|
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
|
|
|
NICOTINE TRANSDERMAL PATCH (7MG/24HR)
|
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
|
|
|
NICOTINE TRANSDERMAL PATCH (7MG/24HR)
|
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
|
|
|
NIFEDIPINE ER TAB [30 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
|
|
|
NIFEDIPINE ER TAB [30 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
|
|
|
NITROFURANTOIN 50MG CAPSULE
|
Facility
OP
|
$14.50
|
|
| Hospital Charge Code |
20220726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: AETNA Commercial |
$13.77
|
| Rate for Payer: AETNA Medicare |
$13.05
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.77
|
| Rate for Payer: BCBS Healthlink |
$13.05
|
| Rate for Payer: BCBS HMK CHIP |
$13.05
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.05
|
| Rate for Payer: BCBS POS |
$13.77
|
| Rate for Payer: BCBS Traditional |
$14.50
|
| Rate for Payer: CASH_PRICE |
$11.60
|
| Rate for Payer: CIGNA Commercial |
$13.77
|
| Rate for Payer: CIGNA Medicare |
$13.05
|
| Rate for Payer: HUMANA Commercial |
$13.05
|
| Rate for Payer: MEDICAID Medicaid |
$13.34
|
| Rate for Payer: MEDICARE Medicare |
$10.15
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.77
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.77
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.77
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.32
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.60
|
|
|
NITROFURANTOIN 50MG CAPSULE
|
Facility
IP
|
$14.50
|
|
| Hospital Charge Code |
20220726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.77
|
| Rate for Payer: AETNA Commercial |
$13.77
|
| Rate for Payer: AETNA Medicare |
$13.05
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.77
|
| Rate for Payer: BCBS Healthlink |
$13.05
|
| Rate for Payer: BCBS HMK CHIP |
$13.05
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.05
|
| Rate for Payer: BCBS POS |
$13.77
|
| Rate for Payer: BCBS Traditional |
$14.50
|
| Rate for Payer: CASH_PRICE |
$11.60
|
| Rate for Payer: CIGNA Commercial |
$13.77
|
| Rate for Payer: CIGNA Medicare |
$13.05
|
| Rate for Payer: HUMANA Commercial |
$13.05
|
| Rate for Payer: MEDICAID Medicaid |
$13.34
|
| Rate for Payer: MEDICARE Medicare |
$10.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.77
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.77
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.32
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.60
|
|
|
NITROFURANTOIN CAP [100 MG]
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
NITROFURANTOIN CAP [100 MG]
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
NITROGLYCERIN 2% OINT [30 GM]
|
Facility
IP
|
$143.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$135.85
|
| Rate for Payer: AETNA Commercial |
$135.85
|
| Rate for Payer: AETNA Medicare |
$128.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$135.85
|
| Rate for Payer: BCBS Healthlink |
$128.70
|
| Rate for Payer: BCBS HMK CHIP |
$128.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$128.70
|
| Rate for Payer: BCBS POS |
$135.85
|
| Rate for Payer: BCBS Traditional |
$143.00
|
| Rate for Payer: CASH_PRICE |
$114.40
|
| Rate for Payer: CIGNA Commercial |
$135.85
|
| Rate for Payer: CIGNA Medicare |
$128.70
|
| Rate for Payer: HUMANA Commercial |
$128.70
|
| Rate for Payer: MEDICAID Medicaid |
$131.56
|
| Rate for Payer: MEDICARE Medicare |
$100.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$138.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$135.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$135.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$121.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$114.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$114.40
|
|
|
NITROGLYCERIN 2% OINT [30 GM]
|
Facility
OP
|
$143.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: AETNA Commercial |
$135.85
|
| Rate for Payer: AETNA Medicare |
$128.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$135.85
|
| Rate for Payer: BCBS Healthlink |
$128.70
|
| Rate for Payer: BCBS HMK CHIP |
$128.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$128.70
|
| Rate for Payer: BCBS POS |
$135.85
|
| Rate for Payer: BCBS Traditional |
$143.00
|
| Rate for Payer: CASH_PRICE |
$114.40
|
| Rate for Payer: CIGNA Commercial |
$135.85
|
| Rate for Payer: CIGNA Medicare |
$128.70
|
| Rate for Payer: HUMANA Commercial |
$128.70
|
| Rate for Payer: MEDICAID Medicaid |
$131.56
|
| Rate for Payer: MEDICARE Medicare |
$100.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$135.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$138.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$135.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$135.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$121.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$114.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$114.40
|
|
|
NITROGLYCERIN PATCH [0.1 MG/HR]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
NITROGLYCERIN PATCH [0.1 MG/HR]
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
NITROGLYCERIN SL TAB [0.4 MG]
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: AETNA Commercial |
$81.70
|
| Rate for Payer: AETNA Medicare |
$77.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$81.70
|
| Rate for Payer: BCBS Healthlink |
$77.40
|
| Rate for Payer: BCBS HMK CHIP |
$77.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$77.40
|
| Rate for Payer: BCBS POS |
$81.70
|
| Rate for Payer: BCBS Traditional |
$86.00
|
| Rate for Payer: CASH_PRICE |
$68.80
|
| Rate for Payer: CIGNA Commercial |
$81.70
|
| Rate for Payer: CIGNA Medicare |
$77.40
|
| Rate for Payer: HUMANA Commercial |
$77.40
|
| Rate for Payer: MEDICAID Medicaid |
$79.12
|
| Rate for Payer: MEDICARE Medicare |
$60.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$81.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$83.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$81.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$81.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$73.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.80
|
|
|
NITROGLYCERIN SL TAB [0.4 MG]
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: AETNA Commercial |
$81.70
|
| Rate for Payer: AETNA Medicare |
$77.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$81.70
|
| Rate for Payer: BCBS Healthlink |
$77.40
|
| Rate for Payer: BCBS HMK CHIP |
$77.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$77.40
|
| Rate for Payer: BCBS POS |
$81.70
|
| Rate for Payer: BCBS Traditional |
$86.00
|
| Rate for Payer: CASH_PRICE |
$68.80
|
| Rate for Payer: CIGNA Commercial |
$81.70
|
| Rate for Payer: CIGNA Medicare |
$77.40
|
| Rate for Payer: HUMANA Commercial |
$77.40
|
| Rate for Payer: MEDICAID Medicaid |
$79.12
|
| Rate for Payer: MEDICARE Medicare |
$60.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$81.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$83.42
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$81.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$81.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$73.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.80
|
|
|
NITROPRUSSIDE INJ [25 MG/ML]
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
NITROPRUSSIDE INJ [25 MG/ML]
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: AETNA Commercial |
$79.80
|
| Rate for Payer: AETNA Medicare |
$75.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$79.80
|
| Rate for Payer: BCBS Healthlink |
$75.60
|
| Rate for Payer: BCBS HMK CHIP |
$75.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$75.60
|
| Rate for Payer: BCBS POS |
$79.80
|
| Rate for Payer: BCBS Traditional |
$84.00
|
| Rate for Payer: CASH_PRICE |
$67.20
|
| Rate for Payer: CIGNA Commercial |
$79.80
|
| Rate for Payer: CIGNA Medicare |
$75.60
|
| Rate for Payer: HUMANA Commercial |
$75.60
|
| Rate for Payer: MEDICAID Medicaid |
$77.28
|
| Rate for Payer: MEDICARE Medicare |
$58.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$79.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$81.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$79.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$79.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$71.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$67.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$67.20
|
|
|
NITRO-TRANSDERM PATCH [0.2 MG / HR]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
NITRO-TRANSDERM PATCH [0.2 MG / HR]
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
.NK CELLS, TOTAL COUNT (506049)
|
Facility
OP
|
$303.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
.NK CELLS, TOTAL COUNT (506049)
|
Facility
IP
|
$303.00
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$303.00 |
| Rate for Payer: AETNA Commercial |
$287.85
|
| Rate for Payer: AETNA Medicare |
$272.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$287.85
|
| Rate for Payer: BCBS Healthlink |
$272.70
|
| Rate for Payer: BCBS HMK CHIP |
$272.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$272.70
|
| Rate for Payer: BCBS POS |
$287.85
|
| Rate for Payer: BCBS Traditional |
$303.00
|
| Rate for Payer: CASH_PRICE |
$242.40
|
| Rate for Payer: CIGNA Commercial |
$287.85
|
| Rate for Payer: CIGNA Medicare |
$272.70
|
| Rate for Payer: HUMANA Commercial |
$272.70
|
| Rate for Payer: MEDICAID Medicaid |
$278.76
|
| Rate for Payer: MEDICARE Medicare |
$212.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$287.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$293.91
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$287.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$287.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$257.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$242.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$242.40
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 11-20
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 21-30
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
