|
PREDNISONE TAB [10 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J7512
|
| 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
|
|
|
PREDNISONE TAB [10 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J7512
|
| 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
|
|
|
PREDNISONE TAB [20 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J7512
|
| 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
|
|
|
PREDNISONE TAB [20 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J7512
|
| 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
|
|
|
PREGABALIN 100 MG CAP-NF
|
Facility
IP
|
$8.00
|
|
| Hospital Charge Code |
20230124
|
|
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
|
|
|
PREGABALIN 100 MG CAP-NF
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
20230124
|
|
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
|
|
|
PREGABALIN 25 MG CAP -NF
|
Facility
IP
|
$8.00
|
|
| Hospital Charge Code |
20230731
|
|
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
|
|
|
PREGABALIN 25 MG CAP -NF
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
20230731
|
|
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
|
|
|
PREGABALIN CAP [75 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
|
|
|
PREGABALIN CAP [75 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
|
|
|
PREGNANCY TEST - RVMC
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
PREGNANCY TEST - RVMC
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
PREGNANCY TEST - TWIN BRIDGES
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
PREGNANCY TEST - TWIN BRIDGES
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
PREGNENOLONE (140707)
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: AETNA Commercial |
$170.05
|
| Rate for Payer: AETNA Medicare |
$161.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$170.05
|
| Rate for Payer: BCBS Healthlink |
$161.10
|
| Rate for Payer: BCBS HMK CHIP |
$161.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$161.10
|
| Rate for Payer: BCBS POS |
$170.05
|
| Rate for Payer: BCBS Traditional |
$179.00
|
| Rate for Payer: CASH_PRICE |
$143.20
|
| Rate for Payer: CIGNA Commercial |
$170.05
|
| Rate for Payer: CIGNA Medicare |
$161.10
|
| Rate for Payer: HUMANA Commercial |
$161.10
|
| Rate for Payer: MEDICAID Medicaid |
$164.68
|
| Rate for Payer: MEDICARE Medicare |
$125.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$170.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$173.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$170.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$170.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$152.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$143.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$143.20
|
|
|
PREGNENOLONE (140707)
|
Facility
IP
|
$179.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: BCBS HMK CHIP |
$161.10
|
| Rate for Payer: AETNA Commercial |
$170.05
|
| Rate for Payer: AETNA Medicare |
$161.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$170.05
|
| Rate for Payer: BCBS Healthlink |
$161.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$161.10
|
| Rate for Payer: BCBS POS |
$170.05
|
| Rate for Payer: BCBS Traditional |
$179.00
|
| Rate for Payer: CASH_PRICE |
$143.20
|
| Rate for Payer: CIGNA Commercial |
$170.05
|
| Rate for Payer: CIGNA Medicare |
$161.10
|
| Rate for Payer: HUMANA Commercial |
$161.10
|
| Rate for Payer: MEDICAID Medicaid |
$164.68
|
| Rate for Payer: MEDICARE Medicare |
$125.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$170.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$173.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$170.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$170.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$152.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$143.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$143.20
|
|
|
PRESCRIPTION/ORAL GI COCKTAIL
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT J8999
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
PRESCRIPTION/ORAL GI COCKTAIL
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT J8999
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
PREVENTATIVE COUNSELING 45 MINUTES
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT 99403
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
PREVENTATIVE COUNSELING 45 MINUTES
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
CPT 99403
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
PRIMIDONE TAB [50 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
|
|
|
PRIMIDONE TAB [50 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
|
|
|
PRIVATE ROOM
|
Facility
IP
|
$1,638.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: AETNA Commercial |
$1,556.10
|
| Rate for Payer: AETNA Medicare |
$1,474.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,556.10
|
| Rate for Payer: BCBS Healthlink |
$1,474.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,474.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,474.20
|
| Rate for Payer: BCBS POS |
$1,556.10
|
| Rate for Payer: BCBS Traditional |
$1,638.00
|
| Rate for Payer: CASH_PRICE |
$1,310.40
|
| Rate for Payer: CIGNA Commercial |
$1,556.10
|
| Rate for Payer: CIGNA Medicare |
$1,474.20
|
| Rate for Payer: HUMANA Commercial |
$1,474.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,506.96
|
| Rate for Payer: MEDICARE Medicare |
$1,146.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,556.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,588.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,556.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,556.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,392.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,310.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,310.40
|
|
|
PRIVATE ROOM
|
Facility
OP
|
$1,638.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: AETNA Commercial |
$1,556.10
|
| Rate for Payer: AETNA Medicare |
$1,474.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,556.10
|
| Rate for Payer: BCBS Healthlink |
$1,474.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,474.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,474.20
|
| Rate for Payer: BCBS POS |
$1,556.10
|
| Rate for Payer: BCBS Traditional |
$1,638.00
|
| Rate for Payer: CASH_PRICE |
$1,310.40
|
| Rate for Payer: CIGNA Commercial |
$1,556.10
|
| Rate for Payer: CIGNA Medicare |
$1,474.20
|
| Rate for Payer: HUMANA Commercial |
$1,474.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,506.96
|
| Rate for Payer: MEDICARE Medicare |
$1,146.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,556.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,588.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,556.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,556.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,392.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,310.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,310.40
|
|
|
PRIVATE ROOM ISOLATION
|
Facility
OP
|
$1,769.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,238.30 |
| Max. Negotiated Rate |
$1,769.00 |
| Rate for Payer: AETNA Commercial |
$1,680.55
|
| Rate for Payer: AETNA Medicare |
$1,592.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,680.55
|
| Rate for Payer: BCBS Healthlink |
$1,592.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,592.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,592.10
|
| Rate for Payer: BCBS POS |
$1,680.55
|
| Rate for Payer: BCBS Traditional |
$1,769.00
|
| Rate for Payer: CASH_PRICE |
$1,415.20
|
| Rate for Payer: CIGNA Commercial |
$1,680.55
|
| Rate for Payer: CIGNA Medicare |
$1,592.10
|
| Rate for Payer: HUMANA Commercial |
$1,592.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,627.48
|
| Rate for Payer: MEDICARE Medicare |
$1,238.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,715.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,680.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,503.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,415.20
|
|
