|
PATELLA STRAP MED
|
Facility
OP
|
$54.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
PATELLA STRAP MED
|
Facility
IP
|
$54.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
PEAK EXPIRATORY FLOW RATE
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
CPT S8110
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
PEAK EXPIRATORY FLOW RATE
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
CPT S8110
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
PEAK FLOW METER
|
Facility
IP
|
$83.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
PEAK FLOW METER
|
Facility
OP
|
$83.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: AETNA Commercial |
$78.85
|
| Rate for Payer: AETNA Medicare |
$74.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$78.85
|
| Rate for Payer: BCBS Healthlink |
$74.70
|
| Rate for Payer: BCBS HMK CHIP |
$74.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$74.70
|
| Rate for Payer: BCBS POS |
$78.85
|
| Rate for Payer: BCBS Traditional |
$83.00
|
| Rate for Payer: CASH_PRICE |
$66.40
|
| Rate for Payer: CIGNA Commercial |
$78.85
|
| Rate for Payer: CIGNA Medicare |
$74.70
|
| Rate for Payer: HUMANA Commercial |
$74.70
|
| Rate for Payer: MEDICAID Medicaid |
$76.36
|
| Rate for Payer: MEDICARE Medicare |
$58.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$78.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$80.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$78.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$78.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$70.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$66.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$66.40
|
|
|
PEAK FLOW METER HAND HELD
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT A4614
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| 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 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
|
|
|
PEAK FLOW METER HAND HELD
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT A4614
|
| 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
|
|
|
PEGFILGRASTIM SYR [6 MG/0.6 ML] SPEC ORD
|
Facility
OP
|
$7,014.00
|
|
|
Service Code
|
CPT Q5108
|
| Hospital Charge Code |
20230714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,909.80 |
| Max. Negotiated Rate |
$7,014.00 |
| Rate for Payer: AETNA Commercial |
$6,663.30
|
| Rate for Payer: AETNA Medicare |
$6,312.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6,663.30
|
| Rate for Payer: BCBS Healthlink |
$6,312.60
|
| Rate for Payer: BCBS HMK CHIP |
$6,312.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6,312.60
|
| Rate for Payer: BCBS POS |
$6,663.30
|
| Rate for Payer: BCBS Traditional |
$7,014.00
|
| Rate for Payer: CASH_PRICE |
$5,611.20
|
| Rate for Payer: CIGNA Commercial |
$6,663.30
|
| Rate for Payer: CIGNA Medicare |
$6,312.60
|
| Rate for Payer: HUMANA Commercial |
$6,312.60
|
| Rate for Payer: MEDICAID Medicaid |
$6,452.88
|
| Rate for Payer: MEDICARE Medicare |
$4,909.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6,663.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6,803.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6,663.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6,663.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5,961.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5,611.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5,611.20
|
|
|
PEGFILGRASTIM SYR [6 MG/0.6 ML] SPEC ORD
|
Facility
IP
|
$7,014.00
|
|
|
Service Code
|
CPT Q5108
|
| Hospital Charge Code |
20230714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,909.80 |
| Max. Negotiated Rate |
$7,014.00 |
| Rate for Payer: AETNA Commercial |
$6,663.30
|
| Rate for Payer: AETNA Medicare |
$6,312.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6,663.30
|
| Rate for Payer: BCBS Healthlink |
$6,312.60
|
| Rate for Payer: BCBS HMK CHIP |
$6,312.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6,312.60
|
| Rate for Payer: BCBS POS |
$6,663.30
|
| Rate for Payer: BCBS Traditional |
$7,014.00
|
| Rate for Payer: CASH_PRICE |
$5,611.20
|
| Rate for Payer: CIGNA Commercial |
$6,663.30
|
| Rate for Payer: CIGNA Medicare |
$6,312.60
|
| Rate for Payer: HUMANA Commercial |
$6,312.60
|
| Rate for Payer: MEDICAID Medicaid |
$6,452.88
|
| Rate for Payer: MEDICARE Medicare |
$4,909.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6,663.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6,803.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6,663.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6,663.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5,961.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5,611.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5,611.20
|
|
|
PENICILLIN G BENZ INJ [1,200,000 U/2 ML]
|
Facility
OP
|
$632.00
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$442.40 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: AETNA Commercial |
$600.40
|
| Rate for Payer: AETNA Medicare |
$568.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$600.40
|
| Rate for Payer: BCBS Healthlink |
$568.80
|
| Rate for Payer: BCBS HMK CHIP |
$568.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$568.80
|
| Rate for Payer: BCBS POS |
$600.40
|
| Rate for Payer: BCBS Traditional |
$632.00
|
| Rate for Payer: CASH_PRICE |
$505.60
|
| Rate for Payer: CIGNA Commercial |
$600.40
|
| Rate for Payer: CIGNA Medicare |
$568.80
|
| Rate for Payer: HUMANA Commercial |
$568.80
|
| Rate for Payer: MEDICAID Medicaid |
$581.44
|
| Rate for Payer: MEDICARE Medicare |
$442.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$600.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$613.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$600.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$600.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$537.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$505.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$505.60
|
|
|
PENICILLIN G BENZ INJ [1,200,000 U/2 ML]
|
Facility
IP
|
$632.00
|
|
|
Service Code
|
CPT J0561
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$442.40 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: AETNA Commercial |
$600.40
|
| Rate for Payer: AETNA Medicare |
$568.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$600.40
|
| Rate for Payer: BCBS Healthlink |
$568.80
|
| Rate for Payer: BCBS HMK CHIP |
$568.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$568.80
|
| Rate for Payer: BCBS POS |
$600.40
|
| Rate for Payer: BCBS Traditional |
$632.00
|
| Rate for Payer: CASH_PRICE |
$505.60
|
| Rate for Payer: CIGNA Commercial |
$600.40
|
| Rate for Payer: CIGNA Medicare |
$568.80
|
| Rate for Payer: HUMANA Commercial |
$568.80
|
| Rate for Payer: MEDICAID Medicaid |
$581.44
|
| Rate for Payer: MEDICARE Medicare |
$442.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$600.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$613.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$600.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$600.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$537.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$505.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$505.60
|
|
|
PENICILLIN V K TAB [250 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
|
|
|
PENICILLIN V K TAB [250 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
|
|
|
PENTOXIFYLLINE ER 400MG TABLET-NF
|
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
|
|
|
PENTOXIFYLLINE ER 400MG TABLET-NF
|
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
|
|
|
PERFLUTREN LIPID MICROSPHERE
|
Facility
IP
|
$351.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: AETNA Commercial |
$333.45
|
| Rate for Payer: AETNA Medicare |
$315.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$333.45
|
| Rate for Payer: BCBS Healthlink |
$315.90
|
| Rate for Payer: BCBS HMK CHIP |
$315.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$315.90
|
| Rate for Payer: BCBS POS |
$333.45
|
| Rate for Payer: BCBS Traditional |
$351.00
|
| Rate for Payer: CASH_PRICE |
$280.80
|
| Rate for Payer: CIGNA Commercial |
$333.45
|
| Rate for Payer: CIGNA Medicare |
$315.90
|
| Rate for Payer: HUMANA Commercial |
$315.90
|
| Rate for Payer: MEDICAID Medicaid |
$322.92
|
| Rate for Payer: MEDICARE Medicare |
$245.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$333.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$340.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$333.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$333.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$298.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$280.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$280.80
|
|
|
PERFLUTREN LIPID MICROSPHERE
|
Facility
OP
|
$351.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$245.70 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: AETNA Commercial |
$333.45
|
| Rate for Payer: AETNA Medicare |
$315.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$333.45
|
| Rate for Payer: BCBS Healthlink |
$315.90
|
| Rate for Payer: BCBS HMK CHIP |
$315.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$315.90
|
| Rate for Payer: BCBS POS |
$333.45
|
| Rate for Payer: BCBS Traditional |
$351.00
|
| Rate for Payer: CASH_PRICE |
$280.80
|
| Rate for Payer: CIGNA Commercial |
$333.45
|
| Rate for Payer: CIGNA Medicare |
$315.90
|
| Rate for Payer: HUMANA Commercial |
$315.90
|
| Rate for Payer: MEDICAID Medicaid |
$322.92
|
| Rate for Payer: MEDICARE Medicare |
$245.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$333.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$340.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$333.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$333.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$298.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$280.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$280.80
|
|
|
PERIPHERAL SMEAR CONSULT (005300)
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
PERIPHERAL SMEAR CONSULT (005300)
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: AETNA Commercial |
$28.50
|
| Rate for Payer: AETNA Medicare |
$27.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$28.50
|
| Rate for Payer: BCBS Healthlink |
$27.00
|
| Rate for Payer: BCBS HMK CHIP |
$27.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$27.00
|
| Rate for Payer: BCBS POS |
$28.50
|
| Rate for Payer: BCBS Traditional |
$30.00
|
| Rate for Payer: CASH_PRICE |
$24.00
|
| Rate for Payer: CIGNA Commercial |
$28.50
|
| Rate for Payer: CIGNA Medicare |
$27.00
|
| Rate for Payer: HUMANA Commercial |
$27.00
|
| Rate for Payer: MEDICAID Medicaid |
$27.60
|
| Rate for Payer: MEDICARE Medicare |
$21.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$28.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$29.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$28.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$28.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$25.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$24.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$24.00
|
|
|
PETROLEUM GAUZE PACKING STRIPS 3X9
|
Facility
IP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
PETROLEUM GAUZE PACKING STRIPS 3X9
|
Facility
OP
|
$21.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
PFEE OP INJ TRANSFOR C/T 1S 64479
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: AETNA Commercial |
$465.50
|
| Rate for Payer: AETNA Medicare |
$441.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$465.50
|
| Rate for Payer: BCBS Healthlink |
$441.00
|
| Rate for Payer: BCBS HMK CHIP |
$441.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$441.00
|
| Rate for Payer: BCBS POS |
$465.50
|
| Rate for Payer: BCBS Traditional |
$490.00
|
| Rate for Payer: CASH_PRICE |
$392.00
|
| Rate for Payer: CIGNA Commercial |
$465.50
|
| Rate for Payer: CIGNA Medicare |
$441.00
|
| Rate for Payer: HUMANA Commercial |
$441.00
|
| Rate for Payer: MEDICAID Medicaid |
$450.80
|
| Rate for Payer: MEDICARE Medicare |
$343.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$465.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$475.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$465.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$465.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$416.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$392.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$392.00
|
|
|
PFEE OP INJ TRANSFOR C/T 1S 64479
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: AETNA Commercial |
$465.50
|
| Rate for Payer: AETNA Medicare |
$441.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$465.50
|
| Rate for Payer: BCBS Healthlink |
$441.00
|
| Rate for Payer: BCBS HMK CHIP |
$441.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$441.00
|
| Rate for Payer: BCBS POS |
$465.50
|
| Rate for Payer: BCBS Traditional |
$490.00
|
| Rate for Payer: CASH_PRICE |
$392.00
|
| Rate for Payer: CIGNA Commercial |
$465.50
|
| Rate for Payer: CIGNA Medicare |
$441.00
|
| Rate for Payer: HUMANA Commercial |
$441.00
|
| Rate for Payer: MEDICAID Medicaid |
$450.80
|
| Rate for Payer: MEDICARE Medicare |
$343.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$465.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$475.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$465.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$465.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$416.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$392.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$392.00
|
|
|
PF ER CLOSED SHOULDER DISLOC W/ANESTHESI
|
Facility
OP
|
$451.00
|
|
|
Service Code
|
CPT 23655 AQ
|
| Hospital Charge Code |
20230101
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$315.70 |
| Max. Negotiated Rate |
$451.00 |
| Rate for Payer: AETNA Commercial |
$428.45
|
| Rate for Payer: AETNA Medicare |
$405.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$428.45
|
| Rate for Payer: BCBS Healthlink |
$405.90
|
| Rate for Payer: BCBS HMK CHIP |
$405.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$405.90
|
| Rate for Payer: BCBS POS |
$428.45
|
| Rate for Payer: BCBS Traditional |
$451.00
|
| Rate for Payer: CASH_PRICE |
$360.80
|
| Rate for Payer: CIGNA Commercial |
$428.45
|
| Rate for Payer: CIGNA Medicare |
$405.90
|
| Rate for Payer: HUMANA Commercial |
$405.90
|
| Rate for Payer: MEDICAID Medicaid |
$414.92
|
| Rate for Payer: MEDICARE Medicare |
$315.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$428.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$437.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$428.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$428.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$383.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$360.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$360.80
|
|
