|
LIDOCAINE/PRILOCAINE 2% CREAM
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
LIDOCAINE/PRILOCAINE 2% CREAM
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
LIDOCAINE TOPICAL GEL [4%]
|
Facility
IP
|
$690.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: AETNA Commercial |
$655.50
|
| Rate for Payer: AETNA Medicare |
$621.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$655.50
|
| Rate for Payer: BCBS Healthlink |
$621.00
|
| Rate for Payer: BCBS HMK CHIP |
$621.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.00
|
| Rate for Payer: BCBS POS |
$655.50
|
| Rate for Payer: BCBS Traditional |
$690.00
|
| Rate for Payer: CASH_PRICE |
$552.00
|
| Rate for Payer: CIGNA Commercial |
$655.50
|
| Rate for Payer: CIGNA Medicare |
$621.00
|
| Rate for Payer: HUMANA Commercial |
$621.00
|
| Rate for Payer: MEDICAID Medicaid |
$634.80
|
| Rate for Payer: MEDICARE Medicare |
$483.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$655.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$669.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$655.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$655.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$586.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.00
|
|
|
LIDOCAINE TOPICAL GEL [4%]
|
Facility
OP
|
$690.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: AETNA Commercial |
$655.50
|
| Rate for Payer: AETNA Medicare |
$621.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$655.50
|
| Rate for Payer: BCBS Healthlink |
$621.00
|
| Rate for Payer: BCBS HMK CHIP |
$621.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.00
|
| Rate for Payer: BCBS POS |
$655.50
|
| Rate for Payer: BCBS Traditional |
$690.00
|
| Rate for Payer: CASH_PRICE |
$552.00
|
| Rate for Payer: CIGNA Commercial |
$655.50
|
| Rate for Payer: CIGNA Medicare |
$621.00
|
| Rate for Payer: HUMANA Commercial |
$621.00
|
| Rate for Payer: MEDICAID Medicaid |
$634.80
|
| Rate for Payer: MEDICARE Medicare |
$483.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$655.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$669.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$655.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$655.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$586.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.00
|
|
|
LIDOCAINE W/EPI 1%/1:100000 INJ [1 ML]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
LIDOCAINE W/EPI 1%/1:100000 INJ [1 ML]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
LINEZOLID TAB [600 MG] NONFORMULARY
|
Facility
OP
|
$559.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$391.30 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: AETNA Commercial |
$531.05
|
| Rate for Payer: AETNA Medicare |
$503.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$531.05
|
| Rate for Payer: BCBS Healthlink |
$503.10
|
| Rate for Payer: BCBS HMK CHIP |
$503.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$503.10
|
| Rate for Payer: BCBS POS |
$531.05
|
| Rate for Payer: BCBS Traditional |
$559.00
|
| Rate for Payer: CASH_PRICE |
$447.20
|
| Rate for Payer: CIGNA Commercial |
$531.05
|
| Rate for Payer: CIGNA Medicare |
$503.10
|
| Rate for Payer: HUMANA Commercial |
$503.10
|
| Rate for Payer: MEDICAID Medicaid |
$514.28
|
| Rate for Payer: MEDICARE Medicare |
$391.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$531.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$542.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$531.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$531.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$475.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$447.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$447.20
|
|
|
LINEZOLID TAB [600 MG] NONFORMULARY
|
Facility
IP
|
$559.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$391.30 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: AETNA Commercial |
$531.05
|
| Rate for Payer: AETNA Medicare |
$503.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$531.05
|
| Rate for Payer: BCBS Healthlink |
$503.10
|
| Rate for Payer: BCBS HMK CHIP |
$503.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$503.10
|
| Rate for Payer: BCBS POS |
$531.05
|
| Rate for Payer: BCBS Traditional |
$559.00
|
| Rate for Payer: CASH_PRICE |
$447.20
|
| Rate for Payer: CIGNA Commercial |
$531.05
|
| Rate for Payer: CIGNA Medicare |
$503.10
|
| Rate for Payer: HUMANA Commercial |
$503.10
|
| Rate for Payer: MEDICAID Medicaid |
$514.28
|
| Rate for Payer: MEDICARE Medicare |
$391.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$531.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$542.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$531.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$531.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$475.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$447.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$447.20
|
|
|
LIPASE
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
LIPASE
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: AETNA Commercial |
$117.80
|
| Rate for Payer: AETNA Medicare |
$111.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$117.80
|
| Rate for Payer: BCBS Healthlink |
$111.60
|
| Rate for Payer: BCBS HMK CHIP |
$111.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$111.60
|
| Rate for Payer: BCBS POS |
$117.80
|
| Rate for Payer: BCBS Traditional |
$124.00
|
| Rate for Payer: CASH_PRICE |
$99.20
|
| Rate for Payer: CIGNA Commercial |
$117.80
|
| Rate for Payer: CIGNA Medicare |
$111.60
|
| Rate for Payer: HUMANA Commercial |
$111.60
|
| Rate for Payer: MEDICAID Medicaid |
$114.08
|
| Rate for Payer: MEDICARE Medicare |
$86.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$117.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$120.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$117.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$117.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$105.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$99.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$99.20
|
|
|
LIPID PANEL
|
Facility
OP
|
$155.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: AETNA Commercial |
$147.25
|
| Rate for Payer: AETNA Medicare |
$139.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$147.25
|
| Rate for Payer: BCBS Healthlink |
$139.50
|
| Rate for Payer: BCBS HMK CHIP |
$139.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$139.50
|
| Rate for Payer: BCBS POS |
$147.25
|
| Rate for Payer: BCBS Traditional |
$155.00
|
| Rate for Payer: CASH_PRICE |
$124.00
|
| Rate for Payer: CIGNA Commercial |
$147.25
|
| Rate for Payer: CIGNA Medicare |
$139.50
|
| Rate for Payer: HUMANA Commercial |
$139.50
|
| Rate for Payer: MEDICAID Medicaid |
$142.60
|
| Rate for Payer: MEDICARE Medicare |
$108.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$147.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$150.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$147.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$147.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$131.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.00
|
|
|
LIPID PANEL
|
Facility
IP
|
$155.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: AETNA Commercial |
$147.25
|
| Rate for Payer: AETNA Medicare |
$139.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$147.25
|
| Rate for Payer: BCBS Healthlink |
$139.50
|
| Rate for Payer: BCBS HMK CHIP |
$139.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$139.50
|
| Rate for Payer: BCBS POS |
$147.25
|
| Rate for Payer: BCBS Traditional |
$155.00
|
| Rate for Payer: CASH_PRICE |
$124.00
|
| Rate for Payer: CIGNA Commercial |
$147.25
|
| Rate for Payer: CIGNA Medicare |
$139.50
|
| Rate for Payer: HUMANA Commercial |
$139.50
|
| Rate for Payer: MEDICAID Medicaid |
$142.60
|
| Rate for Payer: MEDICARE Medicare |
$108.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$147.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$150.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$147.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$147.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$131.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.00
|
|
|
LIPID PANEL W/ DIRECT LDL REFLEX
|
Facility
IP
|
$155.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: AETNA Commercial |
$147.25
|
| Rate for Payer: AETNA Medicare |
$139.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$147.25
|
| Rate for Payer: BCBS Healthlink |
$139.50
|
| Rate for Payer: BCBS HMK CHIP |
$139.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$139.50
|
| Rate for Payer: BCBS POS |
$147.25
|
| Rate for Payer: BCBS Traditional |
$155.00
|
| Rate for Payer: CASH_PRICE |
$124.00
|
| Rate for Payer: CIGNA Commercial |
$147.25
|
| Rate for Payer: CIGNA Medicare |
$139.50
|
| Rate for Payer: HUMANA Commercial |
$139.50
|
| Rate for Payer: MEDICAID Medicaid |
$142.60
|
| Rate for Payer: MEDICARE Medicare |
$108.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$147.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$150.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$147.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$147.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$131.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.00
|
|
|
LIPID PANEL W/ DIRECT LDL REFLEX
|
Facility
OP
|
$155.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: AETNA Commercial |
$147.25
|
| Rate for Payer: AETNA Medicare |
$139.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$147.25
|
| Rate for Payer: BCBS Healthlink |
$139.50
|
| Rate for Payer: BCBS HMK CHIP |
$139.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$139.50
|
| Rate for Payer: BCBS POS |
$147.25
|
| Rate for Payer: BCBS Traditional |
$155.00
|
| Rate for Payer: CASH_PRICE |
$124.00
|
| Rate for Payer: CIGNA Commercial |
$147.25
|
| Rate for Payer: CIGNA Medicare |
$139.50
|
| Rate for Payer: HUMANA Commercial |
$139.50
|
| Rate for Payer: MEDICAID Medicaid |
$142.60
|
| Rate for Payer: MEDICARE Medicare |
$108.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$147.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$150.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$147.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$147.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$131.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.00
|
|
|
LIPOPROTEIN(a) (120188)
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
20221105
|
|
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
|
|
|
LIPOPROTEIN(a) (120188)
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
20221105
|
|
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
|
|
|
LIRAGLUTIDE (VICTOZA) 18MG/3ML PEN NF
|
Facility
IP
|
$1,250.90
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
20230626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.63 |
| Max. Negotiated Rate |
$1,250.90 |
| Rate for Payer: AETNA Commercial |
$1,188.36
|
| Rate for Payer: AETNA Medicare |
$1,125.81
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,188.36
|
| Rate for Payer: BCBS Healthlink |
$1,125.81
|
| Rate for Payer: BCBS HMK CHIP |
$1,125.81
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,125.81
|
| Rate for Payer: BCBS POS |
$1,188.36
|
| Rate for Payer: BCBS Traditional |
$1,250.90
|
| Rate for Payer: CASH_PRICE |
$1,000.72
|
| Rate for Payer: CIGNA Commercial |
$1,188.36
|
| Rate for Payer: CIGNA Medicare |
$1,125.81
|
| Rate for Payer: HUMANA Commercial |
$1,125.81
|
| Rate for Payer: MEDICAID Medicaid |
$1,150.83
|
| Rate for Payer: MEDICARE Medicare |
$875.63
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,188.36
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,213.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,188.36
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,188.36
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,063.27
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,000.72
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,000.72
|
|
|
LIRAGLUTIDE (VICTOZA) 18MG/3ML PEN NF
|
Facility
OP
|
$1,250.90
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
20230626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$875.63 |
| Max. Negotiated Rate |
$1,250.90 |
| Rate for Payer: AETNA Commercial |
$1,188.36
|
| Rate for Payer: AETNA Medicare |
$1,125.81
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,188.36
|
| Rate for Payer: BCBS Healthlink |
$1,125.81
|
| Rate for Payer: BCBS HMK CHIP |
$1,125.81
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,125.81
|
| Rate for Payer: BCBS POS |
$1,188.36
|
| Rate for Payer: BCBS Traditional |
$1,250.90
|
| Rate for Payer: CASH_PRICE |
$1,000.72
|
| Rate for Payer: CIGNA Commercial |
$1,188.36
|
| Rate for Payer: CIGNA Medicare |
$1,125.81
|
| Rate for Payer: HUMANA Commercial |
$1,125.81
|
| Rate for Payer: MEDICAID Medicaid |
$1,150.83
|
| Rate for Payer: MEDICARE Medicare |
$875.63
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,188.36
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,213.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,188.36
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,188.36
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,063.27
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,000.72
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,000.72
|
|
|
LISINOPRIL TAB [10 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
LISINOPRIL TAB [10 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
LISINOPRIL TAB [20 MG] NONFORMULARY
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
LISINOPRIL TAB [20 MG] NONFORMULARY
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
LISINOPRIL TAB [5 MG] NON FORMULARY
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
LISINOPRIL TAB [5 MG] NON FORMULARY
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
LITHIUM (007708)
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
