|
NALBUPHINE INJ [10 MG/ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J2300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
NALOXONE 2MG/2ML PFS
|
Facility
OP
|
$133.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: AETNA Commercial |
$126.35
|
| Rate for Payer: AETNA Medicare |
$119.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$126.35
|
| Rate for Payer: BCBS Healthlink |
$119.70
|
| Rate for Payer: BCBS HMK CHIP |
$119.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$119.70
|
| Rate for Payer: BCBS POS |
$126.35
|
| Rate for Payer: BCBS Traditional |
$133.00
|
| Rate for Payer: CASH_PRICE |
$106.40
|
| Rate for Payer: CIGNA Commercial |
$126.35
|
| Rate for Payer: CIGNA Medicare |
$119.70
|
| Rate for Payer: HUMANA Commercial |
$119.70
|
| Rate for Payer: MEDICAID Medicaid |
$122.36
|
| Rate for Payer: MEDICARE Medicare |
$93.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$126.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$129.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$126.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$126.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$106.40
|
|
|
NALOXONE 2MG/2ML PFS
|
Facility
IP
|
$133.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: AETNA Commercial |
$126.35
|
| Rate for Payer: AETNA Medicare |
$119.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$126.35
|
| Rate for Payer: BCBS Healthlink |
$119.70
|
| Rate for Payer: BCBS HMK CHIP |
$119.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$119.70
|
| Rate for Payer: BCBS POS |
$126.35
|
| Rate for Payer: BCBS Traditional |
$133.00
|
| Rate for Payer: CASH_PRICE |
$106.40
|
| Rate for Payer: CIGNA Commercial |
$126.35
|
| Rate for Payer: CIGNA Medicare |
$119.70
|
| Rate for Payer: HUMANA Commercial |
$119.70
|
| Rate for Payer: MEDICAID Medicaid |
$122.36
|
| Rate for Payer: MEDICARE Medicare |
$93.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$126.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$129.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$126.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$126.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$113.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$106.40
|
|
|
NALOXONE INJ [0.4 MG/ML]
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
NALOXONE INJ [0.4 MG/ML]
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT J2310
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
NALTREXONE 380MG SUSP-INJ-NF
|
Facility
IP
|
$2,520.35
|
|
| Hospital Charge Code |
20221214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,764.24 |
| Max. Negotiated Rate |
$2,520.35 |
| Rate for Payer: AETNA Commercial |
$2,394.33
|
| Rate for Payer: AETNA Medicare |
$2,268.32
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,394.33
|
| Rate for Payer: BCBS Healthlink |
$2,268.32
|
| Rate for Payer: BCBS HMK CHIP |
$2,268.32
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,268.32
|
| Rate for Payer: BCBS POS |
$2,394.33
|
| Rate for Payer: BCBS Traditional |
$2,520.35
|
| Rate for Payer: CASH_PRICE |
$2,016.28
|
| Rate for Payer: CIGNA Commercial |
$2,394.33
|
| Rate for Payer: CIGNA Medicare |
$2,268.32
|
| Rate for Payer: HUMANA Commercial |
$2,268.32
|
| Rate for Payer: MEDICAID Medicaid |
$2,318.72
|
| Rate for Payer: MEDICARE Medicare |
$1,764.24
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,394.33
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,444.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,394.33
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,394.33
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,142.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,016.28
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,016.28
|
|
|
NALTREXONE 380MG SUSP-INJ-NF
|
Facility
OP
|
$2,520.35
|
|
| Hospital Charge Code |
20221214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,764.24 |
| Max. Negotiated Rate |
$2,520.35 |
| Rate for Payer: AETNA Commercial |
$2,394.33
|
| Rate for Payer: AETNA Medicare |
$2,268.32
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,394.33
|
| Rate for Payer: BCBS Healthlink |
$2,268.32
|
| Rate for Payer: BCBS HMK CHIP |
$2,268.32
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,268.32
|
| Rate for Payer: BCBS POS |
$2,394.33
|
| Rate for Payer: BCBS Traditional |
$2,520.35
|
| Rate for Payer: CASH_PRICE |
$2,016.28
|
| Rate for Payer: CIGNA Commercial |
$2,394.33
|
| Rate for Payer: CIGNA Medicare |
$2,268.32
|
| Rate for Payer: HUMANA Commercial |
$2,268.32
|
| Rate for Payer: MEDICAID Medicaid |
$2,318.72
|
| Rate for Payer: MEDICARE Medicare |
$1,764.24
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,394.33
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,444.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,394.33
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,394.33
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,142.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,016.28
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,016.28
|
|
|
NALTREXONE 50MG TABLET
|
Facility
IP
|
$13.82
|
|
| Hospital Charge Code |
20230213
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: AETNA Commercial |
$13.13
|
| Rate for Payer: AETNA Medicare |
$12.44
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.13
|
| Rate for Payer: BCBS Healthlink |
$12.44
|
| Rate for Payer: BCBS HMK CHIP |
$12.44
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.44
|
| Rate for Payer: BCBS POS |
$13.13
|
| Rate for Payer: BCBS Traditional |
$13.82
|
| Rate for Payer: CASH_PRICE |
$11.06
|
| Rate for Payer: CIGNA Commercial |
$13.13
|
| Rate for Payer: CIGNA Medicare |
$12.44
|
| Rate for Payer: HUMANA Commercial |
$12.44
|
| Rate for Payer: MEDICAID Medicaid |
$12.71
|
| Rate for Payer: MEDICARE Medicare |
$9.67
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.13
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.13
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.13
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.06
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.06
|
|
|
NALTREXONE 50MG TABLET
|
Facility
OP
|
$13.82
|
|
| Hospital Charge Code |
20230213
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: AETNA Commercial |
$13.13
|
| Rate for Payer: AETNA Medicare |
$12.44
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.13
|
| Rate for Payer: BCBS Healthlink |
$12.44
|
| Rate for Payer: BCBS HMK CHIP |
$12.44
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.44
|
| Rate for Payer: BCBS POS |
$13.13
|
| Rate for Payer: BCBS Traditional |
$13.82
|
| Rate for Payer: CASH_PRICE |
$11.06
|
| Rate for Payer: CIGNA Commercial |
$13.13
|
| Rate for Payer: CIGNA Medicare |
$12.44
|
| Rate for Payer: HUMANA Commercial |
$12.44
|
| Rate for Payer: MEDICAID Medicaid |
$12.71
|
| Rate for Payer: MEDICARE Medicare |
$9.67
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.13
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.13
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.13
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.06
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.06
|
|
|
NAPROXEN TAB [500 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
|
|
|
NAPROXEN TAB [500 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
|
|
|
NARCAN 0.4MG/ML
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT J2310 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: AETNA Commercial |
$60.80
|
| Rate for Payer: AETNA Medicare |
$57.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$60.80
|
| Rate for Payer: BCBS Healthlink |
$57.60
|
| Rate for Payer: BCBS HMK CHIP |
$57.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$57.60
|
| Rate for Payer: BCBS POS |
$60.80
|
| Rate for Payer: BCBS Traditional |
$64.00
|
| Rate for Payer: CASH_PRICE |
$51.20
|
| Rate for Payer: CIGNA Commercial |
$60.80
|
| Rate for Payer: CIGNA Medicare |
$57.60
|
| Rate for Payer: HUMANA Commercial |
$57.60
|
| Rate for Payer: MEDICAID Medicaid |
$58.88
|
| Rate for Payer: MEDICARE Medicare |
$44.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$60.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$62.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$60.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$51.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$51.20
|
|
|
NARCAN 0.4MG/ML
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT J2310 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: AETNA Commercial |
$60.80
|
| Rate for Payer: AETNA Medicare |
$57.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$60.80
|
| Rate for Payer: BCBS Healthlink |
$57.60
|
| Rate for Payer: BCBS HMK CHIP |
$57.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$57.60
|
| Rate for Payer: BCBS POS |
$60.80
|
| Rate for Payer: BCBS Traditional |
$64.00
|
| Rate for Payer: CASH_PRICE |
$51.20
|
| Rate for Payer: CIGNA Commercial |
$60.80
|
| Rate for Payer: CIGNA Medicare |
$57.60
|
| Rate for Payer: HUMANA Commercial |
$57.60
|
| Rate for Payer: MEDICAID Medicaid |
$58.88
|
| Rate for Payer: MEDICARE Medicare |
$44.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$60.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$62.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$60.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$54.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$51.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$51.20
|
|
|
NASAL AIRWAY 12F
|
Facility
IP
|
$45.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
NASAL AIRWAY 12F
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
NEB TR CONTINUOUS 1ST HOUR
|
Facility
OP
|
$197.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: AETNA Commercial |
$187.15
|
| Rate for Payer: AETNA Medicare |
$177.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$187.15
|
| Rate for Payer: BCBS Healthlink |
$177.30
|
| Rate for Payer: BCBS HMK CHIP |
$177.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$177.30
|
| Rate for Payer: BCBS POS |
$187.15
|
| Rate for Payer: BCBS Traditional |
$197.00
|
| Rate for Payer: CASH_PRICE |
$157.60
|
| Rate for Payer: CIGNA Commercial |
$187.15
|
| Rate for Payer: CIGNA Medicare |
$177.30
|
| Rate for Payer: HUMANA Commercial |
$177.30
|
| Rate for Payer: MEDICAID Medicaid |
$181.24
|
| Rate for Payer: MEDICARE Medicare |
$137.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$187.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$191.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$187.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$187.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$167.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$157.60
|
|
|
NEB TR CONTINUOUS 1ST HOUR
|
Facility
IP
|
$197.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: AETNA Commercial |
$187.15
|
| Rate for Payer: AETNA Medicare |
$177.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$187.15
|
| Rate for Payer: BCBS Healthlink |
$177.30
|
| Rate for Payer: BCBS HMK CHIP |
$177.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$177.30
|
| Rate for Payer: BCBS POS |
$187.15
|
| Rate for Payer: BCBS Traditional |
$197.00
|
| Rate for Payer: CASH_PRICE |
$157.60
|
| Rate for Payer: CIGNA Commercial |
$187.15
|
| Rate for Payer: CIGNA Medicare |
$177.30
|
| Rate for Payer: HUMANA Commercial |
$177.30
|
| Rate for Payer: MEDICAID Medicaid |
$181.24
|
| Rate for Payer: MEDICARE Medicare |
$137.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$187.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$191.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$187.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$187.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$167.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$157.60
|
|
|
NEB TR CONTINUOUS EACH ADDITIONAL HR
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: AETNA Commercial |
$133.00
|
| Rate for Payer: AETNA Medicare |
$126.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$133.00
|
| Rate for Payer: BCBS Healthlink |
$126.00
|
| Rate for Payer: BCBS HMK CHIP |
$126.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$126.00
|
| Rate for Payer: BCBS POS |
$133.00
|
| Rate for Payer: BCBS Traditional |
$140.00
|
| Rate for Payer: CASH_PRICE |
$112.00
|
| Rate for Payer: CIGNA Commercial |
$133.00
|
| Rate for Payer: CIGNA Medicare |
$126.00
|
| Rate for Payer: HUMANA Commercial |
$126.00
|
| Rate for Payer: MEDICAID Medicaid |
$128.80
|
| Rate for Payer: MEDICARE Medicare |
$98.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$133.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$135.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$133.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$133.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$119.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$112.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$112.00
|
|
|
NEB TR CONTINUOUS EACH ADDITIONAL HR
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: AETNA Commercial |
$133.00
|
| Rate for Payer: AETNA Medicare |
$126.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$133.00
|
| Rate for Payer: BCBS Healthlink |
$126.00
|
| Rate for Payer: BCBS HMK CHIP |
$126.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$126.00
|
| Rate for Payer: BCBS POS |
$133.00
|
| Rate for Payer: BCBS Traditional |
$140.00
|
| Rate for Payer: CASH_PRICE |
$112.00
|
| Rate for Payer: CIGNA Commercial |
$133.00
|
| Rate for Payer: CIGNA Medicare |
$126.00
|
| Rate for Payer: HUMANA Commercial |
$126.00
|
| Rate for Payer: MEDICAID Medicaid |
$128.80
|
| Rate for Payer: MEDICARE Medicare |
$98.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$133.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$135.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$133.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$133.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$119.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$112.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$112.00
|
|
|
NEBULIZER 7'' 50/CS
|
Facility
OP
|
$19.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
NEBULIZER 7'' 50/CS
|
Facility
IP
|
$19.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
NEBULIZER PEDS MASK ( FISH)
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
NEBULIZER PEDS MASK ( FISH)
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: AETNA Commercial |
$17.10
|
| Rate for Payer: AETNA Medicare |
$16.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$17.10
|
| Rate for Payer: BCBS Healthlink |
$16.20
|
| Rate for Payer: BCBS HMK CHIP |
$16.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$16.20
|
| Rate for Payer: BCBS POS |
$17.10
|
| Rate for Payer: BCBS Traditional |
$18.00
|
| Rate for Payer: CASH_PRICE |
$14.40
|
| Rate for Payer: CIGNA Commercial |
$17.10
|
| Rate for Payer: CIGNA Medicare |
$16.20
|
| Rate for Payer: HUMANA Commercial |
$16.20
|
| Rate for Payer: MEDICAID Medicaid |
$16.56
|
| Rate for Payer: MEDICARE Medicare |
$12.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$17.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$17.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$17.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$17.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$15.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$14.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$14.40
|
|
|
NEBULIZER TREATMENT-CLINIC
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: AETNA Commercial |
$61.75
|
| Rate for Payer: AETNA Medicare |
$58.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$61.75
|
| Rate for Payer: BCBS Healthlink |
$58.50
|
| Rate for Payer: BCBS HMK CHIP |
$58.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$58.50
|
| Rate for Payer: BCBS POS |
$61.75
|
| Rate for Payer: BCBS Traditional |
$65.00
|
| Rate for Payer: CASH_PRICE |
$52.00
|
| Rate for Payer: CIGNA Commercial |
$61.75
|
| Rate for Payer: CIGNA Medicare |
$58.50
|
| Rate for Payer: HUMANA Commercial |
$58.50
|
| Rate for Payer: MEDICAID Medicaid |
$59.80
|
| Rate for Payer: MEDICARE Medicare |
$45.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$61.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$63.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$61.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$61.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$55.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.00
|
|
|
NEBULIZER TREATMENT-CLINIC
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: AETNA Commercial |
$61.75
|
| Rate for Payer: AETNA Medicare |
$58.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$61.75
|
| Rate for Payer: BCBS Healthlink |
$58.50
|
| Rate for Payer: BCBS HMK CHIP |
$58.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$58.50
|
| Rate for Payer: BCBS POS |
$61.75
|
| Rate for Payer: BCBS Traditional |
$65.00
|
| Rate for Payer: CASH_PRICE |
$52.00
|
| Rate for Payer: CIGNA Commercial |
$61.75
|
| Rate for Payer: CIGNA Medicare |
$58.50
|
| Rate for Payer: HUMANA Commercial |
$58.50
|
| Rate for Payer: MEDICAID Medicaid |
$59.80
|
| Rate for Payer: MEDICARE Medicare |
$45.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$61.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$63.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$61.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$61.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$55.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.00
|
|
