|
THYROID PEROXIDASE ANTIBODIES (006676)
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
THYROID PEROXIDASE ANTIBODIES (006676)
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
TICAGRELOR TAB [90 MG]
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
TICAGRELOR TAB [90 MG]
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
TIMOLOL MALEATE OPTH. GTTS 0.5%
|
Facility
OP
|
$700.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: AETNA Commercial |
$665.00
|
| Rate for Payer: AETNA Medicare |
$630.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$665.00
|
| Rate for Payer: BCBS Healthlink |
$630.00
|
| Rate for Payer: BCBS HMK CHIP |
$630.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$630.00
|
| Rate for Payer: BCBS POS |
$665.00
|
| Rate for Payer: BCBS Traditional |
$700.00
|
| Rate for Payer: CASH_PRICE |
$560.00
|
| Rate for Payer: CIGNA Commercial |
$665.00
|
| Rate for Payer: CIGNA Medicare |
$630.00
|
| Rate for Payer: HUMANA Commercial |
$630.00
|
| Rate for Payer: MEDICAID Medicaid |
$644.00
|
| Rate for Payer: MEDICARE Medicare |
$490.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$665.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$679.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$665.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$665.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$595.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$560.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$560.00
|
|
|
TIMOLOL MALEATE OPTH. GTTS 0.5%
|
Facility
IP
|
$700.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: AETNA Commercial |
$665.00
|
| Rate for Payer: AETNA Medicare |
$630.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$665.00
|
| Rate for Payer: BCBS Healthlink |
$630.00
|
| Rate for Payer: BCBS HMK CHIP |
$630.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$630.00
|
| Rate for Payer: BCBS POS |
$665.00
|
| Rate for Payer: BCBS Traditional |
$700.00
|
| Rate for Payer: CASH_PRICE |
$560.00
|
| Rate for Payer: CIGNA Commercial |
$665.00
|
| Rate for Payer: CIGNA Medicare |
$630.00
|
| Rate for Payer: HUMANA Commercial |
$630.00
|
| Rate for Payer: MEDICAID Medicaid |
$644.00
|
| Rate for Payer: MEDICARE Medicare |
$490.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$665.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$679.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$665.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$665.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$595.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$560.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$560.00
|
|
|
TIOTROPIUM BROMIDE INH [18 MCG]
|
Facility
OP
|
$397.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$277.90 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: AETNA Commercial |
$377.15
|
| Rate for Payer: AETNA Medicare |
$357.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$377.15
|
| Rate for Payer: BCBS Healthlink |
$357.30
|
| Rate for Payer: BCBS HMK CHIP |
$357.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$357.30
|
| Rate for Payer: BCBS POS |
$377.15
|
| Rate for Payer: BCBS Traditional |
$397.00
|
| Rate for Payer: CASH_PRICE |
$317.60
|
| Rate for Payer: CIGNA Commercial |
$377.15
|
| Rate for Payer: CIGNA Medicare |
$357.30
|
| Rate for Payer: HUMANA Commercial |
$357.30
|
| Rate for Payer: MEDICAID Medicaid |
$365.24
|
| Rate for Payer: MEDICARE Medicare |
$277.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$377.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$385.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$377.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$377.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$337.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$317.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$317.60
|
|
|
TIOTROPIUM BROMIDE INH [18 MCG]
|
Facility
IP
|
$397.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$277.90 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: AETNA Commercial |
$377.15
|
| Rate for Payer: AETNA Medicare |
$357.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$377.15
|
| Rate for Payer: BCBS Healthlink |
$357.30
|
| Rate for Payer: BCBS HMK CHIP |
$357.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$357.30
|
| Rate for Payer: BCBS POS |
$377.15
|
| Rate for Payer: BCBS Traditional |
$397.00
|
| Rate for Payer: CASH_PRICE |
$317.60
|
| Rate for Payer: CIGNA Commercial |
$377.15
|
| Rate for Payer: CIGNA Medicare |
$357.30
|
| Rate for Payer: HUMANA Commercial |
$357.30
|
| Rate for Payer: MEDICAID Medicaid |
$365.24
|
| Rate for Payer: MEDICARE Medicare |
$277.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$377.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$385.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$377.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$377.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$337.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$317.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$317.60
|
|
|
TIZANIDINE TAB [4 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
|
|
|
TIZANIDINE TAB [4 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
|
|
|
TOBRAMYCIN 0.3% OPTH SOL
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: AETNA Commercial |
$46.55
|
| Rate for Payer: AETNA Medicare |
$44.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$46.55
|
| Rate for Payer: BCBS Healthlink |
$44.10
|
| Rate for Payer: BCBS HMK CHIP |
$44.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$44.10
|
| Rate for Payer: BCBS POS |
$46.55
|
| Rate for Payer: BCBS Traditional |
$49.00
|
| Rate for Payer: CASH_PRICE |
$39.20
|
| Rate for Payer: CIGNA Commercial |
$46.55
|
| Rate for Payer: CIGNA Medicare |
$44.10
|
| Rate for Payer: HUMANA Commercial |
$44.10
|
| Rate for Payer: MEDICAID Medicaid |
$45.08
|
| Rate for Payer: MEDICARE Medicare |
$34.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$46.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$47.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$46.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$46.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$41.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$39.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$39.20
|
|
|
TOBRAMYCIN 0.3% OPTH SOL
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: AETNA Commercial |
$46.55
|
| Rate for Payer: AETNA Medicare |
$44.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$46.55
|
| Rate for Payer: BCBS Healthlink |
$44.10
|
| Rate for Payer: BCBS HMK CHIP |
$44.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$44.10
|
| Rate for Payer: BCBS POS |
$46.55
|
| Rate for Payer: BCBS Traditional |
$49.00
|
| Rate for Payer: CASH_PRICE |
$39.20
|
| Rate for Payer: CIGNA Commercial |
$46.55
|
| Rate for Payer: CIGNA Medicare |
$44.10
|
| Rate for Payer: HUMANA Commercial |
$44.10
|
| Rate for Payer: MEDICAID Medicaid |
$45.08
|
| Rate for Payer: MEDICARE Medicare |
$34.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$46.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$47.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$46.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$46.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$41.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$39.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$39.20
|
|
|
TOPIRAMATE (716285)
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
TOPIRAMATE (716285)
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$131.00 |
| Rate for Payer: AETNA Commercial |
$124.45
|
| Rate for Payer: AETNA Medicare |
$117.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$124.45
|
| Rate for Payer: BCBS Healthlink |
$117.90
|
| Rate for Payer: BCBS HMK CHIP |
$117.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$117.90
|
| Rate for Payer: BCBS POS |
$124.45
|
| Rate for Payer: BCBS Traditional |
$131.00
|
| Rate for Payer: CASH_PRICE |
$104.80
|
| Rate for Payer: CIGNA Commercial |
$124.45
|
| Rate for Payer: CIGNA Medicare |
$117.90
|
| Rate for Payer: HUMANA Commercial |
$117.90
|
| Rate for Payer: MEDICAID Medicaid |
$120.52
|
| Rate for Payer: MEDICARE Medicare |
$91.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$124.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$127.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$124.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$124.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$111.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$104.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$104.80
|
|
|
TOPIRAMATE 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
|
|
|
TOPIRAMATE 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
|
|
|
TORSEMIDE TAB [20 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
TORSEMIDE TAB [20 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
.TOTAL IRON-BINDING CAPACITY
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| 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 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
|
|
|
.TOTAL IRON-BINDING CAPACITY
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
.TOTAL PROTEIN, URINE
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: AETNA Commercial |
$11.40
|
| Rate for Payer: AETNA Medicare |
$10.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.40
|
| Rate for Payer: BCBS Healthlink |
$10.80
|
| Rate for Payer: BCBS HMK CHIP |
$10.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10.80
|
| Rate for Payer: BCBS POS |
$11.40
|
| Rate for Payer: BCBS Traditional |
$12.00
|
| Rate for Payer: CASH_PRICE |
$9.60
|
| Rate for Payer: CIGNA Commercial |
$11.40
|
| Rate for Payer: CIGNA Medicare |
$10.80
|
| Rate for Payer: HUMANA Commercial |
$10.80
|
| Rate for Payer: MEDICAID Medicaid |
$11.04
|
| Rate for Payer: MEDICARE Medicare |
$8.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.60
|
|
|
.TOTAL PROTEIN, URINE
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: AETNA Commercial |
$11.40
|
| Rate for Payer: AETNA Medicare |
$10.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$11.40
|
| Rate for Payer: BCBS Healthlink |
$10.80
|
| Rate for Payer: BCBS HMK CHIP |
$10.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$10.80
|
| Rate for Payer: BCBS POS |
$11.40
|
| Rate for Payer: BCBS Traditional |
$12.00
|
| Rate for Payer: CASH_PRICE |
$9.60
|
| Rate for Payer: CIGNA Commercial |
$11.40
|
| Rate for Payer: CIGNA Medicare |
$10.80
|
| Rate for Payer: HUMANA Commercial |
$10.80
|
| Rate for Payer: MEDICAID Medicaid |
$11.04
|
| Rate for Payer: MEDICARE Medicare |
$8.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$11.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$11.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$11.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$11.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$10.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$9.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$9.60
|
|
|
T PALLIDUM SCREENING CASCADE (082345)
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
T PALLIDUM SCREENING CASCADE (082345)
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
TRAMADOL 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: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| 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 - 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
|
|
