|
NEBULIZER TREATMENT-HOSPITAL
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
NEBULIZER TREATMENT-HOSPITAL
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
NEG PRESS WOUND TX </=50CM
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: AETNA Commercial |
$396.15
|
| Rate for Payer: AETNA Medicare |
$375.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$396.15
|
| Rate for Payer: BCBS Healthlink |
$375.30
|
| Rate for Payer: BCBS HMK CHIP |
$375.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$375.30
|
| Rate for Payer: BCBS POS |
$396.15
|
| Rate for Payer: BCBS Traditional |
$417.00
|
| Rate for Payer: CASH_PRICE |
$333.60
|
| Rate for Payer: CIGNA Commercial |
$396.15
|
| Rate for Payer: CIGNA Medicare |
$375.30
|
| Rate for Payer: HUMANA Commercial |
$375.30
|
| Rate for Payer: MEDICAID Medicaid |
$383.64
|
| Rate for Payer: MEDICARE Medicare |
$291.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$396.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$404.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$396.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$396.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$354.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$333.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$333.60
|
|
|
NEG PRESS WOUND TX </=50CM
|
Facility
IP
|
$417.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: AETNA Commercial |
$396.15
|
| Rate for Payer: AETNA Medicare |
$375.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$396.15
|
| Rate for Payer: BCBS Healthlink |
$375.30
|
| Rate for Payer: BCBS HMK CHIP |
$375.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$375.30
|
| Rate for Payer: BCBS POS |
$396.15
|
| Rate for Payer: BCBS Traditional |
$417.00
|
| Rate for Payer: CASH_PRICE |
$333.60
|
| Rate for Payer: CIGNA Commercial |
$396.15
|
| Rate for Payer: CIGNA Medicare |
$375.30
|
| Rate for Payer: HUMANA Commercial |
$375.30
|
| Rate for Payer: MEDICAID Medicaid |
$383.64
|
| Rate for Payer: MEDICARE Medicare |
$291.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$396.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$404.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$396.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$396.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$354.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$333.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$333.60
|
|
|
NEG PRE WOUND THERAPY W/DISP EQ >50CM
|
Facility
IP
|
$554.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$554.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$470.90
|
| Rate for Payer: AETNA Commercial |
$526.30
|
| Rate for Payer: AETNA Medicare |
$498.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$526.30
|
| Rate for Payer: BCBS Healthlink |
$498.60
|
| Rate for Payer: BCBS HMK CHIP |
$498.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$498.60
|
| Rate for Payer: BCBS POS |
$526.30
|
| Rate for Payer: BCBS Traditional |
$554.00
|
| Rate for Payer: CASH_PRICE |
$443.20
|
| Rate for Payer: CIGNA Commercial |
$526.30
|
| Rate for Payer: CIGNA Medicare |
$498.60
|
| Rate for Payer: HUMANA Commercial |
$498.60
|
| Rate for Payer: MEDICAID Medicaid |
$509.68
|
| Rate for Payer: MEDICARE Medicare |
$387.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$526.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$537.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$526.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$526.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$443.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$443.20
|
|
|
NEG PRE WOUND THERAPY W/DISP EQ >50CM
|
Facility
OP
|
$554.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$554.00 |
| Rate for Payer: AETNA Commercial |
$526.30
|
| Rate for Payer: AETNA Medicare |
$498.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$526.30
|
| Rate for Payer: BCBS Healthlink |
$498.60
|
| Rate for Payer: BCBS HMK CHIP |
$498.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$498.60
|
| Rate for Payer: BCBS POS |
$526.30
|
| Rate for Payer: BCBS Traditional |
$554.00
|
| Rate for Payer: CASH_PRICE |
$443.20
|
| Rate for Payer: CIGNA Commercial |
$526.30
|
| Rate for Payer: CIGNA Medicare |
$498.60
|
| Rate for Payer: HUMANA Commercial |
$498.60
|
| Rate for Payer: MEDICAID Medicaid |
$509.68
|
| Rate for Payer: MEDICARE Medicare |
$387.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$526.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$537.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$526.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$526.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$470.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$443.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$443.20
|
|
|
NEISSERIA GONORRHOEAE, NAA (188086)
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
NEISSERIA GONORRHOEAE, NAA (188086)
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: AETNA Commercial |
$52.25
|
| Rate for Payer: AETNA Medicare |
$49.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$52.25
|
| Rate for Payer: BCBS Healthlink |
$49.50
|
| Rate for Payer: BCBS HMK CHIP |
$49.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$49.50
|
| Rate for Payer: BCBS POS |
$52.25
|
| Rate for Payer: BCBS Traditional |
$55.00
|
| Rate for Payer: CASH_PRICE |
$44.00
|
| Rate for Payer: CIGNA Commercial |
$52.25
|
| Rate for Payer: CIGNA Medicare |
$49.50
|
| Rate for Payer: HUMANA Commercial |
$49.50
|
| Rate for Payer: MEDICAID Medicaid |
$50.60
|
| Rate for Payer: MEDICARE Medicare |
$38.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$52.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$53.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$52.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$52.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$46.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.00
|
|
|
NEISSERI GONORRHOEAE AMP PROB TECH
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
NEISSERI GONORRHOEAE AMP PROB TECH
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| 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 MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
|
NETARSUDIL 0.02% SOLUTION 2.5 ML-NF
|
Facility
OP
|
$677.40
|
|
| Hospital Charge Code |
20221116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$474.18 |
| Max. Negotiated Rate |
$677.40 |
| Rate for Payer: AETNA Commercial |
$643.53
|
| Rate for Payer: AETNA Medicare |
$609.66
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$643.53
|
| Rate for Payer: BCBS Healthlink |
$609.66
|
| Rate for Payer: BCBS HMK CHIP |
$609.66
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$609.66
|
| Rate for Payer: BCBS POS |
$643.53
|
| Rate for Payer: BCBS Traditional |
$677.40
|
| Rate for Payer: CASH_PRICE |
$541.92
|
| Rate for Payer: CIGNA Commercial |
$643.53
|
| Rate for Payer: CIGNA Medicare |
$609.66
|
| Rate for Payer: HUMANA Commercial |
$609.66
|
| Rate for Payer: MEDICAID Medicaid |
$623.21
|
| Rate for Payer: MEDICARE Medicare |
$474.18
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$643.53
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$657.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$643.53
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$643.53
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$575.79
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$541.92
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$541.92
|
|
|
NETARSUDIL 0.02% SOLUTION 2.5 ML-NF
|
Facility
IP
|
$677.40
|
|
| Hospital Charge Code |
20221116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$474.18 |
| Max. Negotiated Rate |
$677.40 |
| Rate for Payer: AETNA Commercial |
$643.53
|
| Rate for Payer: AETNA Medicare |
$609.66
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$643.53
|
| Rate for Payer: BCBS Healthlink |
$609.66
|
| Rate for Payer: BCBS HMK CHIP |
$609.66
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$609.66
|
| Rate for Payer: BCBS POS |
$643.53
|
| Rate for Payer: BCBS Traditional |
$677.40
|
| Rate for Payer: CASH_PRICE |
$541.92
|
| Rate for Payer: CIGNA Commercial |
$643.53
|
| Rate for Payer: CIGNA Medicare |
$609.66
|
| Rate for Payer: HUMANA Commercial |
$609.66
|
| Rate for Payer: MEDICAID Medicaid |
$623.21
|
| Rate for Payer: MEDICARE Medicare |
$474.18
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$643.53
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$657.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$643.53
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$643.53
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$575.79
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$541.92
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$541.92
|
|
|
NEUROMUSCULAR REEDUCATION PER 15
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
NEUROMUSCULAR REEDUCATION PER 15
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: AETNA Commercial |
$103.55
|
| Rate for Payer: AETNA Medicare |
$98.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$103.55
|
| Rate for Payer: BCBS Healthlink |
$98.10
|
| Rate for Payer: BCBS HMK CHIP |
$98.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$98.10
|
| Rate for Payer: BCBS POS |
$103.55
|
| Rate for Payer: BCBS Traditional |
$109.00
|
| Rate for Payer: CASH_PRICE |
$87.20
|
| Rate for Payer: CIGNA Commercial |
$103.55
|
| Rate for Payer: CIGNA Medicare |
$98.10
|
| Rate for Payer: HUMANA Commercial |
$98.10
|
| Rate for Payer: MEDICAID Medicaid |
$100.28
|
| Rate for Payer: MEDICARE Medicare |
$76.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$103.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$105.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$103.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$103.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$92.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$87.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$87.20
|
|
|
NF-Anoro Ellipta Inhalation Powder
|
Facility
IP
|
$374.32
|
|
| Hospital Charge Code |
20220706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.02 |
| Max. Negotiated Rate |
$374.32 |
| Rate for Payer: AETNA Commercial |
$355.60
|
| Rate for Payer: AETNA Medicare |
$336.89
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$355.60
|
| Rate for Payer: BCBS Healthlink |
$336.89
|
| Rate for Payer: BCBS HMK CHIP |
$336.89
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$336.89
|
| Rate for Payer: BCBS POS |
$355.60
|
| Rate for Payer: BCBS Traditional |
$374.32
|
| Rate for Payer: CASH_PRICE |
$299.46
|
| Rate for Payer: CIGNA Commercial |
$355.60
|
| Rate for Payer: CIGNA Medicare |
$336.89
|
| Rate for Payer: HUMANA Commercial |
$336.89
|
| Rate for Payer: MEDICAID Medicaid |
$344.37
|
| Rate for Payer: MEDICARE Medicare |
$262.02
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$355.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$363.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$355.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$355.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$318.17
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$299.46
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$299.46
|
|
|
NF-Anoro Ellipta Inhalation Powder
|
Facility
OP
|
$374.32
|
|
| Hospital Charge Code |
20220706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$262.02 |
| Max. Negotiated Rate |
$374.32 |
| Rate for Payer: AETNA Commercial |
$355.60
|
| Rate for Payer: AETNA Medicare |
$336.89
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$355.60
|
| Rate for Payer: BCBS Healthlink |
$336.89
|
| Rate for Payer: BCBS HMK CHIP |
$336.89
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$336.89
|
| Rate for Payer: BCBS POS |
$355.60
|
| Rate for Payer: BCBS Traditional |
$374.32
|
| Rate for Payer: CASH_PRICE |
$299.46
|
| Rate for Payer: CIGNA Commercial |
$355.60
|
| Rate for Payer: CIGNA Medicare |
$336.89
|
| Rate for Payer: HUMANA Commercial |
$336.89
|
| Rate for Payer: MEDICAID Medicaid |
$344.37
|
| Rate for Payer: MEDICARE Medicare |
$262.02
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$355.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$363.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$355.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$355.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$318.17
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$299.46
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$299.46
|
|
|
NF-Brimonidine-Timolol Ophth Soln 0.2%-0
|
Facility
IP
|
$649.15
|
|
| Hospital Charge Code |
20230420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$454.40 |
| Max. Negotiated Rate |
$649.15 |
| Rate for Payer: AETNA Commercial |
$616.69
|
| Rate for Payer: AETNA Medicare |
$584.24
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$616.69
|
| Rate for Payer: BCBS Healthlink |
$584.24
|
| Rate for Payer: BCBS HMK CHIP |
$584.24
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$584.24
|
| Rate for Payer: BCBS POS |
$616.69
|
| Rate for Payer: BCBS Traditional |
$649.15
|
| Rate for Payer: CASH_PRICE |
$519.32
|
| Rate for Payer: CIGNA Commercial |
$616.69
|
| Rate for Payer: CIGNA Medicare |
$584.24
|
| Rate for Payer: HUMANA Commercial |
$584.24
|
| Rate for Payer: MEDICAID Medicaid |
$597.22
|
| Rate for Payer: MEDICARE Medicare |
$454.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$616.69
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$629.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$616.69
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$616.69
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$551.78
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$519.32
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$519.32
|
|
|
NF-Brimonidine-Timolol Ophth Soln 0.2%-0
|
Facility
OP
|
$649.15
|
|
| Hospital Charge Code |
20230420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$454.40 |
| Max. Negotiated Rate |
$649.15 |
| Rate for Payer: AETNA Commercial |
$616.69
|
| Rate for Payer: AETNA Medicare |
$584.24
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$616.69
|
| Rate for Payer: BCBS Healthlink |
$584.24
|
| Rate for Payer: BCBS HMK CHIP |
$584.24
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$584.24
|
| Rate for Payer: BCBS POS |
$616.69
|
| Rate for Payer: BCBS Traditional |
$649.15
|
| Rate for Payer: CASH_PRICE |
$519.32
|
| Rate for Payer: CIGNA Commercial |
$616.69
|
| Rate for Payer: CIGNA Medicare |
$584.24
|
| Rate for Payer: HUMANA Commercial |
$584.24
|
| Rate for Payer: MEDICAID Medicaid |
$597.22
|
| Rate for Payer: MEDICARE Medicare |
$454.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$616.69
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$629.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$616.69
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$616.69
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$551.78
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$519.32
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$519.32
|
|
|
NF-Budesonide-Formoterol INH 80-4.5MCG
|
Facility
OP
|
$756.20
|
|
| Hospital Charge Code |
20220708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$529.34 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: AETNA Commercial |
$718.39
|
| Rate for Payer: AETNA Medicare |
$680.58
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$718.39
|
| Rate for Payer: BCBS Healthlink |
$680.58
|
| Rate for Payer: BCBS HMK CHIP |
$680.58
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$680.58
|
| Rate for Payer: BCBS POS |
$718.39
|
| Rate for Payer: BCBS Traditional |
$756.20
|
| Rate for Payer: CASH_PRICE |
$604.96
|
| Rate for Payer: CIGNA Commercial |
$718.39
|
| Rate for Payer: CIGNA Medicare |
$680.58
|
| Rate for Payer: HUMANA Commercial |
$680.58
|
| Rate for Payer: MEDICAID Medicaid |
$695.70
|
| Rate for Payer: MEDICARE Medicare |
$529.34
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$718.39
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$733.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$718.39
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$718.39
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$642.77
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$604.96
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$604.96
|
|
|
NF-Budesonide-Formoterol INH 80-4.5MCG
|
Facility
IP
|
$756.20
|
|
| Hospital Charge Code |
20220708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$529.34 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: AETNA Commercial |
$718.39
|
| Rate for Payer: AETNA Medicare |
$680.58
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$718.39
|
| Rate for Payer: BCBS Healthlink |
$680.58
|
| Rate for Payer: BCBS HMK CHIP |
$680.58
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$680.58
|
| Rate for Payer: BCBS POS |
$718.39
|
| Rate for Payer: BCBS Traditional |
$756.20
|
| Rate for Payer: CASH_PRICE |
$604.96
|
| Rate for Payer: CIGNA Commercial |
$718.39
|
| Rate for Payer: CIGNA Medicare |
$680.58
|
| Rate for Payer: HUMANA Commercial |
$680.58
|
| Rate for Payer: MEDICAID Medicaid |
$695.70
|
| Rate for Payer: MEDICARE Medicare |
$529.34
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$718.39
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$733.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$718.39
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$718.39
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$642.77
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$604.96
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$604.96
|
|
|
NF-Prazosin HCl Oral Capsule 2MG
|
Facility
IP
|
$8.00
|
|
| Hospital Charge Code |
20220706
|
|
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
|
|
|
NF-Prazosin HCl Oral Capsule 2MG
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
20220706
|
|
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
|
|
|
NICARDIPINE 20MG / 200ML NS PREMIX
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: AETNA Commercial |
$389.50
|
| Rate for Payer: AETNA Medicare |
$369.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$389.50
|
| Rate for Payer: BCBS Healthlink |
$369.00
|
| Rate for Payer: BCBS HMK CHIP |
$369.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$369.00
|
| Rate for Payer: BCBS POS |
$389.50
|
| Rate for Payer: BCBS Traditional |
$410.00
|
| Rate for Payer: CASH_PRICE |
$328.00
|
| Rate for Payer: CIGNA Commercial |
$389.50
|
| Rate for Payer: CIGNA Medicare |
$369.00
|
| Rate for Payer: HUMANA Commercial |
$369.00
|
| Rate for Payer: MEDICAID Medicaid |
$377.20
|
| Rate for Payer: MEDICARE Medicare |
$287.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$389.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$397.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$389.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$389.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$348.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$328.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$328.00
|
|
|
NICARDIPINE 20MG / 200ML NS PREMIX
|
Facility
IP
|
$410.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: AETNA Commercial |
$389.50
|
| Rate for Payer: AETNA Medicare |
$369.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$389.50
|
| Rate for Payer: BCBS Healthlink |
$369.00
|
| Rate for Payer: BCBS HMK CHIP |
$369.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$369.00
|
| Rate for Payer: BCBS POS |
$389.50
|
| Rate for Payer: BCBS Traditional |
$410.00
|
| Rate for Payer: CASH_PRICE |
$328.00
|
| Rate for Payer: CIGNA Commercial |
$389.50
|
| Rate for Payer: CIGNA Medicare |
$369.00
|
| Rate for Payer: HUMANA Commercial |
$369.00
|
| Rate for Payer: MEDICAID Medicaid |
$377.20
|
| Rate for Payer: MEDICARE Medicare |
$287.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$389.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$397.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$389.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$389.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$348.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$328.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$328.00
|
|
|
NICOTINE TRANSDERMAL PATCH [21 MG/24 HR]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| 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 - 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
|
|
