|
SODIUM BICARB INJ 8.4% [50 MEQ/50 ML]
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: AETNA Commercial |
$61.75
|
| Rate for Payer: AETNA Medicare |
$58.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$61.75
|
| Rate for Payer: BCBS Healthlink |
$58.50
|
| Rate for Payer: BCBS HMK CHIP |
$58.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$58.50
|
| Rate for Payer: BCBS POS |
$61.75
|
| Rate for Payer: BCBS Traditional |
$65.00
|
| Rate for Payer: CASH_PRICE |
$52.00
|
| Rate for Payer: CIGNA Commercial |
$61.75
|
| Rate for Payer: CIGNA Medicare |
$58.50
|
| Rate for Payer: HUMANA Commercial |
$58.50
|
| Rate for Payer: MEDICAID Medicaid |
$59.80
|
| Rate for Payer: MEDICARE Medicare |
$45.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$61.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$63.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$61.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$61.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$55.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.00
|
|
|
SODIUM CHLORIDE 0.9% NEB SOLN [3 ML]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT A4216
|
| 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
|
|
|
SODIUM CHLORIDE 0.9% NEB SOLN [3 ML]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT A4216
|
| 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
|
|
|
SODIUM CHLORIDE MOISTURIZING NASAL SPRAY
|
Facility
IP
|
$8.00
|
|
| Hospital Charge Code |
20230803
|
|
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
|
|
|
SODIUM CHLORIDE MOISTURIZING NASAL SPRAY
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
20230803
|
|
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
|
|
|
SODIUM NITRITE INJ [300 MG/10ml ]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
SODIUM NITRITE INJ [300 MG/10ml ]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: AETNA Commercial |
$24.70
|
| Rate for Payer: AETNA Medicare |
$23.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$24.70
|
| Rate for Payer: BCBS Healthlink |
$23.40
|
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$23.40
|
| Rate for Payer: BCBS POS |
$24.70
|
| Rate for Payer: BCBS Traditional |
$26.00
|
| Rate for Payer: CASH_PRICE |
$20.80
|
| Rate for Payer: CIGNA Commercial |
$24.70
|
| Rate for Payer: CIGNA Medicare |
$23.40
|
| Rate for Payer: HUMANA Commercial |
$23.40
|
| Rate for Payer: MEDICAID Medicaid |
$23.92
|
| Rate for Payer: MEDICARE Medicare |
$18.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$24.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$25.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$24.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$24.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$22.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.80
|
|
|
SODIUM PHOSPHATE ENEMA [1 OZ]
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: AETNA Commercial |
$14.25
|
| Rate for Payer: AETNA Medicare |
$13.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14.25
|
| Rate for Payer: BCBS Healthlink |
$13.50
|
| Rate for Payer: BCBS HMK CHIP |
$13.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.50
|
| Rate for Payer: BCBS POS |
$14.25
|
| Rate for Payer: BCBS Traditional |
$15.00
|
| Rate for Payer: CASH_PRICE |
$12.00
|
| Rate for Payer: CIGNA Commercial |
$14.25
|
| Rate for Payer: CIGNA Medicare |
$13.50
|
| Rate for Payer: HUMANA Commercial |
$13.50
|
| Rate for Payer: MEDICAID Medicaid |
$13.80
|
| Rate for Payer: MEDICARE Medicare |
$10.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.00
|
|
|
SODIUM PHOSPHATE ENEMA [1 OZ]
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: AETNA Commercial |
$14.25
|
| Rate for Payer: AETNA Medicare |
$13.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14.25
|
| Rate for Payer: BCBS Healthlink |
$13.50
|
| Rate for Payer: BCBS HMK CHIP |
$13.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.50
|
| Rate for Payer: BCBS POS |
$14.25
|
| Rate for Payer: BCBS Traditional |
$15.00
|
| Rate for Payer: CASH_PRICE |
$12.00
|
| Rate for Payer: CIGNA Commercial |
$14.25
|
| Rate for Payer: CIGNA Medicare |
$13.50
|
| Rate for Payer: HUMANA Commercial |
$13.50
|
| Rate for Payer: MEDICAID Medicaid |
$13.80
|
| Rate for Payer: MEDICARE Medicare |
$10.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.00
|
|
|
SODIUM POLYSTYRENE SULFONATE
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
SODIUM POLYSTYRENE SULFONATE
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: AETNA Commercial |
$42.75
|
| Rate for Payer: AETNA Medicare |
$40.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$42.75
|
| Rate for Payer: BCBS Healthlink |
$40.50
|
| Rate for Payer: BCBS HMK CHIP |
$40.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$40.50
|
| Rate for Payer: BCBS POS |
$42.75
|
| Rate for Payer: BCBS Traditional |
$45.00
|
| Rate for Payer: CASH_PRICE |
$36.00
|
| Rate for Payer: CIGNA Commercial |
$42.75
|
| Rate for Payer: CIGNA Medicare |
$40.50
|
| Rate for Payer: HUMANA Commercial |
$40.50
|
| Rate for Payer: MEDICAID Medicaid |
$41.40
|
| Rate for Payer: MEDICARE Medicare |
$31.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$42.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$43.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$42.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$42.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$38.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$36.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$36.00
|
|
|
SODIUM, RANDOM URINE (013326)
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
SODIUM, RANDOM URINE (013326)
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
SOLIFENACIN 5MG TABLET - NONFORMULARY
|
Facility
OP
|
$41.95
|
|
| Hospital Charge Code |
20230213
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.36 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: AETNA Commercial |
$39.85
|
| Rate for Payer: AETNA Medicare |
$37.76
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.85
|
| Rate for Payer: BCBS Healthlink |
$37.76
|
| Rate for Payer: BCBS HMK CHIP |
$37.76
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.76
|
| Rate for Payer: BCBS POS |
$39.85
|
| Rate for Payer: BCBS Traditional |
$41.95
|
| Rate for Payer: CASH_PRICE |
$33.56
|
| Rate for Payer: CIGNA Commercial |
$39.85
|
| Rate for Payer: CIGNA Medicare |
$37.76
|
| Rate for Payer: HUMANA Commercial |
$37.76
|
| Rate for Payer: MEDICAID Medicaid |
$38.59
|
| Rate for Payer: MEDICARE Medicare |
$29.36
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.66
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.56
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.56
|
|
|
SOLIFENACIN 5MG TABLET - NONFORMULARY
|
Facility
IP
|
$41.95
|
|
| Hospital Charge Code |
20230213
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.36 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: AETNA Commercial |
$39.85
|
| Rate for Payer: AETNA Medicare |
$37.76
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.85
|
| Rate for Payer: BCBS Healthlink |
$37.76
|
| Rate for Payer: BCBS HMK CHIP |
$37.76
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.76
|
| Rate for Payer: BCBS POS |
$39.85
|
| Rate for Payer: BCBS Traditional |
$41.95
|
| Rate for Payer: CASH_PRICE |
$33.56
|
| Rate for Payer: CIGNA Commercial |
$39.85
|
| Rate for Payer: CIGNA Medicare |
$37.76
|
| Rate for Payer: HUMANA Commercial |
$37.76
|
| Rate for Payer: MEDICAID Medicaid |
$38.59
|
| Rate for Payer: MEDICARE Medicare |
$29.36
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.66
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.56
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.56
|
|
|
SOTALOL TAB [80 MG]
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
SOTALOL TAB [80 MG]
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Facility
OP
|
$299.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: AETNA Commercial |
$284.05
|
| Rate for Payer: AETNA Medicare |
$269.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$284.05
|
| Rate for Payer: BCBS Healthlink |
$269.10
|
| Rate for Payer: BCBS HMK CHIP |
$269.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$269.10
|
| Rate for Payer: BCBS POS |
$284.05
|
| Rate for Payer: BCBS Traditional |
$299.00
|
| Rate for Payer: CASH_PRICE |
$239.20
|
| Rate for Payer: CIGNA Commercial |
$284.05
|
| Rate for Payer: CIGNA Medicare |
$269.10
|
| Rate for Payer: HUMANA Commercial |
$269.10
|
| Rate for Payer: MEDICAID Medicaid |
$275.08
|
| Rate for Payer: MEDICARE Medicare |
$209.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$284.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$290.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$284.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$284.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$254.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$239.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$239.20
|
|
|
SPECIAL STAIN GROUP 1 MICROORGANISMS I&R
|
Facility
IP
|
$299.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: AETNA Commercial |
$284.05
|
| Rate for Payer: AETNA Medicare |
$269.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$284.05
|
| Rate for Payer: BCBS Healthlink |
$269.10
|
| Rate for Payer: BCBS HMK CHIP |
$269.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$269.10
|
| Rate for Payer: BCBS POS |
$284.05
|
| Rate for Payer: BCBS Traditional |
$299.00
|
| Rate for Payer: CASH_PRICE |
$239.20
|
| Rate for Payer: CIGNA Commercial |
$284.05
|
| Rate for Payer: CIGNA Medicare |
$269.10
|
| Rate for Payer: HUMANA Commercial |
$269.10
|
| Rate for Payer: MEDICAID Medicaid |
$275.08
|
| Rate for Payer: MEDICARE Medicare |
$209.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$284.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$290.03
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$284.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$284.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$254.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$239.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$239.20
|
|
|
SPECIMEN HANDLING CHARGE
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
SPECIMEN HANDLING CHARGE
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: AETNA Commercial |
$23.75
|
| Rate for Payer: AETNA Medicare |
$22.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$23.75
|
| Rate for Payer: BCBS Healthlink |
$22.50
|
| Rate for Payer: BCBS HMK CHIP |
$22.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$22.50
|
| Rate for Payer: BCBS POS |
$23.75
|
| Rate for Payer: BCBS Traditional |
$25.00
|
| Rate for Payer: CASH_PRICE |
$20.00
|
| Rate for Payer: CIGNA Commercial |
$23.75
|
| Rate for Payer: CIGNA Medicare |
$22.50
|
| Rate for Payer: HUMANA Commercial |
$22.50
|
| Rate for Payer: MEDICAID Medicaid |
$23.00
|
| Rate for Payer: MEDICARE Medicare |
$17.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$23.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$24.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$23.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$23.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$21.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$20.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$20.00
|
|
|
SPICA THUMB SPLINT
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: AETNA Commercial |
$160.55
|
| Rate for Payer: AETNA Medicare |
$152.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$160.55
|
| Rate for Payer: BCBS Healthlink |
$152.10
|
| Rate for Payer: BCBS HMK CHIP |
$152.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$152.10
|
| Rate for Payer: BCBS POS |
$160.55
|
| Rate for Payer: BCBS Traditional |
$169.00
|
| Rate for Payer: CASH_PRICE |
$135.20
|
| Rate for Payer: CIGNA Commercial |
$160.55
|
| Rate for Payer: CIGNA Medicare |
$152.10
|
| Rate for Payer: HUMANA Commercial |
$152.10
|
| Rate for Payer: MEDICAID Medicaid |
$155.48
|
| Rate for Payer: MEDICARE Medicare |
$118.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$160.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$163.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$160.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$160.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$143.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$135.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$135.20
|
|
|
SPICA THUMB SPLINT
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$143.65
|
| Rate for Payer: AETNA Commercial |
$160.55
|
| Rate for Payer: AETNA Medicare |
$152.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$160.55
|
| Rate for Payer: BCBS Healthlink |
$152.10
|
| Rate for Payer: BCBS HMK CHIP |
$152.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$152.10
|
| Rate for Payer: BCBS POS |
$160.55
|
| Rate for Payer: BCBS Traditional |
$169.00
|
| Rate for Payer: CASH_PRICE |
$135.20
|
| Rate for Payer: CIGNA Commercial |
$160.55
|
| Rate for Payer: CIGNA Medicare |
$152.10
|
| Rate for Payer: HUMANA Commercial |
$152.10
|
| Rate for Payer: MEDICAID Medicaid |
$155.48
|
| Rate for Payer: MEDICARE Medicare |
$118.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$160.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$163.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$160.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$160.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$135.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$135.20
|
|
|
SPIROMETRY AFTER BRONCHODILATOR
|
Facility
OP
|
$387.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: AETNA Commercial |
$367.65
|
| Rate for Payer: AETNA Medicare |
$348.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$367.65
|
| Rate for Payer: BCBS Healthlink |
$348.30
|
| Rate for Payer: BCBS HMK CHIP |
$348.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$348.30
|
| Rate for Payer: BCBS POS |
$367.65
|
| Rate for Payer: BCBS Traditional |
$387.00
|
| Rate for Payer: CASH_PRICE |
$309.60
|
| Rate for Payer: CIGNA Commercial |
$367.65
|
| Rate for Payer: CIGNA Medicare |
$348.30
|
| Rate for Payer: HUMANA Commercial |
$348.30
|
| Rate for Payer: MEDICAID Medicaid |
$356.04
|
| Rate for Payer: MEDICARE Medicare |
$270.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$367.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$375.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$367.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$367.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$309.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$309.60
|
|
|
SPIROMETRY AFTER BRONCHODILATOR
|
Facility
IP
|
$387.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: AETNA Commercial |
$367.65
|
| Rate for Payer: AETNA Medicare |
$348.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$367.65
|
| Rate for Payer: BCBS Healthlink |
$348.30
|
| Rate for Payer: BCBS HMK CHIP |
$348.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$348.30
|
| Rate for Payer: BCBS POS |
$367.65
|
| Rate for Payer: BCBS Traditional |
$387.00
|
| Rate for Payer: CASH_PRICE |
$309.60
|
| Rate for Payer: CIGNA Commercial |
$367.65
|
| Rate for Payer: CIGNA Medicare |
$348.30
|
| Rate for Payer: HUMANA Commercial |
$348.30
|
| Rate for Payer: MEDICAID Medicaid |
$356.04
|
| Rate for Payer: MEDICARE Medicare |
$270.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$367.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$375.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$367.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$367.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$328.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$309.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$309.60
|
|
