|
MEROPENEM 500MG INJ
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
MEROPENEM 500MG INJ
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$68.40
|
| Rate for Payer: AETNA Commercial |
$68.40
|
| Rate for Payer: AETNA Medicare |
$64.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$68.40
|
| Rate for Payer: BCBS Healthlink |
$64.80
|
| Rate for Payer: BCBS HMK CHIP |
$64.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$64.80
|
| Rate for Payer: BCBS POS |
$68.40
|
| Rate for Payer: BCBS Traditional |
$72.00
|
| Rate for Payer: CASH_PRICE |
$57.60
|
| Rate for Payer: CIGNA Commercial |
$68.40
|
| Rate for Payer: CIGNA Medicare |
$64.80
|
| Rate for Payer: HUMANA Commercial |
$64.80
|
| Rate for Payer: MEDICAID Medicaid |
$66.24
|
| Rate for Payer: MEDICARE Medicare |
$50.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$69.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$68.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$68.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$61.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$57.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$57.60
|
|
|
MEROPENEM/NS IVPB : 1GM/50ML
|
Facility
OP
|
$79.55
|
|
| Hospital Charge Code |
20230626
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$79.55 |
| Rate for Payer: AETNA Commercial |
$75.57
|
| Rate for Payer: AETNA Medicare |
$71.59
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.57
|
| Rate for Payer: BCBS Healthlink |
$71.59
|
| Rate for Payer: BCBS HMK CHIP |
$71.59
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.59
|
| Rate for Payer: BCBS POS |
$75.57
|
| Rate for Payer: BCBS Traditional |
$79.55
|
| Rate for Payer: CASH_PRICE |
$63.64
|
| Rate for Payer: CIGNA Commercial |
$75.57
|
| Rate for Payer: CIGNA Medicare |
$71.59
|
| Rate for Payer: HUMANA Commercial |
$71.59
|
| Rate for Payer: MEDICAID Medicaid |
$73.19
|
| Rate for Payer: MEDICARE Medicare |
$55.68
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.57
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.57
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.57
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.62
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.64
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.64
|
|
|
MEROPENEM/NS IVPB : 1GM/50ML
|
Facility
IP
|
$79.55
|
|
| Hospital Charge Code |
20230626
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$79.55 |
| Rate for Payer: AETNA Commercial |
$75.57
|
| Rate for Payer: AETNA Medicare |
$71.59
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.57
|
| Rate for Payer: BCBS Healthlink |
$71.59
|
| Rate for Payer: BCBS HMK CHIP |
$71.59
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.59
|
| Rate for Payer: BCBS POS |
$75.57
|
| Rate for Payer: BCBS Traditional |
$79.55
|
| Rate for Payer: CASH_PRICE |
$63.64
|
| Rate for Payer: CIGNA Commercial |
$75.57
|
| Rate for Payer: CIGNA Medicare |
$71.59
|
| Rate for Payer: HUMANA Commercial |
$71.59
|
| Rate for Payer: MEDICAID Medicaid |
$73.19
|
| Rate for Payer: MEDICARE Medicare |
$55.68
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.57
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.57
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.57
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.62
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.64
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.64
|
|
|
MESALAMINE 0.375 GRAM CAPSULE-NF
|
Facility
IP
|
$14.75
|
|
| Hospital Charge Code |
20230719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$14.75 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14.01
|
| Rate for Payer: AETNA Commercial |
$14.01
|
| Rate for Payer: AETNA Medicare |
$13.28
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14.01
|
| Rate for Payer: BCBS Healthlink |
$13.28
|
| Rate for Payer: BCBS HMK CHIP |
$13.28
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.28
|
| Rate for Payer: BCBS POS |
$14.01
|
| Rate for Payer: BCBS Traditional |
$14.75
|
| Rate for Payer: CASH_PRICE |
$11.80
|
| Rate for Payer: CIGNA Commercial |
$14.01
|
| Rate for Payer: CIGNA Medicare |
$13.28
|
| Rate for Payer: HUMANA Commercial |
$13.28
|
| Rate for Payer: MEDICAID Medicaid |
$13.57
|
| Rate for Payer: MEDICARE Medicare |
$10.32
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14.01
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14.01
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.54
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.80
|
|
|
MESALAMINE 0.375 GRAM CAPSULE-NF
|
Facility
OP
|
$14.75
|
|
| Hospital Charge Code |
20230719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$14.75 |
| Rate for Payer: AETNA Commercial |
$14.01
|
| Rate for Payer: AETNA Medicare |
$13.28
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14.01
|
| Rate for Payer: BCBS Healthlink |
$13.28
|
| Rate for Payer: BCBS HMK CHIP |
$13.28
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.28
|
| Rate for Payer: BCBS POS |
$14.01
|
| Rate for Payer: BCBS Traditional |
$14.75
|
| Rate for Payer: CASH_PRICE |
$11.80
|
| Rate for Payer: CIGNA Commercial |
$14.01
|
| Rate for Payer: CIGNA Medicare |
$13.28
|
| Rate for Payer: HUMANA Commercial |
$13.28
|
| Rate for Payer: MEDICAID Medicaid |
$13.57
|
| Rate for Payer: MEDICARE Medicare |
$10.32
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14.01
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14.01
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14.01
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.54
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.80
|
|
|
METANEPHRINES, 24-HOUR, URINE (004234)
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: AETNA Commercial |
$71.25
|
| Rate for Payer: AETNA Medicare |
$67.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$71.25
|
| Rate for Payer: BCBS Healthlink |
$67.50
|
| Rate for Payer: BCBS HMK CHIP |
$67.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$67.50
|
| Rate for Payer: BCBS POS |
$71.25
|
| Rate for Payer: BCBS Traditional |
$75.00
|
| Rate for Payer: CASH_PRICE |
$60.00
|
| Rate for Payer: CIGNA Commercial |
$71.25
|
| Rate for Payer: CIGNA Medicare |
$67.50
|
| Rate for Payer: HUMANA Commercial |
$67.50
|
| Rate for Payer: MEDICAID Medicaid |
$69.00
|
| Rate for Payer: MEDICARE Medicare |
$52.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$71.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$72.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$71.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$71.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$63.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.00
|
|
|
METANEPHRINES, 24-HOUR, URINE (004234)
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: AETNA Commercial |
$71.25
|
| Rate for Payer: AETNA Medicare |
$67.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$71.25
|
| Rate for Payer: BCBS Healthlink |
$67.50
|
| Rate for Payer: BCBS HMK CHIP |
$67.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$67.50
|
| Rate for Payer: BCBS POS |
$71.25
|
| Rate for Payer: BCBS Traditional |
$75.00
|
| Rate for Payer: CASH_PRICE |
$60.00
|
| Rate for Payer: CIGNA Commercial |
$71.25
|
| Rate for Payer: CIGNA Medicare |
$67.50
|
| Rate for Payer: HUMANA Commercial |
$67.50
|
| Rate for Payer: MEDICAID Medicaid |
$69.00
|
| Rate for Payer: MEDICARE Medicare |
$52.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$71.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$72.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$71.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$71.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$63.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.00
|
|
|
METANEPHRINES, FREE (121806)
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: AETNA Commercial |
$374.30
|
| Rate for Payer: AETNA Medicare |
$354.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$374.30
|
| Rate for Payer: BCBS Healthlink |
$354.60
|
| Rate for Payer: BCBS HMK CHIP |
$354.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$354.60
|
| Rate for Payer: BCBS POS |
$374.30
|
| Rate for Payer: BCBS Traditional |
$394.00
|
| Rate for Payer: CASH_PRICE |
$315.20
|
| Rate for Payer: CIGNA Commercial |
$374.30
|
| Rate for Payer: CIGNA Medicare |
$354.60
|
| Rate for Payer: HUMANA Commercial |
$354.60
|
| Rate for Payer: MEDICAID Medicaid |
$362.48
|
| Rate for Payer: MEDICARE Medicare |
$275.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$374.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$382.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$374.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$374.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$334.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$315.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$315.20
|
|
|
METANEPHRINES, FREE (121806)
|
Facility
IP
|
$394.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$394.00 |
| Rate for Payer: AETNA Commercial |
$374.30
|
| Rate for Payer: AETNA Medicare |
$354.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$374.30
|
| Rate for Payer: BCBS Healthlink |
$354.60
|
| Rate for Payer: BCBS HMK CHIP |
$354.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$354.60
|
| Rate for Payer: BCBS POS |
$374.30
|
| Rate for Payer: BCBS Traditional |
$394.00
|
| Rate for Payer: CASH_PRICE |
$315.20
|
| Rate for Payer: CIGNA Commercial |
$374.30
|
| Rate for Payer: CIGNA Medicare |
$354.60
|
| Rate for Payer: HUMANA Commercial |
$354.60
|
| Rate for Payer: MEDICAID Medicaid |
$362.48
|
| Rate for Payer: MEDICARE Medicare |
$275.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$374.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$382.18
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$374.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$374.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$334.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$315.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$315.20
|
|
|
METFORMIN ER 500MG TAB 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
|
|
|
METFORMIN ER 500MG TAB 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
|
|
|
METFORMIN TAB [500 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
|
|
|
METFORMIN TAB [500 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
|
|
|
METHOCARBAMOL TAB [750 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
|
|
|
METHOCARBAMOL TAB [750 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
|
|
|
METHYLERGONOVINE MAL INJ [0.2 MG/ML] NF
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
METHYLERGONOVINE MAL INJ [0.2 MG/ML] NF
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT J2210
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: AETNA Commercial |
$76.00
|
| Rate for Payer: AETNA Medicare |
$72.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.00
|
| Rate for Payer: BCBS Healthlink |
$72.00
|
| Rate for Payer: BCBS HMK CHIP |
$72.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.00
|
| Rate for Payer: BCBS POS |
$76.00
|
| Rate for Payer: BCBS Traditional |
$80.00
|
| Rate for Payer: CASH_PRICE |
$64.00
|
| Rate for Payer: CIGNA Commercial |
$76.00
|
| Rate for Payer: CIGNA Medicare |
$72.00
|
| Rate for Payer: HUMANA Commercial |
$72.00
|
| Rate for Payer: MEDICAID Medicaid |
$73.60
|
| Rate for Payer: MEDICARE Medicare |
$56.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$77.60
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.00
|
|
|
METHYLMALONIC ACID, QUANT (706961)
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
METHYLMALONIC ACID, QUANT (706961)
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
METHYLNALTREXONE INJ [12 MG]
|
Facility
OP
|
$530.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: AETNA Commercial |
$503.50
|
| Rate for Payer: AETNA Medicare |
$477.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$503.50
|
| Rate for Payer: BCBS Healthlink |
$477.00
|
| Rate for Payer: BCBS HMK CHIP |
$477.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$477.00
|
| Rate for Payer: BCBS POS |
$503.50
|
| Rate for Payer: BCBS Traditional |
$530.00
|
| Rate for Payer: CASH_PRICE |
$424.00
|
| Rate for Payer: CIGNA Commercial |
$503.50
|
| Rate for Payer: CIGNA Medicare |
$477.00
|
| Rate for Payer: HUMANA Commercial |
$477.00
|
| Rate for Payer: MEDICAID Medicaid |
$487.60
|
| Rate for Payer: MEDICARE Medicare |
$371.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$503.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$514.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$503.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$503.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$450.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$424.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$424.00
|
|
|
METHYLNALTREXONE INJ [12 MG]
|
Facility
IP
|
$530.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: AETNA Commercial |
$503.50
|
| Rate for Payer: AETNA Medicare |
$477.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$503.50
|
| Rate for Payer: BCBS Healthlink |
$477.00
|
| Rate for Payer: BCBS HMK CHIP |
$477.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$477.00
|
| Rate for Payer: BCBS POS |
$503.50
|
| Rate for Payer: BCBS Traditional |
$530.00
|
| Rate for Payer: CASH_PRICE |
$424.00
|
| Rate for Payer: CIGNA Commercial |
$503.50
|
| Rate for Payer: CIGNA Medicare |
$477.00
|
| Rate for Payer: HUMANA Commercial |
$477.00
|
| Rate for Payer: MEDICAID Medicaid |
$487.60
|
| Rate for Payer: MEDICARE Medicare |
$371.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$503.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$514.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$503.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$503.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$450.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$424.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$424.00
|
|
|
METHYLPREDNISOLONE 1GM INJ
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: AETNA Commercial |
$132.05
|
| Rate for Payer: AETNA Medicare |
$125.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$132.05
|
| Rate for Payer: BCBS Healthlink |
$125.10
|
| Rate for Payer: BCBS HMK CHIP |
$125.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$125.10
|
| Rate for Payer: BCBS POS |
$132.05
|
| Rate for Payer: BCBS Traditional |
$139.00
|
| Rate for Payer: CASH_PRICE |
$111.20
|
| Rate for Payer: CIGNA Commercial |
$132.05
|
| Rate for Payer: CIGNA Medicare |
$125.10
|
| Rate for Payer: HUMANA Commercial |
$125.10
|
| Rate for Payer: MEDICAID Medicaid |
$127.88
|
| Rate for Payer: MEDICARE Medicare |
$97.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$132.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$134.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$132.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$132.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
|
METHYLPREDNISOLONE 1GM INJ
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: AETNA Commercial |
$132.05
|
| Rate for Payer: AETNA Medicare |
$125.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$132.05
|
| Rate for Payer: BCBS Healthlink |
$125.10
|
| Rate for Payer: BCBS HMK CHIP |
$125.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$125.10
|
| Rate for Payer: BCBS POS |
$132.05
|
| Rate for Payer: BCBS Traditional |
$139.00
|
| Rate for Payer: CASH_PRICE |
$111.20
|
| Rate for Payer: CIGNA Commercial |
$132.05
|
| Rate for Payer: CIGNA Medicare |
$125.10
|
| Rate for Payer: HUMANA Commercial |
$125.10
|
| Rate for Payer: MEDICAID Medicaid |
$127.88
|
| Rate for Payer: MEDICARE Medicare |
$97.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$132.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$134.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$132.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$132.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
|
METHYLPREDNISOLONE INJ [125 MG]
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: AETNA Commercial |
$38.00
|
| Rate for Payer: AETNA Medicare |
$36.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.00
|
| Rate for Payer: BCBS Healthlink |
$36.00
|
| Rate for Payer: BCBS HMK CHIP |
$36.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.00
|
| Rate for Payer: BCBS POS |
$38.00
|
| Rate for Payer: BCBS Traditional |
$40.00
|
| Rate for Payer: CASH_PRICE |
$32.00
|
| Rate for Payer: CIGNA Commercial |
$38.00
|
| Rate for Payer: CIGNA Medicare |
$36.00
|
| Rate for Payer: HUMANA Commercial |
$36.00
|
| Rate for Payer: MEDICAID Medicaid |
$36.80
|
| Rate for Payer: MEDICARE Medicare |
$28.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$38.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.00
|
|
