|
MITOCHONDRIAL ANTIBODY (006650)
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
20221105
|
|
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
|
|
|
MONTELUKAST TAB [10 MG]
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: AETNA Commercial |
$18.05
|
| Rate for Payer: AETNA Medicare |
$17.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$18.05
|
| Rate for Payer: BCBS Healthlink |
$17.10
|
| Rate for Payer: BCBS HMK CHIP |
$17.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$17.10
|
| Rate for Payer: BCBS POS |
$18.05
|
| Rate for Payer: BCBS Traditional |
$19.00
|
| Rate for Payer: CASH_PRICE |
$15.20
|
| Rate for Payer: CIGNA Commercial |
$18.05
|
| Rate for Payer: CIGNA Medicare |
$17.10
|
| Rate for Payer: HUMANA Commercial |
$17.10
|
| Rate for Payer: MEDICAID Medicaid |
$17.48
|
| Rate for Payer: MEDICARE Medicare |
$13.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$18.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$18.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$18.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$18.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$15.20
|
|
|
MONTELUKAST TAB [10 MG]
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: AETNA Commercial |
$18.05
|
| Rate for Payer: AETNA Medicare |
$17.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$18.05
|
| Rate for Payer: BCBS Healthlink |
$17.10
|
| Rate for Payer: BCBS HMK CHIP |
$17.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$17.10
|
| Rate for Payer: BCBS POS |
$18.05
|
| Rate for Payer: BCBS Traditional |
$19.00
|
| Rate for Payer: CASH_PRICE |
$15.20
|
| Rate for Payer: CIGNA Commercial |
$18.05
|
| Rate for Payer: CIGNA Medicare |
$17.10
|
| Rate for Payer: HUMANA Commercial |
$17.10
|
| Rate for Payer: MEDICAID Medicaid |
$17.48
|
| Rate for Payer: MEDICARE Medicare |
$13.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$18.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$18.43
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$18.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$18.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$15.20
|
|
|
MORPHINE ER TAB [15 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
|
|
|
MORPHINE ER TAB [15 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
|
|
|
MORPHINE INJ [10 MG/ML] VL
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
MORPHINE INJ [10 MG/ML] VL
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| 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 MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
MORPHINE INJ [4 MG/ML] VL
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
MORPHINE INJ [4 MG/ML] VL
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J2270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
MORPHINE ORAL SOL [10 MG/ 5ML] 100 ML
|
Facility
IP
|
$41.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
MORPHINE ORAL SOL [10 MG/ 5ML] 100 ML
|
Facility
OP
|
$41.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$34.85
|
| Rate for Payer: AETNA Commercial |
$38.95
|
| Rate for Payer: AETNA Medicare |
$36.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$38.95
|
| Rate for Payer: BCBS Healthlink |
$36.90
|
| Rate for Payer: BCBS HMK CHIP |
$36.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$36.90
|
| Rate for Payer: BCBS POS |
$38.95
|
| Rate for Payer: BCBS Traditional |
$41.00
|
| Rate for Payer: CASH_PRICE |
$32.80
|
| Rate for Payer: CIGNA Commercial |
$38.95
|
| Rate for Payer: CIGNA Medicare |
$36.90
|
| Rate for Payer: HUMANA Commercial |
$36.90
|
| Rate for Payer: MEDICAID Medicaid |
$37.72
|
| Rate for Payer: MEDICARE Medicare |
$28.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$38.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$39.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$38.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$38.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$32.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$32.80
|
|
|
MORPHINE SOLN (ROXANOL) 10MG/5ML UD CUP
|
Facility
OP
|
$8.00
|
|
| 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
|
|
|
MORPHINE SOLN (ROXANOL) 10MG/5ML UD CUP
|
Facility
IP
|
$8.00
|
|
| 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
|
|
|
MRA ABDOMEN W WO CONTRAST
|
Facility
OP
|
$2,462.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,723.40 |
| Max. Negotiated Rate |
$2,462.00 |
| Rate for Payer: AETNA Commercial |
$2,338.90
|
| Rate for Payer: AETNA Medicare |
$2,215.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,338.90
|
| Rate for Payer: BCBS Healthlink |
$2,215.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,215.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,215.80
|
| Rate for Payer: BCBS POS |
$2,338.90
|
| Rate for Payer: BCBS Traditional |
$2,462.00
|
| Rate for Payer: CASH_PRICE |
$1,969.60
|
| Rate for Payer: CIGNA Commercial |
$2,338.90
|
| Rate for Payer: CIGNA Medicare |
$2,215.80
|
| Rate for Payer: HUMANA Commercial |
$2,215.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,265.04
|
| Rate for Payer: MEDICARE Medicare |
$1,723.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,388.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,338.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,092.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,969.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,969.60
|
|
|
MRA ABDOMEN W WO CONTRAST
|
Facility
IP
|
$2,462.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,723.40 |
| Max. Negotiated Rate |
$2,462.00 |
| Rate for Payer: AETNA Commercial |
$2,338.90
|
| Rate for Payer: AETNA Medicare |
$2,215.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,338.90
|
| Rate for Payer: BCBS Healthlink |
$2,215.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,215.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,215.80
|
| Rate for Payer: BCBS POS |
$2,338.90
|
| Rate for Payer: BCBS Traditional |
$2,462.00
|
| Rate for Payer: CASH_PRICE |
$1,969.60
|
| Rate for Payer: CIGNA Commercial |
$2,338.90
|
| Rate for Payer: CIGNA Medicare |
$2,215.80
|
| Rate for Payer: HUMANA Commercial |
$2,215.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,265.04
|
| Rate for Payer: MEDICARE Medicare |
$1,723.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,388.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,338.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,092.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,969.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,969.60
|
|
|
MR ABDOMEN W CONTRAST
|
Facility
OP
|
$2,462.00
|
|
|
Service Code
|
CPT 74182 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,723.40 |
| Max. Negotiated Rate |
$2,462.00 |
| Rate for Payer: AETNA Commercial |
$2,338.90
|
| Rate for Payer: AETNA Medicare |
$2,215.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,338.90
|
| Rate for Payer: BCBS Healthlink |
$2,215.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,215.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,215.80
|
| Rate for Payer: BCBS POS |
$2,338.90
|
| Rate for Payer: BCBS Traditional |
$2,462.00
|
| Rate for Payer: CASH_PRICE |
$1,969.60
|
| Rate for Payer: CIGNA Commercial |
$2,338.90
|
| Rate for Payer: CIGNA Medicare |
$2,215.80
|
| Rate for Payer: HUMANA Commercial |
$2,215.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,265.04
|
| Rate for Payer: MEDICARE Medicare |
$1,723.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,388.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,338.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,092.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,969.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,969.60
|
|
|
MR ABDOMEN W CONTRAST
|
Facility
IP
|
$2,462.00
|
|
|
Service Code
|
CPT 74182 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,723.40 |
| Max. Negotiated Rate |
$2,462.00 |
| Rate for Payer: AETNA Commercial |
$2,338.90
|
| Rate for Payer: AETNA Medicare |
$2,215.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,338.90
|
| Rate for Payer: BCBS Healthlink |
$2,215.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,215.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,215.80
|
| Rate for Payer: BCBS POS |
$2,338.90
|
| Rate for Payer: BCBS Traditional |
$2,462.00
|
| Rate for Payer: CASH_PRICE |
$1,969.60
|
| Rate for Payer: CIGNA Commercial |
$2,338.90
|
| Rate for Payer: CIGNA Medicare |
$2,215.80
|
| Rate for Payer: HUMANA Commercial |
$2,215.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,265.04
|
| Rate for Payer: MEDICARE Medicare |
$1,723.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,388.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,338.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,338.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,092.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,969.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,969.60
|
|
|
MR ABDOMEN WO CONTRAST
|
Facility
IP
|
$2,331.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,631.70 |
| Max. Negotiated Rate |
$2,331.00 |
| Rate for Payer: AETNA Commercial |
$2,214.45
|
| Rate for Payer: AETNA Medicare |
$2,097.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,214.45
|
| Rate for Payer: BCBS Healthlink |
$2,097.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,097.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,097.90
|
| Rate for Payer: BCBS POS |
$2,214.45
|
| Rate for Payer: BCBS Traditional |
$2,331.00
|
| Rate for Payer: CASH_PRICE |
$1,864.80
|
| Rate for Payer: CIGNA Commercial |
$2,214.45
|
| Rate for Payer: CIGNA Medicare |
$2,097.90
|
| Rate for Payer: HUMANA Commercial |
$2,097.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,144.52
|
| Rate for Payer: MEDICARE Medicare |
$1,631.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,214.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,261.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,214.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,214.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,981.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,864.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,864.80
|
|
|
MR ABDOMEN WO CONTRAST
|
Facility
OP
|
$2,331.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,631.70 |
| Max. Negotiated Rate |
$2,331.00 |
| Rate for Payer: AETNA Commercial |
$2,214.45
|
| Rate for Payer: AETNA Medicare |
$2,097.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,214.45
|
| Rate for Payer: BCBS Healthlink |
$2,097.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,097.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,097.90
|
| Rate for Payer: BCBS POS |
$2,214.45
|
| Rate for Payer: BCBS Traditional |
$2,331.00
|
| Rate for Payer: CASH_PRICE |
$1,864.80
|
| Rate for Payer: CIGNA Commercial |
$2,214.45
|
| Rate for Payer: CIGNA Medicare |
$2,097.90
|
| Rate for Payer: HUMANA Commercial |
$2,097.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,144.52
|
| Rate for Payer: MEDICARE Medicare |
$1,631.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,214.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,261.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,214.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,214.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,981.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,864.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,864.80
|
|
|
MR ABDOMEN W WO CONTRAST
|
Facility
OP
|
$3,320.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,324.00 |
| Max. Negotiated Rate |
$3,320.00 |
| Rate for Payer: AETNA Commercial |
$3,154.00
|
| Rate for Payer: AETNA Medicare |
$2,988.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,154.00
|
| Rate for Payer: BCBS Healthlink |
$2,988.00
|
| Rate for Payer: BCBS HMK CHIP |
$2,988.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,988.00
|
| Rate for Payer: BCBS POS |
$3,154.00
|
| Rate for Payer: BCBS Traditional |
$3,320.00
|
| Rate for Payer: CASH_PRICE |
$2,656.00
|
| Rate for Payer: CIGNA Commercial |
$3,154.00
|
| Rate for Payer: CIGNA Medicare |
$2,988.00
|
| Rate for Payer: HUMANA Commercial |
$2,988.00
|
| Rate for Payer: MEDICAID Medicaid |
$3,054.40
|
| Rate for Payer: MEDICARE Medicare |
$2,324.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,154.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,220.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,154.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,154.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,822.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,656.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,656.00
|
|
|
MR ABDOMEN W WO CONTRAST
|
Facility
IP
|
$3,320.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,324.00 |
| Max. Negotiated Rate |
$3,320.00 |
| Rate for Payer: AETNA Commercial |
$3,154.00
|
| Rate for Payer: AETNA Medicare |
$2,988.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,154.00
|
| Rate for Payer: BCBS Healthlink |
$2,988.00
|
| Rate for Payer: BCBS HMK CHIP |
$2,988.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,988.00
|
| Rate for Payer: BCBS POS |
$3,154.00
|
| Rate for Payer: BCBS Traditional |
$3,320.00
|
| Rate for Payer: CASH_PRICE |
$2,656.00
|
| Rate for Payer: CIGNA Commercial |
$3,154.00
|
| Rate for Payer: CIGNA Medicare |
$2,988.00
|
| Rate for Payer: HUMANA Commercial |
$2,988.00
|
| Rate for Payer: MEDICAID Medicaid |
$3,054.40
|
| Rate for Payer: MEDICARE Medicare |
$2,324.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,154.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,220.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,154.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,154.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,822.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,656.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,656.00
|
|
|
MRA CHEST W WO CONTRAST
|
Facility
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,196.30 |
| Max. Negotiated Rate |
$1,709.00 |
| Rate for Payer: AETNA Commercial |
$1,623.55
|
| Rate for Payer: AETNA Medicare |
$1,538.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,623.55
|
| Rate for Payer: BCBS Healthlink |
$1,538.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,538.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,538.10
|
| Rate for Payer: BCBS POS |
$1,623.55
|
| Rate for Payer: BCBS Traditional |
$1,709.00
|
| Rate for Payer: CASH_PRICE |
$1,367.20
|
| Rate for Payer: CIGNA Commercial |
$1,623.55
|
| Rate for Payer: CIGNA Medicare |
$1,538.10
|
| Rate for Payer: HUMANA Commercial |
$1,538.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,572.28
|
| Rate for Payer: MEDICARE Medicare |
$1,196.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,623.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,657.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,623.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,623.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,452.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,367.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,367.20
|
|
|
MRA CHEST W WO CONTRAST
|
Facility
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,196.30 |
| Max. Negotiated Rate |
$1,709.00 |
| Rate for Payer: AETNA Commercial |
$1,623.55
|
| Rate for Payer: AETNA Medicare |
$1,538.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,623.55
|
| Rate for Payer: BCBS Healthlink |
$1,538.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,538.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,538.10
|
| Rate for Payer: BCBS POS |
$1,623.55
|
| Rate for Payer: BCBS Traditional |
$1,709.00
|
| Rate for Payer: CASH_PRICE |
$1,367.20
|
| Rate for Payer: CIGNA Commercial |
$1,623.55
|
| Rate for Payer: CIGNA Medicare |
$1,538.10
|
| Rate for Payer: HUMANA Commercial |
$1,538.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,572.28
|
| Rate for Payer: MEDICARE Medicare |
$1,196.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,623.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,657.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,623.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,623.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,452.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,367.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,367.20
|
|
|
MRA HEAD W CONTRAST
|
Facility
IP
|
$2,348.00
|
|
|
Service Code
|
CPT 70545 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,643.60 |
| Max. Negotiated Rate |
$2,348.00 |
| Rate for Payer: AETNA Commercial |
$2,230.60
|
| Rate for Payer: AETNA Medicare |
$2,113.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,230.60
|
| Rate for Payer: BCBS Healthlink |
$2,113.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,113.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,113.20
|
| Rate for Payer: BCBS POS |
$2,230.60
|
| Rate for Payer: BCBS Traditional |
$2,348.00
|
| Rate for Payer: CASH_PRICE |
$1,878.40
|
| Rate for Payer: CIGNA Commercial |
$2,230.60
|
| Rate for Payer: CIGNA Medicare |
$2,113.20
|
| Rate for Payer: HUMANA Commercial |
$2,113.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,160.16
|
| Rate for Payer: MEDICARE Medicare |
$1,643.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,230.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,277.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,230.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,230.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,995.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,878.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,878.40
|
|
|
MRA HEAD W CONTRAST
|
Facility
OP
|
$2,348.00
|
|
|
Service Code
|
CPT 70545 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,643.60 |
| Max. Negotiated Rate |
$2,348.00 |
| Rate for Payer: AETNA Commercial |
$2,230.60
|
| Rate for Payer: AETNA Medicare |
$2,113.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,230.60
|
| Rate for Payer: BCBS Healthlink |
$2,113.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,113.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,113.20
|
| Rate for Payer: BCBS POS |
$2,230.60
|
| Rate for Payer: BCBS Traditional |
$2,348.00
|
| Rate for Payer: CASH_PRICE |
$1,878.40
|
| Rate for Payer: CIGNA Commercial |
$2,230.60
|
| Rate for Payer: CIGNA Medicare |
$2,113.20
|
| Rate for Payer: HUMANA Commercial |
$2,113.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,160.16
|
| Rate for Payer: MEDICARE Medicare |
$1,643.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,230.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,277.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,230.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,230.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,995.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,878.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,878.40
|
|
