate for Payer: MEDICAID Medicaid |
$30.36
|
| Rate for Payer: MEDICARE Medicare |
$23.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$31.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$32.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$31.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$31.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$28.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$26.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$26.40
|
|
|
LAB CRYOGLOBULIN
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
LAB CRYOGLOBULIN
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: AETNA Commercial |
$67.45
|
| Rate for Payer: AETNA Medicare |
$63.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$67.45
|
| Rate for Payer: BCBS Healthlink |
$63.90
|
| Rate for Payer: BCBS HMK CHIP |
$63.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$63.90
|
| Rate for Payer: BCBS POS |
$67.45
|
| Rate for Payer: BCBS Traditional |
$71.00
|
| Rate for Payer: CASH_PRICE |
$56.80
|
| Rate for Payer: CIGNA Commercial |
$67.45
|
| Rate for Payer: CIGNA Medicare |
$63.90
|
| Rate for Payer: HUMANA Commercial |
$63.90
|
| Rate for Payer: MEDICAID Medicaid |
$65.32
|
| Rate for Payer: MEDICARE Medicare |
$49.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$67.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$68.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$67.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$67.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$60.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$56.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$56.80
|
|
|
LAB CRYPTOSPORIDIUM/CYCLOSPORA
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
LAB CRYPTOSPORIDIUM/CYCLOSPORA
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
LAB CSF CELL COUNT
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
LAB CSF CELL COUNT
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
LAB CULTURE BODY FLUIDS
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
LAB CULTURE BODY FLUIDS
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
LAB CULTURE CHLAMYDIA
|
Facility
IP
|
$81.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
|
|
LAB CULTURE CHLAMYDIA
|
Facility
OP
|
$81.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
|
|
LAB CULTURE ID OF AEROBIC
|
Facility
IP
|
$142.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: BCBS HMK CHIP |
$127.80
|
| Rate for Payer: AETNA Commercial |
$134.90
|
| Rate for Payer: AETNA Medicare |
$127.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$134.90
|
| Rate for Payer: BCBS Healthlink |
$127.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$127.80
|
| Rate for Payer: BCBS POS |
$134.90
|
| Rate for Payer: BCBS Traditional |
$142.00
|
| Rate for Payer: CASH_PRICE |
$113.60
|
| Rate for Payer: CIGNA Commercial |
$134.90
|
| Rate for Payer: CIGNA Medicare |
$127.80
|
| Rate for Payer: HUMANA Commercial |
$127.80
|
| Rate for Payer: MEDICAID Medicaid |
$130.64
|
| Rate for Payer: MEDICARE Medicare |
$99.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$134.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$137.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$134.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$134.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$120.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$113.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$113.60
|
|
|
LAB CULTURE ID OF AEROBIC
|
Facility
OP
|
$142.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$142.00 |
| Rate for Payer: AETNA Commercial |
$134.90
|
| Rate for Payer: AETNA Medicare |
$127.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$134.90
|
| Rate for Payer: BCBS Healthlink |
$127.80
|
| Rate for Payer: BCBS HMK CHIP |
$127.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$127.80
|
| Rate for Payer: BCBS POS |
$134.90
|
| Rate for Payer: BCBS Traditional |
$142.00
|
| Rate for Payer: CASH_PRICE |
$113.60
|
| Rate for Payer: CIGNA Commercial |
$134.90
|
| Rate for Payer: CIGNA Medicare |
$127.80
|
| Rate for Payer: HUMANA Commercial |
$127.80
|
| Rate for Payer: MEDICAID Medicaid |
$130.64
|
| Rate for Payer: MEDICARE Medicare |
$99.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$134.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$137.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$134.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$134.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$120.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$113.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$113.60
|
|
|
LAB CULTURE TYPING PER ANTISERUM
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
LAB CULTURE TYPING PER ANTISERUM
|
Facility
IP
|
$68.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: AETNA Commercial |
$64.60
|
| Rate for Payer: AETNA Medicare |
$61.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$64.60
|
| Rate for Payer: BCBS Healthlink |
$61.20
|
| Rate for Payer: BCBS HMK CHIP |
$61.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$61.20
|
| Rate for Payer: BCBS POS |
$64.60
|
| Rate for Payer: BCBS Traditional |
$68.00
|
| Rate for Payer: CASH_PRICE |
$54.40
|
| Rate for Payer: CIGNA Commercial |
$64.60
|
| Rate for Payer: CIGNA Medicare |
$61.20
|
| Rate for Payer: HUMANA Commercial |
$61.20
|
| Rate for Payer: MEDICAID Medicaid |
$62.56
|
| Rate for Payer: MEDICARE Medicare |
$47.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$64.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$65.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$64.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$57.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$54.40
|
|
|
LAB CYTOMEG DNA QUANT
|
Facility
OP
|
$204.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: AETNA Commercial |
$193.80
|
| Rate for Payer: AETNA Medicare |
$183.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$193.80
|
| Rate for Payer: BCBS Healthlink |
$183.60
|
| Rate for Payer: BCBS HMK CHIP |
$183.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$183.60
|
| Rate for Payer: BCBS POS |
$193.80
|
| Rate for Payer: BCBS Traditional |
$204.00
|
| Rate for Payer: CASH_PRICE |
$163.20
|
| Rate for Payer: CIGNA Commercial |
$193.80
|
| Rate for Payer: CIGNA Medicare |
$183.60
|
| Rate for Payer: HUMANA Commercial |
$183.60
|
| Rate for Payer: MEDICAID Medicaid |
$187.68
|
| Rate for Payer: MEDICARE Medicare |
$142.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$193.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$197.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$193.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$193.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$173.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$163.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$163.20
|
|
|
LAB CYTOMEG DNA QUANT
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: BCBS HMK CHIP |
$183.60
|
| Rate for Payer: AETNA Commercial |
$193.80
|
| Rate for Payer: AETNA Medicare |
$183.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$193.80
|
| Rate for Payer: BCBS Healthlink |
$183.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$183.60
|
| Rate for Payer: BCBS POS |
$193.80
|
| Rate for Payer: BCBS Traditional |
$204.00
|
| Rate for Payer: CASH_PRICE |
$163.20
|
| Rate for Payer: CIGNA Commercial |
$193.80
|
| Rate for Payer: CIGNA Medicare |
$183.60
|
| Rate for Payer: HUMANA Commercial |
$183.60
|
| Rate for Payer: MEDICAID Medicaid |
$187.68
|
| Rate for Payer: MEDICARE Medicare |
$142.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$193.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$197.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$193.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$193.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$173.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$163.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$163.20
|
|
|
LAB DETECT AGNT MULT DNA AMPLI
|
Facility
OP
|
$312.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: AETNA Commercial |
$296.40
|
| Rate for Payer: AETNA Medicare |
$280.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$296.40
|
| Rate for Payer: BCBS Healthlink |
$280.80
|
| Rate for Payer: BCBS HMK CHIP |
$280.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$280.80
|
| Rate for Payer: BCBS POS |
$296.40
|
| Rate for Payer: BCBS Traditional |
$312.00
|
| Rate for Payer: CASH_PRICE |
$249.60
|
| Rate for Payer: CIGNA Commercial |
$296.40
|
| Rate for Payer: CIGNA Medicare |
$280.80
|
| Rate for Payer: HUMANA Commercial |
$280.80
|
| Rate for Payer: MEDICAID Medicaid |
$287.04
|
| Rate for Payer: MEDICARE Medicare |
$218.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$296.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$302.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$296.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$296.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$265.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$249.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$249.60
|
|
|
LAB DETECT AGNT MULT DNA AMPLI
|
Facility
IP
|
$312.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: BCBS HMK CHIP |
$280.80
|
| Rate for Payer: AETNA Commercial |
$296.40
|
| Rate for Payer: AETNA Medicare |
$280.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$296.40
|
| Rate for Payer: BCBS Healthlink |
$280.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$280.80
|
| Rate for Payer: BCBS POS |
$296.40
|
| Rate for Payer: BCBS Traditional |
$312.00
|
| Rate for Payer: CASH_PRICE |
$249.60
|
| Rate for Payer: CIGNA Commercial |
$296.40
|
| Rate for Payer: CIGNA Medicare |
$280.80
|
| Rate for Payer: HUMANA Commercial |
$280.80
|
| Rate for Payer: MEDICAID Medicaid |
$287.04
|
| Rate for Payer: MEDICARE Medicare |
$218.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$296.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$302.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$296.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$296.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$265.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$249.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$249.60
|
|
|
LAB DIMERIC INHIBIN A
|
Facility
OP
|
$291.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: AETNA Commercial |
$276.45
|
| Rate for Payer: AETNA Medicare |
$261.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$276.45
|
| Rate for Payer: BCBS Healthlink |
$261.90
|
| Rate for Payer: BCBS HMK CHIP |
$261.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.90
|
| Rate for Payer: BCBS POS |
$276.45
|
| Rate for Payer: BCBS Traditional |
$291.00
|
| Rate for Payer: CASH_PRICE |
$232.80
|
| Rate for Payer: CIGNA Commercial |
$276.45
|
| Rate for Payer: CIGNA Medicare |
$261.90
|
| Rate for Payer: HUMANA Commercial |
$261.90
|
| Rate for Payer: MEDICAID Medicaid |
$267.72
|
| Rate for Payer: MEDICARE Medicare |
$203.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$276.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$282.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$276.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$276.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$247.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.80
|
|
|
LAB DIMERIC INHIBIN A
|
Facility
IP
|
$291.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: AETNA Commercial |
$276.45
|
| Rate for Payer: AETNA Medicare |
$261.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$276.45
|
| Rate for Payer: BCBS Healthlink |
$261.90
|
| Rate for Payer: BCBS HMK CHIP |
$261.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.90
|
| Rate for Payer: BCBS POS |
$276.45
|
| Rate for Payer: BCBS Traditional |
$291.00
|
| Rate for Payer: CASH_PRICE |
$232.80
|
| Rate for Payer: CIGNA Commercial |
$276.45
|
| Rate for Payer: CIGNA Medicare |
$261.90
|
| Rate for Payer: HUMANA Commercial |
$261.90
|
| Rate for Payer: MEDICAID Medicaid |
$267.72
|
| Rate for Payer: MEDICARE Medicare |
$203.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$276.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$282.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$276.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$276.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$247.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.80
|
|
|
LAB DNA/RNA AMPLIFIED PROBE ID
|
Facility
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$786.10 |
| Max. Negotiated Rate |
$1,123.00 |
| Rate for Payer: AETNA Commercial |
$1,066.85
|
| Rate for Payer: AETNA Medicare |
$1,010.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,066.85
|
| Rate for Payer: BCBS Healthlink |
$1,010.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,010.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,010.70
|
| Rate for Payer: BCBS POS |
$1,066.85
|
| Rate for Payer: BCBS Traditional |
$1,123.00
|
| Rate for Payer: CASH_PRICE |
$898.40
|
| Rate for Payer: CIGNA Commercial |
$1,066.85
|
| Rate for Payer: CIGNA Medicare |
$1,010.70
|
| Rate for Payer: HUMANA Commercial |
$1,010.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,033.16
|
| Rate for Payer: MEDICARE Medicare |
$786.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,066.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,089.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,066.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,066.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$954.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$898.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$898.40
|
|
|
LAB DNA/RNA AMPLIFIED PROBE ID
|
Facility
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$786.10 |
| Max. Negotiated Rate |
$1,123.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,010.70
|
| Rate for Payer: AETNA Commercial |
$1,066.85
|
| Rate for Payer: AETNA Medicare |
$1,010.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,066.85
|
| Rate for Payer: BCBS Healthlink |
$1,010.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,010.70
|
| Rate for Payer: BCBS POS |
$1,066.85
|
| Rate for Payer: BCBS Traditional |
$1,123.00
|
| Rate for Payer: CASH_PRICE |
$898.40
|
| Rate for Payer: CIGNA Commercial |
$1,066.85
|
| Rate for Payer: CIGNA Medicare |
$1,010.70
|
| Rate for Payer: HUMANA Commercial |
$1,010.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,033.16
|
| Rate for Payer: MEDICARE Medicare |
$786.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,066.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,089.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,066.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,066.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$954.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$898.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$898.40
|
|
