|
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
|
|
|
TRANEXAMIC ACID 100MG/ML 10ML VIAL
|
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
|
|
|
TRANEXAMIC ACID 100MG/ML 10ML VIAL
|
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
|
|
|
TRANSFERRIN (004937)
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
|
TRANSFERRIN (004937)
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: AETNA Commercial |
$86.45
|
| Rate for Payer: AETNA Medicare |
$81.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$86.45
|
| Rate for Payer: BCBS Healthlink |
$81.90
|
| Rate for Payer: BCBS HMK CHIP |
$81.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$81.90
|
| Rate for Payer: BCBS POS |
$86.45
|
| Rate for Payer: BCBS Traditional |
$91.00
|
| Rate for Payer: CASH_PRICE |
$72.80
|
| Rate for Payer: CIGNA Commercial |
$86.45
|
| Rate for Payer: CIGNA Medicare |
$81.90
|
| Rate for Payer: HUMANA Commercial |
$81.90
|
| Rate for Payer: MEDICAID Medicaid |
$83.72
|
| Rate for Payer: MEDICARE Medicare |
$63.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$86.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$88.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$86.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$86.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$77.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$72.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$72.80
|
|
|
TRAUMA ACTIVATION
|
Facility
OP
|
$3,713.00
|
|
|
Service Code
|
CPT G0390
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,599.10 |
| Max. Negotiated Rate |
$3,713.00 |
| Rate for Payer: AETNA Commercial |
$3,527.35
|
| Rate for Payer: AETNA Medicare |
$3,341.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,527.35
|
| Rate for Payer: BCBS Healthlink |
$3,341.70
|
| Rate for Payer: BCBS HMK CHIP |
$3,341.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,341.70
|
| Rate for Payer: BCBS POS |
$3,527.35
|
| Rate for Payer: BCBS Traditional |
$3,713.00
|
| Rate for Payer: CASH_PRICE |
$2,970.40
|
| Rate for Payer: CIGNA Commercial |
$3,527.35
|
| Rate for Payer: CIGNA Medicare |
$3,341.70
|
| Rate for Payer: HUMANA Commercial |
$3,341.70
|
| Rate for Payer: MEDICAID Medicaid |
$3,415.96
|
| Rate for Payer: MEDICARE Medicare |
$2,599.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,527.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,601.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,527.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,527.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3,156.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,970.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,970.40
|
|
|
TRAUMA ACTIVATION
|
Facility
IP
|
$3,713.00
|
|
|
Service Code
|
CPT G0390
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,599.10 |
| Max. Negotiated Rate |
$3,713.00 |
| Rate for Payer: AETNA Commercial |
$3,527.35
|
| Rate for Payer: AETNA Medicare |
$3,341.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,527.35
|
| Rate for Payer: BCBS Healthlink |
$3,341.70
|
| Rate for Payer: BCBS HMK CHIP |
$3,341.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,341.70
|
| Rate for Payer: BCBS POS |
$3,527.35
|
| Rate for Payer: BCBS Traditional |
$3,713.00
|
| Rate for Payer: CASH_PRICE |
$2,970.40
|
| Rate for Payer: CIGNA Commercial |
$3,527.35
|
| Rate for Payer: CIGNA Medicare |
$3,341.70
|
| Rate for Payer: HUMANA Commercial |
$3,341.70
|
| Rate for Payer: MEDICAID Medicaid |
$3,415.96
|
| Rate for Payer: MEDICARE Medicare |
$2,599.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,527.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,601.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,527.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,527.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3,156.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,970.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,970.40
|
|
|
TRAVOPROST 0.004% SOLUTION 2.5 ML -NF
|
Facility
IP
|
$525.65
|
|
| Hospital Charge Code |
20221116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$367.95 |
| Max. Negotiated Rate |
$525.65 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$499.37
|
| Rate for Payer: AETNA Commercial |
$499.37
|
| Rate for Payer: AETNA Medicare |
$473.08
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$499.37
|
| Rate for Payer: BCBS Healthlink |
$473.08
|
| Rate for Payer: BCBS HMK CHIP |
$473.08
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$473.08
|
| Rate for Payer: BCBS POS |
$499.37
|
| Rate for Payer: BCBS Traditional |
$525.65
|
| Rate for Payer: CASH_PRICE |
$420.52
|
| Rate for Payer: CIGNA Commercial |
$499.37
|
| Rate for Payer: CIGNA Medicare |
$473.08
|
| Rate for Payer: HUMANA Commercial |
$473.08
|
| Rate for Payer: MEDICAID Medicaid |
$483.60
|
| Rate for Payer: MEDICARE Medicare |
$367.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$499.37
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$499.37
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.52
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.52
|
|
|
TRAVOPROST 0.004% SOLUTION 2.5 ML -NF
|
Facility
OP
|
$525.65
|
|
| Hospital Charge Code |
20221116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$367.95 |
| Max. Negotiated Rate |
$525.65 |
| Rate for Payer: AETNA Commercial |
$499.37
|
| Rate for Payer: AETNA Medicare |
$473.08
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$499.37
|
| Rate for Payer: BCBS Healthlink |
$473.08
|
| Rate for Payer: BCBS HMK CHIP |
$473.08
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$473.08
|
| Rate for Payer: BCBS POS |
$499.37
|
| Rate for Payer: BCBS Traditional |
$525.65
|
| Rate for Payer: CASH_PRICE |
$420.52
|
| Rate for Payer: CIGNA Commercial |
$499.37
|
| Rate for Payer: CIGNA Medicare |
$473.08
|
| Rate for Payer: HUMANA Commercial |
$473.08
|
| Rate for Payer: MEDICAID Medicaid |
$483.60
|
| Rate for Payer: MEDICARE Medicare |
$367.95
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$499.37
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$499.37
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$499.37
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.52
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.52
|
|
|
TRAZODONE 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
|
|
|
TRAZODONE 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
|
|
|
TR DRAINAGE OF FINGER ABCESS
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: AETNA Commercial |
$252.70
|
| Rate for Payer: AETNA Medicare |
$239.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$252.70
|
| Rate for Payer: BCBS Healthlink |
$239.40
|
| Rate for Payer: BCBS HMK CHIP |
$239.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$239.40
|
| Rate for Payer: BCBS POS |
$252.70
|
| Rate for Payer: BCBS Traditional |
$266.00
|
| Rate for Payer: CASH_PRICE |
$212.80
|
| Rate for Payer: CIGNA Commercial |
$252.70
|
| Rate for Payer: CIGNA Medicare |
$239.40
|
| Rate for Payer: HUMANA Commercial |
$239.40
|
| Rate for Payer: MEDICAID Medicaid |
$244.72
|
| Rate for Payer: MEDICARE Medicare |
$186.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$252.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$258.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$252.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$252.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$226.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$212.80
|
|
|
TR DRAINAGE OF FINGER ABCESS
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: AETNA Commercial |
$252.70
|
| Rate for Payer: AETNA Medicare |
$239.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$252.70
|
| Rate for Payer: BCBS Healthlink |
$239.40
|
| Rate for Payer: BCBS HMK CHIP |
$239.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$239.40
|
| Rate for Payer: BCBS POS |
$252.70
|
| Rate for Payer: BCBS Traditional |
$266.00
|
| Rate for Payer: CASH_PRICE |
$212.80
|
| Rate for Payer: CIGNA Commercial |
$252.70
|
| Rate for Payer: CIGNA Medicare |
$239.40
|
| Rate for Payer: HUMANA Commercial |
$239.40
|
| Rate for Payer: MEDICAID Medicaid |
$244.72
|
| Rate for Payer: MEDICARE Medicare |
$186.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$252.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$258.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$252.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$252.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$226.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$212.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$212.80
|
|
|
TR DRESS/DEBRIDE BURN >10%TOTAL LARGE
|
Facility
OP
|
$495.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: AETNA Commercial |
$470.25
|
| Rate for Payer: AETNA Medicare |
$445.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$470.25
|
| Rate for Payer: BCBS Healthlink |
$445.50
|
| Rate for Payer: BCBS HMK CHIP |
$445.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$445.50
|
| Rate for Payer: BCBS POS |
$470.25
|
| Rate for Payer: BCBS Traditional |
$495.00
|
| Rate for Payer: CASH_PRICE |
$396.00
|
| Rate for Payer: CIGNA Commercial |
$470.25
|
| Rate for Payer: CIGNA Medicare |
$445.50
|
| Rate for Payer: HUMANA Commercial |
$445.50
|
| Rate for Payer: MEDICAID Medicaid |
$455.40
|
| Rate for Payer: MEDICARE Medicare |
$346.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$470.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$480.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$470.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$470.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$420.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$396.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$396.00
|
|
|
TR DRESS/DEBRIDE BURN >10%TOTAL LARGE
|
Facility
IP
|
$495.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: AETNA Commercial |
$470.25
|
| Rate for Payer: AETNA Medicare |
$445.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$470.25
|
| Rate for Payer: BCBS Healthlink |
$445.50
|
| Rate for Payer: BCBS HMK CHIP |
$445.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$445.50
|
| Rate for Payer: BCBS POS |
$470.25
|
| Rate for Payer: BCBS Traditional |
$495.00
|
| Rate for Payer: CASH_PRICE |
$396.00
|
| Rate for Payer: CIGNA Commercial |
$470.25
|
| Rate for Payer: CIGNA Medicare |
$445.50
|
| Rate for Payer: HUMANA Commercial |
$445.50
|
| Rate for Payer: MEDICAID Medicaid |
$455.40
|
| Rate for Payer: MEDICARE Medicare |
$346.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$470.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$480.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$470.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$470.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$420.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$396.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$396.00
|
|
|
TREAT FRACTURE RADIUS & ULNA W/MANI
|
Facility
IP
|
$729.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.30 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: AETNA Commercial |
$692.55
|
| Rate for Payer: AETNA Medicare |
$656.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$692.55
|
| Rate for Payer: BCBS Healthlink |
$656.10
|
| Rate for Payer: BCBS HMK CHIP |
$656.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$656.10
|
| Rate for Payer: BCBS POS |
$692.55
|
| Rate for Payer: BCBS Traditional |
$729.00
|
| Rate for Payer: CASH_PRICE |
$583.20
|
| Rate for Payer: CIGNA Commercial |
$692.55
|
| Rate for Payer: CIGNA Medicare |
$656.10
|
| Rate for Payer: HUMANA Commercial |
$656.10
|
| Rate for Payer: MEDICAID Medicaid |
$670.68
|
| Rate for Payer: MEDICARE Medicare |
$510.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$692.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$707.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$692.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$692.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$619.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$583.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$583.20
|
|
|
TREAT FRACTURE RADIUS & ULNA W/MANI
|
Facility
OP
|
$729.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.30 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: AETNA Commercial |
$692.55
|
| Rate for Payer: AETNA Medicare |
$656.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$692.55
|
| Rate for Payer: BCBS Healthlink |
$656.10
|
| Rate for Payer: BCBS HMK CHIP |
$656.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$656.10
|
| Rate for Payer: BCBS POS |
$692.55
|
| Rate for Payer: BCBS Traditional |
$729.00
|
| Rate for Payer: CASH_PRICE |
$583.20
|
| Rate for Payer: CIGNA Commercial |
$692.55
|
| Rate for Payer: CIGNA Medicare |
$656.10
|
| Rate for Payer: HUMANA Commercial |
$656.10
|
| Rate for Payer: MEDICAID Medicaid |
$670.68
|
| Rate for Payer: MEDICARE Medicare |
$510.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$692.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$707.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$692.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$692.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$619.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$583.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$583.20
|
|
|
TREATMENT RM
|
Facility
IP
|
$1,556.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.20 |
| Max. Negotiated Rate |
$1,556.00 |
| Rate for Payer: AETNA Commercial |
$1,478.20
|
| Rate for Payer: AETNA Medicare |
$1,400.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,478.20
|
| Rate for Payer: BCBS Healthlink |
$1,400.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,400.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,400.40
|
| Rate for Payer: BCBS POS |
$1,478.20
|
| Rate for Payer: BCBS Traditional |
$1,556.00
|
| Rate for Payer: CASH_PRICE |
$1,244.80
|
| Rate for Payer: CIGNA Commercial |
$1,478.20
|
| Rate for Payer: CIGNA Medicare |
$1,400.40
|
| Rate for Payer: HUMANA Commercial |
$1,400.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,431.52
|
| Rate for Payer: MEDICARE Medicare |
$1,089.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,478.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,509.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,478.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,478.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,322.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,244.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,244.80
|
|
|
TREATMENT RM
|
Facility
OP
|
$1,556.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.20 |
| Max. Negotiated Rate |
$1,556.00 |
| Rate for Payer: AETNA Commercial |
$1,478.20
|
| Rate for Payer: AETNA Medicare |
$1,400.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,478.20
|
| Rate for Payer: BCBS Healthlink |
$1,400.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,400.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,400.40
|
| Rate for Payer: BCBS POS |
$1,478.20
|
| Rate for Payer: BCBS Traditional |
$1,556.00
|
| Rate for Payer: CASH_PRICE |
$1,244.80
|
| Rate for Payer: CIGNA Commercial |
$1,478.20
|
| Rate for Payer: CIGNA Medicare |
$1,400.40
|
| Rate for Payer: HUMANA Commercial |
$1,400.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,431.52
|
| Rate for Payer: MEDICARE Medicare |
$1,089.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,478.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,509.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,478.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,478.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,322.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,244.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,244.80
|
|
|
TREATMENT RM CHG TUBE GASTROSTOMY
|
Facility
OP
|
$552.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: AETNA Commercial |
$524.40
|
| Rate for Payer: AETNA Medicare |
$496.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$524.40
|
| Rate for Payer: BCBS Healthlink |
$496.80
|
| Rate for Payer: BCBS HMK CHIP |
$496.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$496.80
|
| Rate for Payer: BCBS POS |
$524.40
|
| Rate for Payer: BCBS Traditional |
$552.00
|
| Rate for Payer: CASH_PRICE |
$441.60
|
| Rate for Payer: CIGNA Commercial |
$524.40
|
| Rate for Payer: CIGNA Medicare |
$496.80
|
| Rate for Payer: HUMANA Commercial |
$496.80
|
| Rate for Payer: MEDICAID Medicaid |
$507.84
|
| Rate for Payer: MEDICARE Medicare |
$386.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$524.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$535.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$524.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$524.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$469.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$441.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$441.60
|
|
|
TREATMENT RM CHG TUBE GASTROSTOMY
|
Facility
IP
|
$552.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: AETNA Commercial |
$524.40
|
| Rate for Payer: AETNA Medicare |
$496.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$524.40
|
| Rate for Payer: BCBS Healthlink |
$496.80
|
| Rate for Payer: BCBS HMK CHIP |
$496.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$496.80
|
| Rate for Payer: BCBS POS |
$524.40
|
| Rate for Payer: BCBS Traditional |
$552.00
|
| Rate for Payer: CASH_PRICE |
$441.60
|
| Rate for Payer: CIGNA Commercial |
$524.40
|
| Rate for Payer: CIGNA Medicare |
$496.80
|
| Rate for Payer: HUMANA Commercial |
$496.80
|
| Rate for Payer: MEDICAID Medicaid |
$507.84
|
| Rate for Payer: MEDICARE Medicare |
$386.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$524.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$535.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$524.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$524.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$469.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$441.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$441.60
|
|
|
TREATMENT RN NURSE ONLY
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
TREATMENT RN NURSE ONLY
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: AETNA Commercial |
$84.55
|
| Rate for Payer: AETNA Medicare |
$80.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$84.55
|
| Rate for Payer: BCBS Healthlink |
$80.10
|
| Rate for Payer: BCBS HMK CHIP |
$80.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$80.10
|
| Rate for Payer: BCBS POS |
$84.55
|
| Rate for Payer: BCBS Traditional |
$89.00
|
| Rate for Payer: CASH_PRICE |
$71.20
|
| Rate for Payer: CIGNA Commercial |
$84.55
|
| Rate for Payer: CIGNA Medicare |
$80.10
|
| Rate for Payer: HUMANA Commercial |
$80.10
|
| Rate for Payer: MEDICAID Medicaid |
$81.88
|
| Rate for Payer: MEDICARE Medicare |
$62.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$84.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$86.33
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$84.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$84.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$75.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$71.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$71.20
|
|
|
TRESIBA 100U/1ML INJECTION 10ML VIAL-NF
|
Facility
OP
|
$726.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$508.20 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: AETNA Commercial |
$689.70
|
| Rate for Payer: AETNA Medicare |
$653.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$689.70
|
| Rate for Payer: BCBS Healthlink |
$653.40
|
| Rate for Payer: BCBS HMK CHIP |
$653.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$653.40
|
| Rate for Payer: BCBS POS |
$689.70
|
| Rate for Payer: BCBS Traditional |
$726.00
|
| Rate for Payer: CASH_PRICE |
$580.80
|
| Rate for Payer: CIGNA Commercial |
$689.70
|
| Rate for Payer: CIGNA Medicare |
$653.40
|
| Rate for Payer: HUMANA Commercial |
$653.40
|
| Rate for Payer: MEDICAID Medicaid |
$667.92
|
| Rate for Payer: MEDICARE Medicare |
$508.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$689.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$704.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$689.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$689.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$617.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$580.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$580.80
|
|
|
TRESIBA 100U/1ML INJECTION 10ML VIAL-NF
|
Facility
IP
|
$726.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$508.20 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: AETNA Commercial |
$689.70
|
| Rate for Payer: AETNA Medicare |
$653.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$689.70
|
| Rate for Payer: BCBS Healthlink |
$653.40
|
| Rate for Payer: BCBS HMK CHIP |
$653.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$653.40
|
| Rate for Payer: BCBS POS |
$689.70
|
| Rate for Payer: BCBS Traditional |
$726.00
|
| Rate for Payer: CASH_PRICE |
$580.80
|
| Rate for Payer: CIGNA Commercial |
$689.70
|
| Rate for Payer: CIGNA Medicare |
$653.40
|
| Rate for Payer: HUMANA Commercial |
$653.40
|
| Rate for Payer: MEDICAID Medicaid |
$667.92
|
| Rate for Payer: MEDICARE Medicare |
$508.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$689.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$704.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$689.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$689.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$617.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$580.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$580.80
|
|
