|
LAB D NASE B ANTIBODY
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
LAB D NASE B ANTIBODY
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
LAB DRUG TEST PRSMV DIR OPT OBS
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: AETNA Commercial |
$58.90
|
| Rate for Payer: AETNA Medicare |
$55.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$58.90
|
| Rate for Payer: BCBS Healthlink |
$55.80
|
| Rate for Payer: BCBS HMK CHIP |
$55.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$55.80
|
| Rate for Payer: BCBS POS |
$58.90
|
| Rate for Payer: BCBS Traditional |
$62.00
|
| Rate for Payer: CASH_PRICE |
$49.60
|
| Rate for Payer: CIGNA Commercial |
$58.90
|
| Rate for Payer: CIGNA Medicare |
$55.80
|
| Rate for Payer: HUMANA Commercial |
$55.80
|
| Rate for Payer: MEDICAID Medicaid |
$57.04
|
| Rate for Payer: MEDICARE Medicare |
$43.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$58.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$60.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$58.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$58.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$52.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$49.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$49.60
|
|
|
LAB DRUG TEST PRSMV DIR OPT OBS
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: AETNA Commercial |
$58.90
|
| Rate for Payer: AETNA Medicare |
$55.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$58.90
|
| Rate for Payer: BCBS Healthlink |
$55.80
|
| Rate for Payer: BCBS HMK CHIP |
$55.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$55.80
|
| Rate for Payer: BCBS POS |
$58.90
|
| Rate for Payer: BCBS Traditional |
$62.00
|
| Rate for Payer: CASH_PRICE |
$49.60
|
| Rate for Payer: CIGNA Commercial |
$58.90
|
| Rate for Payer: CIGNA Medicare |
$55.80
|
| Rate for Payer: HUMANA Commercial |
$55.80
|
| Rate for Payer: MEDICAID Medicaid |
$57.04
|
| Rate for Payer: MEDICARE Medicare |
$43.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$58.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$60.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$58.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$58.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$52.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$49.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$49.60
|
|
|
LAB ESTROGEN
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
LAB ESTROGEN
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AETNA Commercial |
$94.05
|
| Rate for Payer: AETNA Medicare |
$89.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$94.05
|
| Rate for Payer: BCBS Healthlink |
$89.10
|
| Rate for Payer: BCBS HMK CHIP |
$89.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$89.10
|
| Rate for Payer: BCBS POS |
$94.05
|
| Rate for Payer: BCBS Traditional |
$99.00
|
| Rate for Payer: CASH_PRICE |
$79.20
|
| Rate for Payer: CIGNA Commercial |
$94.05
|
| Rate for Payer: CIGNA Medicare |
$89.10
|
| Rate for Payer: HUMANA Commercial |
$89.10
|
| Rate for Payer: MEDICAID Medicaid |
$91.08
|
| Rate for Payer: MEDICARE Medicare |
$69.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$94.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$96.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$94.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$94.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$84.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$79.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$79.20
|
|
|
LAB ESTROGEN LEVEL
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: AETNA Commercial |
$69.35
|
| Rate for Payer: AETNA Medicare |
$65.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$69.35
|
| Rate for Payer: BCBS Healthlink |
$65.70
|
| Rate for Payer: BCBS HMK CHIP |
$65.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$65.70
|
| Rate for Payer: BCBS POS |
$69.35
|
| Rate for Payer: BCBS Traditional |
$73.00
|
| Rate for Payer: CASH_PRICE |
$58.40
|
| Rate for Payer: CIGNA Commercial |
$69.35
|
| Rate for Payer: CIGNA Medicare |
$65.70
|
| Rate for Payer: HUMANA Commercial |
$65.70
|
| Rate for Payer: MEDICAID Medicaid |
$67.16
|
| Rate for Payer: MEDICARE Medicare |
$51.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$69.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$70.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$69.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$69.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$58.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$58.40
|
|
|
LAB ESTROGEN LEVEL
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: AETNA Commercial |
$69.35
|
| Rate for Payer: AETNA Medicare |
$65.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$69.35
|
| Rate for Payer: BCBS Healthlink |
$65.70
|
| Rate for Payer: BCBS HMK CHIP |
$65.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$65.70
|
| Rate for Payer: BCBS POS |
$69.35
|
| Rate for Payer: BCBS Traditional |
$73.00
|
| Rate for Payer: CASH_PRICE |
$58.40
|
| Rate for Payer: CIGNA Commercial |
$69.35
|
| Rate for Payer: CIGNA Medicare |
$65.70
|
| Rate for Payer: HUMANA Commercial |
$65.70
|
| Rate for Payer: MEDICAID Medicaid |
$67.16
|
| Rate for Payer: MEDICARE Medicare |
$51.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$69.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$70.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$69.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$69.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$58.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$58.40
|
|
|
LABETALOL [100 MG/20 ML] 20ML MDV
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
LABETALOL [100 MG/20 ML] 20ML MDV
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
LABETALOL INJ [20 MG/4 ML] 4ML SYRINGE
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
LABETALOL INJ [20 MG/4 ML] 4ML SYRINGE
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
LAB ETHOSUXIMIDE LEVEL
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 80168
|
| 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 ETHOSUXIMIDE LEVEL
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 80168
|
| 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 FINGER STICK BLOOD COUNT(GLUCOMOTER)
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
LAB FINGER STICK BLOOD COUNT(GLUCOMOTER)
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
LAB FLUORESCENT NONINFEST AB
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
LAB FLUORESCENT NONINFEST AB
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: BCBS HMK CHIP |
$121.50
|
| Rate for Payer: AETNA Commercial |
$128.25
|
| Rate for Payer: AETNA Medicare |
$121.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$128.25
|
| Rate for Payer: BCBS Healthlink |
$121.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$121.50
|
| Rate for Payer: BCBS POS |
$128.25
|
| Rate for Payer: BCBS Traditional |
$135.00
|
| Rate for Payer: CASH_PRICE |
$108.00
|
| Rate for Payer: CIGNA Commercial |
$128.25
|
| Rate for Payer: CIGNA Medicare |
$121.50
|
| Rate for Payer: HUMANA Commercial |
$121.50
|
| Rate for Payer: MEDICAID Medicaid |
$124.20
|
| Rate for Payer: MEDICARE Medicare |
$94.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$128.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$130.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$128.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$128.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$114.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$108.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$108.00
|
|
|
LAB FREE ERYTHROCYTE PROTOPORPHYRIN
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: AETNA Commercial |
$93.10
|
| Rate for Payer: AETNA Medicare |
$88.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$93.10
|
| Rate for Payer: BCBS Healthlink |
$88.20
|
| Rate for Payer: BCBS HMK CHIP |
$88.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$88.20
|
| Rate for Payer: BCBS POS |
$93.10
|
| Rate for Payer: BCBS Traditional |
$98.00
|
| Rate for Payer: CASH_PRICE |
$78.40
|
| Rate for Payer: CIGNA Commercial |
$93.10
|
| Rate for Payer: CIGNA Medicare |
$88.20
|
| Rate for Payer: HUMANA Commercial |
$88.20
|
| Rate for Payer: MEDICAID Medicaid |
$90.16
|
| Rate for Payer: MEDICARE Medicare |
$68.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$93.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$95.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$93.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$93.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$83.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$78.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$78.40
|
|
|
LAB FREE ERYTHROCYTE PROTOPORPHYRIN
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: AETNA Commercial |
$93.10
|
| Rate for Payer: AETNA Medicare |
$88.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$93.10
|
| Rate for Payer: BCBS Healthlink |
$88.20
|
| Rate for Payer: BCBS HMK CHIP |
$88.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$88.20
|
| Rate for Payer: BCBS POS |
$93.10
|
| Rate for Payer: BCBS Traditional |
$98.00
|
| Rate for Payer: CASH_PRICE |
$78.40
|
| Rate for Payer: CIGNA Commercial |
$93.10
|
| Rate for Payer: CIGNA Medicare |
$88.20
|
| Rate for Payer: HUMANA Commercial |
$88.20
|
| Rate for Payer: MEDICAID Medicaid |
$90.16
|
| Rate for Payer: MEDICARE Medicare |
$68.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$93.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$95.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$93.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$93.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$83.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$78.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$78.40
|
|
|
LAB FREE INSULIN
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
CPT 83527
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
LAB FREE INSULIN
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT 83527
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
LAB FREE KAPTA LAMBDA LIGHT
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
LAB FREE KAPTA LAMBDA LIGHT
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
LAB FUNGAL CULTURE
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: AETNA Commercial |
$83.60
|
| Rate for Payer: AETNA Medicare |
$79.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$83.60
|
| Rate for Payer: BCBS Healthlink |
$79.20
|
| Rate for Payer: BCBS HMK CHIP |
$79.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$79.20
|
| Rate for Payer: BCBS POS |
$83.60
|
| Rate for Payer: BCBS Traditional |
$88.00
|
| Rate for Payer: CASH_PRICE |
$70.40
|
| Rate for Payer: CIGNA Commercial |
$83.60
|
| Rate for Payer: CIGNA Medicare |
$79.20
|
| Rate for Payer: HUMANA Commercial |
$79.20
|
| Rate for Payer: MEDICAID Medicaid |
$80.96
|
| Rate for Payer: MEDICARE Medicare |
$61.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$83.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$85.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$83.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$83.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$74.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$70.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$70.40
|
|
