|
OCCULT BLOOD, GASTRIC
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
OCCULT BLOOD, GASTRIC
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: AETNA Commercial |
$51.30
|
| Rate for Payer: AETNA Medicare |
$48.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$51.30
|
| Rate for Payer: BCBS Healthlink |
$48.60
|
| Rate for Payer: BCBS HMK CHIP |
$48.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$48.60
|
| Rate for Payer: BCBS POS |
$51.30
|
| Rate for Payer: BCBS Traditional |
$54.00
|
| Rate for Payer: CASH_PRICE |
$43.20
|
| Rate for Payer: CIGNA Commercial |
$51.30
|
| Rate for Payer: CIGNA Medicare |
$48.60
|
| Rate for Payer: HUMANA Commercial |
$48.60
|
| Rate for Payer: MEDICAID Medicaid |
$49.68
|
| Rate for Payer: MEDICARE Medicare |
$37.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$51.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$52.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$51.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$51.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$43.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$43.20
|
|
|
OFLOXACIN 0.3% OPH DRP [5 ML]
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
OFLOXACIN 0.3% OPH DRP [5 ML]
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: AETNA Commercial |
$77.90
|
| Rate for Payer: AETNA Medicare |
$73.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$77.90
|
| Rate for Payer: BCBS Healthlink |
$73.80
|
| Rate for Payer: BCBS HMK CHIP |
$73.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$73.80
|
| Rate for Payer: BCBS POS |
$77.90
|
| Rate for Payer: BCBS Traditional |
$82.00
|
| Rate for Payer: CASH_PRICE |
$65.60
|
| Rate for Payer: CIGNA Commercial |
$77.90
|
| Rate for Payer: CIGNA Medicare |
$73.80
|
| Rate for Payer: HUMANA Commercial |
$73.80
|
| Rate for Payer: MEDICAID Medicaid |
$75.44
|
| Rate for Payer: MEDICARE Medicare |
$57.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$77.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$79.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$77.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$77.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$69.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$65.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$65.60
|
|
|
OLANZAPINE INJ [10 MG]
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
OLANZAPINE INJ [10 MG]
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
OLANZAPINE TAB [2.5 MG] - NONFORMULARY
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
OLANZAPINE TAB [2.5 MG] - NONFORMULARY
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
OMEPRAZOLE DR CAP [20 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
|
|
|
OMEPRAZOLE DR CAP [20 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
|
|
|
OMNIPAQUE 300mg/ml (PAIN INJ)
|
Facility
IP
|
$177.60
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
20221110
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: AETNA Commercial |
$168.72
|
| Rate for Payer: AETNA Medicare |
$159.84
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$168.72
|
| Rate for Payer: BCBS Healthlink |
$159.84
|
| Rate for Payer: BCBS HMK CHIP |
$159.84
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$159.84
|
| Rate for Payer: BCBS POS |
$168.72
|
| Rate for Payer: BCBS Traditional |
$177.60
|
| Rate for Payer: CASH_PRICE |
$142.08
|
| Rate for Payer: CIGNA Commercial |
$168.72
|
| Rate for Payer: CIGNA Medicare |
$159.84
|
| Rate for Payer: HUMANA Commercial |
$159.84
|
| Rate for Payer: MEDICAID Medicaid |
$163.39
|
| Rate for Payer: MEDICARE Medicare |
$124.32
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$168.72
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$172.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$168.72
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$168.72
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$150.96
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$142.08
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$142.08
|
|
|
OMNIPAQUE 300mg/ml (PAIN INJ)
|
Facility
OP
|
$177.60
|
|
|
Service Code
|
CPT Q9967
|
| Hospital Charge Code |
20221110
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$124.32 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$150.96
|
| Rate for Payer: AETNA Commercial |
$168.72
|
| Rate for Payer: AETNA Medicare |
$159.84
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$168.72
|
| Rate for Payer: BCBS Healthlink |
$159.84
|
| Rate for Payer: BCBS HMK CHIP |
$159.84
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$159.84
|
| Rate for Payer: BCBS POS |
$168.72
|
| Rate for Payer: BCBS Traditional |
$177.60
|
| Rate for Payer: CASH_PRICE |
$142.08
|
| Rate for Payer: CIGNA Commercial |
$168.72
|
| Rate for Payer: CIGNA Medicare |
$159.84
|
| Rate for Payer: HUMANA Commercial |
$159.84
|
| Rate for Payer: MEDICAID Medicaid |
$163.39
|
| Rate for Payer: MEDICARE Medicare |
$124.32
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$168.72
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$172.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$168.72
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$168.72
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$142.08
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$142.08
|
|
|
ONDANSETRON INJ [2 MG/ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
ONDANSETRON INJ [2 MG/ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
ONDANSETRON ODT TAB [4 MG]
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT Q0162
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$66.30
|
| Rate for Payer: AETNA Commercial |
$74.10
|
| Rate for Payer: AETNA Medicare |
$70.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$74.10
|
| Rate for Payer: BCBS Healthlink |
$70.20
|
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$70.20
|
| Rate for Payer: BCBS POS |
$74.10
|
| Rate for Payer: BCBS Traditional |
$78.00
|
| Rate for Payer: CASH_PRICE |
$62.40
|
| Rate for Payer: CIGNA Commercial |
$74.10
|
| Rate for Payer: CIGNA Medicare |
$70.20
|
| Rate for Payer: HUMANA Commercial |
$70.20
|
| Rate for Payer: MEDICAID Medicaid |
$71.76
|
| Rate for Payer: MEDICARE Medicare |
$54.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$74.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$75.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$74.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$74.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$62.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$62.40
|
|
|
ONDANSETRON ODT TAB [4 MG]
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT Q0162
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: AETNA Commercial |
$74.10
|
| Rate for Payer: AETNA Medicare |
$70.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$74.10
|
| Rate for Payer: BCBS Healthlink |
$70.20
|
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$70.20
|
| Rate for Payer: BCBS POS |
$74.10
|
| Rate for Payer: BCBS Traditional |
$78.00
|
| Rate for Payer: CASH_PRICE |
$62.40
|
| Rate for Payer: CIGNA Commercial |
$74.10
|
| Rate for Payer: CIGNA Medicare |
$70.20
|
| Rate for Payer: HUMANA Commercial |
$70.20
|
| Rate for Payer: MEDICAID Medicaid |
$71.76
|
| Rate for Payer: MEDICARE Medicare |
$54.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$74.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$75.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$74.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$74.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$66.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$62.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$62.40
|
|
|
.ONE ALLELE OR ALLELE GRP EA (MOLC PATH)
|
Facility
IP
|
$469.00
|
|
|
Service Code
|
CPT 81383
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: BCBS HMK CHIP |
$422.10
|
| Rate for Payer: AETNA Commercial |
$445.55
|
| Rate for Payer: AETNA Medicare |
$422.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$445.55
|
| Rate for Payer: BCBS Healthlink |
$422.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$422.10
|
| Rate for Payer: BCBS POS |
$445.55
|
| Rate for Payer: BCBS Traditional |
$469.00
|
| Rate for Payer: CASH_PRICE |
$375.20
|
| Rate for Payer: CIGNA Commercial |
$445.55
|
| Rate for Payer: CIGNA Medicare |
$422.10
|
| Rate for Payer: HUMANA Commercial |
$422.10
|
| Rate for Payer: MEDICAID Medicaid |
$431.48
|
| Rate for Payer: MEDICARE Medicare |
$328.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$445.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$454.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$445.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$445.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$398.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$375.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$375.20
|
|
|
.ONE ALLELE OR ALLELE GRP EA (MOLC PATH)
|
Facility
OP
|
$469.00
|
|
|
Service Code
|
CPT 81383
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: AETNA Commercial |
$445.55
|
| Rate for Payer: AETNA Medicare |
$422.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$445.55
|
| Rate for Payer: BCBS Healthlink |
$422.10
|
| Rate for Payer: BCBS HMK CHIP |
$422.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$422.10
|
| Rate for Payer: BCBS POS |
$445.55
|
| Rate for Payer: BCBS Traditional |
$469.00
|
| Rate for Payer: CASH_PRICE |
$375.20
|
| Rate for Payer: CIGNA Commercial |
$445.55
|
| Rate for Payer: CIGNA Medicare |
$422.10
|
| Rate for Payer: HUMANA Commercial |
$422.10
|
| Rate for Payer: MEDICAID Medicaid |
$431.48
|
| Rate for Payer: MEDICARE Medicare |
$328.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$445.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$454.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$445.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$445.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$398.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$375.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$375.20
|
|
|
.ONE ANTIGEN EQUIVALENT EACH (MOLC PATH)
|
Facility
OP
|
$469.00
|
|
|
Service Code
|
CPT 81377
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: AETNA Commercial |
$445.55
|
| Rate for Payer: AETNA Medicare |
$422.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$445.55
|
| Rate for Payer: BCBS Healthlink |
$422.10
|
| Rate for Payer: BCBS HMK CHIP |
$422.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$422.10
|
| Rate for Payer: BCBS POS |
$445.55
|
| Rate for Payer: BCBS Traditional |
$469.00
|
| Rate for Payer: CASH_PRICE |
$375.20
|
| Rate for Payer: CIGNA Commercial |
$445.55
|
| Rate for Payer: CIGNA Medicare |
$422.10
|
| Rate for Payer: HUMANA Commercial |
$422.10
|
| Rate for Payer: MEDICAID Medicaid |
$431.48
|
| Rate for Payer: MEDICARE Medicare |
$328.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$445.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$454.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$445.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$445.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$398.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$375.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$375.20
|
|
|
.ONE ANTIGEN EQUIVALENT EACH (MOLC PATH)
|
Facility
IP
|
$469.00
|
|
|
Service Code
|
CPT 81377
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: AETNA Commercial |
$445.55
|
| Rate for Payer: AETNA Medicare |
$422.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$445.55
|
| Rate for Payer: BCBS Healthlink |
$422.10
|
| Rate for Payer: BCBS HMK CHIP |
$422.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$422.10
|
| Rate for Payer: BCBS POS |
$445.55
|
| Rate for Payer: BCBS Traditional |
$469.00
|
| Rate for Payer: CASH_PRICE |
$375.20
|
| Rate for Payer: CIGNA Commercial |
$445.55
|
| Rate for Payer: CIGNA Medicare |
$422.10
|
| Rate for Payer: HUMANA Commercial |
$422.10
|
| Rate for Payer: MEDICAID Medicaid |
$431.48
|
| Rate for Payer: MEDICARE Medicare |
$328.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$445.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$454.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$445.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$445.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$398.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$375.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$375.20
|
|
|
OP IJ INTERCOSTAL NRVE BLK EA ADD 64421
|
Facility
IP
|
$2,129.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$1,490.30 |
| Max. Negotiated Rate |
$2,129.00 |
| Rate for Payer: AETNA Commercial |
$2,022.55
|
| Rate for Payer: AETNA Medicare |
$1,916.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,022.55
|
| Rate for Payer: BCBS Healthlink |
$1,916.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,916.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,916.10
|
| Rate for Payer: BCBS POS |
$2,022.55
|
| Rate for Payer: BCBS Traditional |
$2,129.00
|
| Rate for Payer: CASH_PRICE |
$1,703.20
|
| Rate for Payer: CIGNA Commercial |
$2,022.55
|
| Rate for Payer: CIGNA Medicare |
$1,916.10
|
| Rate for Payer: HUMANA Commercial |
$1,916.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,958.68
|
| Rate for Payer: MEDICARE Medicare |
$1,490.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,022.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,065.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,022.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,022.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,809.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,703.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,703.20
|
|
|
OP IJ INTERCOSTAL NRVE BLK EA ADD 64421
|
Facility
OP
|
$2,129.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$1,490.30 |
| Max. Negotiated Rate |
$2,129.00 |
| Rate for Payer: AETNA Commercial |
$2,022.55
|
| Rate for Payer: AETNA Medicare |
$1,916.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,022.55
|
| Rate for Payer: BCBS Healthlink |
$1,916.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,916.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,916.10
|
| Rate for Payer: BCBS POS |
$2,022.55
|
| Rate for Payer: BCBS Traditional |
$2,129.00
|
| Rate for Payer: CASH_PRICE |
$1,703.20
|
| Rate for Payer: CIGNA Commercial |
$2,022.55
|
| Rate for Payer: CIGNA Medicare |
$1,916.10
|
| Rate for Payer: HUMANA Commercial |
$1,916.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,958.68
|
| Rate for Payer: MEDICARE Medicare |
$1,490.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,022.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,065.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,022.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,022.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,809.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,703.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,703.20
|
|
|
OP IJ PERIPH NV BLOCK/LESSER OCC 64450
|
Facility
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$975.10 |
| Max. Negotiated Rate |
$1,393.00 |
| Rate for Payer: AETNA Commercial |
$1,323.35
|
| Rate for Payer: AETNA Medicare |
$1,253.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,323.35
|
| Rate for Payer: BCBS Healthlink |
$1,253.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,253.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,253.70
|
| Rate for Payer: BCBS POS |
$1,323.35
|
| Rate for Payer: BCBS Traditional |
$1,393.00
|
| Rate for Payer: CASH_PRICE |
$1,114.40
|
| Rate for Payer: CIGNA Commercial |
$1,323.35
|
| Rate for Payer: CIGNA Medicare |
$1,253.70
|
| Rate for Payer: HUMANA Commercial |
$1,253.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,281.56
|
| Rate for Payer: MEDICARE Medicare |
$975.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,323.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,351.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,323.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,323.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,184.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,114.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,114.40
|
|
|
OP IJ PERIPH NV BLOCK/LESSER OCC 64450
|
Facility
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$975.10 |
| Max. Negotiated Rate |
$1,393.00 |
| Rate for Payer: AETNA Commercial |
$1,323.35
|
| Rate for Payer: AETNA Medicare |
$1,253.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,323.35
|
| Rate for Payer: BCBS Healthlink |
$1,253.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,253.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,253.70
|
| Rate for Payer: BCBS POS |
$1,323.35
|
| Rate for Payer: BCBS Traditional |
$1,393.00
|
| Rate for Payer: CASH_PRICE |
$1,114.40
|
| Rate for Payer: CIGNA Commercial |
$1,323.35
|
| Rate for Payer: CIGNA Medicare |
$1,253.70
|
| Rate for Payer: HUMANA Commercial |
$1,253.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,281.56
|
| Rate for Payer: MEDICARE Medicare |
$975.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,323.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,351.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,323.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,323.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,184.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,114.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,114.40
|
|
|
OP IJ RFA RFA PERPH NV/SUPSCAP 64640
|
Facility
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,085.00 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: AETNA Commercial |
$1,472.50
|
| Rate for Payer: AETNA Medicare |
$1,395.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,472.50
|
| Rate for Payer: BCBS Healthlink |
$1,395.00
|
| Rate for Payer: BCBS HMK CHIP |
$1,395.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,395.00
|
| Rate for Payer: BCBS POS |
$1,472.50
|
| Rate for Payer: BCBS Traditional |
$1,550.00
|
| Rate for Payer: CASH_PRICE |
$1,240.00
|
| Rate for Payer: CIGNA Commercial |
$1,472.50
|
| Rate for Payer: CIGNA Medicare |
$1,395.00
|
| Rate for Payer: HUMANA Commercial |
$1,395.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,426.00
|
| Rate for Payer: MEDICARE Medicare |
$1,085.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,472.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,503.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,472.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,472.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,317.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,240.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,240.00
|
|
