|
QUETIAPINE TAB [25 MG]
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
RACEPINEPHRINE NEB SLN [2.25%]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 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
|
|
|
RACEPINEPHRINE NEB SLN [2.25%]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 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
|
|
|
RALOXIFENE HCL TAB [60 MG] NON FORMULARY
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
RALOXIFENE HCL TAB [60 MG] NON FORMULARY
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AETNA Commercial |
$22.80
|
| Rate for Payer: AETNA Medicare |
$21.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$22.80
|
| Rate for Payer: BCBS Healthlink |
$21.60
|
| Rate for Payer: BCBS HMK CHIP |
$21.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$21.60
|
| Rate for Payer: BCBS POS |
$22.80
|
| Rate for Payer: BCBS Traditional |
$24.00
|
| Rate for Payer: CASH_PRICE |
$19.20
|
| Rate for Payer: CIGNA Commercial |
$22.80
|
| Rate for Payer: CIGNA Medicare |
$21.60
|
| Rate for Payer: HUMANA Commercial |
$21.60
|
| Rate for Payer: MEDICAID Medicaid |
$22.08
|
| Rate for Payer: MEDICARE Medicare |
$16.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$22.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$23.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$22.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$22.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$20.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$19.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$19.20
|
|
|
RAPID INFLUENZA TEST - RVMC
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
RAPID INFLUENZA TEST - RVMC
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
RAPID INFLUENZA TEST - TWIN BRIDGES
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
RAPID INFLUENZA TEST - TWIN BRIDGES
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: AETNA Commercial |
$151.05
|
| Rate for Payer: AETNA Medicare |
$143.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$151.05
|
| Rate for Payer: BCBS Healthlink |
$143.10
|
| Rate for Payer: BCBS HMK CHIP |
$143.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$143.10
|
| Rate for Payer: BCBS POS |
$151.05
|
| Rate for Payer: BCBS Traditional |
$159.00
|
| Rate for Payer: CASH_PRICE |
$127.20
|
| Rate for Payer: CIGNA Commercial |
$151.05
|
| Rate for Payer: CIGNA Medicare |
$143.10
|
| Rate for Payer: HUMANA Commercial |
$143.10
|
| Rate for Payer: MEDICAID Medicaid |
$146.28
|
| Rate for Payer: MEDICARE Medicare |
$111.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$151.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$154.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$151.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$151.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$135.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$127.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$127.20
|
|
|
RAPID STREP TEST - RVMC
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: AETNA Commercial |
$43.70
|
| Rate for Payer: AETNA Medicare |
$41.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$43.70
|
| Rate for Payer: BCBS Healthlink |
$41.40
|
| Rate for Payer: BCBS HMK CHIP |
$41.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$41.40
|
| Rate for Payer: BCBS POS |
$43.70
|
| Rate for Payer: BCBS Traditional |
$46.00
|
| Rate for Payer: CASH_PRICE |
$36.80
|
| Rate for Payer: CIGNA Commercial |
$43.70
|
| Rate for Payer: CIGNA Medicare |
$41.40
|
| Rate for Payer: HUMANA Commercial |
$41.40
|
| Rate for Payer: MEDICAID Medicaid |
$42.32
|
| Rate for Payer: MEDICARE Medicare |
$32.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$43.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$44.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$43.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$43.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.80
|
|
|
RAPID STREP TEST - RVMC
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: AETNA Commercial |
$43.70
|
| Rate for Payer: AETNA Medicare |
$41.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$43.70
|
| Rate for Payer: BCBS Healthlink |
$41.40
|
| Rate for Payer: BCBS HMK CHIP |
$41.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$41.40
|
| Rate for Payer: BCBS POS |
$43.70
|
| Rate for Payer: BCBS Traditional |
$46.00
|
| Rate for Payer: CASH_PRICE |
$36.80
|
| Rate for Payer: CIGNA Commercial |
$43.70
|
| Rate for Payer: CIGNA Medicare |
$41.40
|
| Rate for Payer: HUMANA Commercial |
$41.40
|
| Rate for Payer: MEDICAID Medicaid |
$42.32
|
| Rate for Payer: MEDICARE Medicare |
$32.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$43.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$44.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$43.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$43.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.80
|
|
|
RAPID STREP TEST - TWIN BRIDGES
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: AETNA Commercial |
$43.70
|
| Rate for Payer: AETNA Medicare |
$41.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$43.70
|
| Rate for Payer: BCBS Healthlink |
$41.40
|
| Rate for Payer: BCBS HMK CHIP |
$41.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$41.40
|
| Rate for Payer: BCBS POS |
$43.70
|
| Rate for Payer: BCBS Traditional |
$46.00
|
| Rate for Payer: CASH_PRICE |
$36.80
|
| Rate for Payer: CIGNA Commercial |
$43.70
|
| Rate for Payer: CIGNA Medicare |
$41.40
|
| Rate for Payer: HUMANA Commercial |
$41.40
|
| Rate for Payer: MEDICAID Medicaid |
$42.32
|
| Rate for Payer: MEDICARE Medicare |
$32.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$43.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$44.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$43.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$43.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.80
|
|
|
RAPID STREP TEST - TWIN BRIDGES
|
Facility
IP
|
$46.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: AETNA Commercial |
$43.70
|
| Rate for Payer: AETNA Medicare |
$41.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$43.70
|
| Rate for Payer: BCBS Healthlink |
$41.40
|
| Rate for Payer: BCBS HMK CHIP |
$41.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$41.40
|
| Rate for Payer: BCBS POS |
$43.70
|
| Rate for Payer: BCBS Traditional |
$46.00
|
| Rate for Payer: CASH_PRICE |
$36.80
|
| Rate for Payer: CIGNA Commercial |
$43.70
|
| Rate for Payer: CIGNA Medicare |
$41.40
|
| Rate for Payer: HUMANA Commercial |
$41.40
|
| Rate for Payer: MEDICAID Medicaid |
$42.32
|
| Rate for Payer: MEDICARE Medicare |
$32.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$43.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$44.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$43.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$43.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$39.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.80
|
|
|
RED BLOOD CELL COUNT, BLOOD
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
RED BLOOD CELL COUNT, BLOOD
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
REMDESIVIR INJ [100 MG]
|
Facility
OP
|
$918.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: AETNA Commercial |
$872.10
|
| Rate for Payer: AETNA Medicare |
$826.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$872.10
|
| Rate for Payer: BCBS Healthlink |
$826.20
|
| Rate for Payer: BCBS HMK CHIP |
$826.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$826.20
|
| Rate for Payer: BCBS POS |
$872.10
|
| Rate for Payer: BCBS Traditional |
$918.00
|
| Rate for Payer: CASH_PRICE |
$734.40
|
| Rate for Payer: CIGNA Commercial |
$872.10
|
| Rate for Payer: CIGNA Medicare |
$826.20
|
| Rate for Payer: HUMANA Commercial |
$826.20
|
| Rate for Payer: MEDICAID Medicaid |
$844.56
|
| Rate for Payer: MEDICARE Medicare |
$642.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$872.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$890.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$872.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$872.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$780.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$734.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$734.40
|
|
|
REMDESIVIR INJ [100 MG]
|
Facility
IP
|
$918.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: AETNA Commercial |
$872.10
|
| Rate for Payer: AETNA Medicare |
$826.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$872.10
|
| Rate for Payer: BCBS Healthlink |
$826.20
|
| Rate for Payer: BCBS HMK CHIP |
$826.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$826.20
|
| Rate for Payer: BCBS POS |
$872.10
|
| Rate for Payer: BCBS Traditional |
$918.00
|
| Rate for Payer: CASH_PRICE |
$734.40
|
| Rate for Payer: CIGNA Commercial |
$872.10
|
| Rate for Payer: CIGNA Medicare |
$826.20
|
| Rate for Payer: HUMANA Commercial |
$826.20
|
| Rate for Payer: MEDICAID Medicaid |
$844.56
|
| Rate for Payer: MEDICARE Medicare |
$642.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$872.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$890.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$872.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$872.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$780.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$734.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$734.40
|
|
|
REMOTE 30 DAY ECG REV/REPORT CON, REC, R
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: AETNA Commercial |
$342.00
|
| Rate for Payer: AETNA Medicare |
$324.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$342.00
|
| Rate for Payer: BCBS Healthlink |
$324.00
|
| Rate for Payer: BCBS HMK CHIP |
$324.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$324.00
|
| Rate for Payer: BCBS POS |
$342.00
|
| Rate for Payer: BCBS Traditional |
$360.00
|
| Rate for Payer: CASH_PRICE |
$288.00
|
| Rate for Payer: CIGNA Commercial |
$342.00
|
| Rate for Payer: CIGNA Medicare |
$324.00
|
| Rate for Payer: HUMANA Commercial |
$324.00
|
| Rate for Payer: MEDICAID Medicaid |
$331.20
|
| Rate for Payer: MEDICARE Medicare |
$252.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$342.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$349.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$342.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$342.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$306.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$288.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$288.00
|
|
|
REMOTE 30 DAY ECG REV/REPORT CON, REC, R
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: AETNA Commercial |
$342.00
|
| Rate for Payer: AETNA Medicare |
$324.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$342.00
|
| Rate for Payer: BCBS Healthlink |
$324.00
|
| Rate for Payer: BCBS HMK CHIP |
$324.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$324.00
|
| Rate for Payer: BCBS POS |
$342.00
|
| Rate for Payer: BCBS Traditional |
$360.00
|
| Rate for Payer: CASH_PRICE |
$288.00
|
| Rate for Payer: CIGNA Commercial |
$342.00
|
| Rate for Payer: CIGNA Medicare |
$324.00
|
| Rate for Payer: HUMANA Commercial |
$324.00
|
| Rate for Payer: MEDICAID Medicaid |
$331.20
|
| Rate for Payer: MEDICARE Medicare |
$252.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$342.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$349.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$342.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$342.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$306.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$288.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$288.00
|
|
|
REMOVAL FB CORNEAL WITH SLIT LAMP
|
Facility
IP
|
$378.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: AETNA Commercial |
$359.10
|
| Rate for Payer: AETNA Medicare |
$340.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$359.10
|
| Rate for Payer: BCBS Healthlink |
$340.20
|
| Rate for Payer: BCBS HMK CHIP |
$340.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$340.20
|
| Rate for Payer: BCBS POS |
$359.10
|
| Rate for Payer: BCBS Traditional |
$378.00
|
| Rate for Payer: CASH_PRICE |
$302.40
|
| Rate for Payer: CIGNA Commercial |
$359.10
|
| Rate for Payer: CIGNA Medicare |
$340.20
|
| Rate for Payer: HUMANA Commercial |
$340.20
|
| Rate for Payer: MEDICAID Medicaid |
$347.76
|
| Rate for Payer: MEDICARE Medicare |
$264.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$359.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$366.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$359.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$359.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$321.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$302.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$302.40
|
|
|
REMOVAL FB CORNEAL WITH SLIT LAMP
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: AETNA Commercial |
$359.10
|
| Rate for Payer: AETNA Medicare |
$340.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$359.10
|
| Rate for Payer: BCBS Healthlink |
$340.20
|
| Rate for Payer: BCBS HMK CHIP |
$340.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$340.20
|
| Rate for Payer: BCBS POS |
$359.10
|
| Rate for Payer: BCBS Traditional |
$378.00
|
| Rate for Payer: CASH_PRICE |
$302.40
|
| Rate for Payer: CIGNA Commercial |
$359.10
|
| Rate for Payer: CIGNA Medicare |
$340.20
|
| Rate for Payer: HUMANA Commercial |
$340.20
|
| Rate for Payer: MEDICAID Medicaid |
$347.76
|
| Rate for Payer: MEDICARE Medicare |
$264.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$359.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$366.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$359.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$359.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$321.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$302.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$302.40
|
|
|
REMOVAL FB CORNEAL W/O SLIT LAMP
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
REMOVAL FB CORNEAL W/O SLIT LAMP
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: AETNA Commercial |
$321.10
|
| Rate for Payer: AETNA Medicare |
$304.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$321.10
|
| Rate for Payer: BCBS Healthlink |
$304.20
|
| Rate for Payer: BCBS HMK CHIP |
$304.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$304.20
|
| Rate for Payer: BCBS POS |
$321.10
|
| Rate for Payer: BCBS Traditional |
$338.00
|
| Rate for Payer: CASH_PRICE |
$270.40
|
| Rate for Payer: CIGNA Commercial |
$321.10
|
| Rate for Payer: CIGNA Medicare |
$304.20
|
| Rate for Payer: HUMANA Commercial |
$304.20
|
| Rate for Payer: MEDICAID Medicaid |
$310.96
|
| Rate for Payer: MEDICARE Medicare |
$236.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$321.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$327.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$321.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$321.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$287.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$270.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$270.40
|
|
|
REMOVAL FB EXTERNAL AUDITORY CANAL
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
|
REMOVAL FB EXTERNAL AUDITORY CANAL
|
Facility
IP
|
$240.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: BCBS HMK CHIP |
$216.00
|
| Rate for Payer: AETNA Commercial |
$228.00
|
| Rate for Payer: AETNA Medicare |
$216.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$228.00
|
| Rate for Payer: BCBS Healthlink |
$216.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$216.00
|
| Rate for Payer: BCBS POS |
$228.00
|
| Rate for Payer: BCBS Traditional |
$240.00
|
| Rate for Payer: CASH_PRICE |
$192.00
|
| Rate for Payer: CIGNA Commercial |
$228.00
|
| Rate for Payer: CIGNA Medicare |
$216.00
|
| Rate for Payer: HUMANA Commercial |
$216.00
|
| Rate for Payer: MEDICAID Medicaid |
$220.80
|
| Rate for Payer: MEDICARE Medicare |
$168.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$228.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$232.80
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$228.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$228.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$204.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$192.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$192.00
|
|
