|
VAC - DTap INJ [0.5ML]
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
VAC - DTap INJ [0.5ML]
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: AETNA Commercial |
$100.70
|
| Rate for Payer: AETNA Medicare |
$95.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$100.70
|
| Rate for Payer: BCBS Healthlink |
$95.40
|
| Rate for Payer: BCBS HMK CHIP |
$95.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$95.40
|
| Rate for Payer: BCBS POS |
$100.70
|
| Rate for Payer: BCBS Traditional |
$106.00
|
| Rate for Payer: CASH_PRICE |
$84.80
|
| Rate for Payer: CIGNA Commercial |
$100.70
|
| Rate for Payer: CIGNA Medicare |
$95.40
|
| Rate for Payer: HUMANA Commercial |
$95.40
|
| Rate for Payer: MEDICAID Medicaid |
$97.52
|
| Rate for Payer: MEDICARE Medicare |
$74.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$100.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$102.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$100.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$100.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$90.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.80
|
|
|
VAC - DTaP-IPV-Hib-Hep B (VAXELIS)[0.5ML
|
Facility
IP
|
$508.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: AETNA Commercial |
$482.60
|
| Rate for Payer: AETNA Medicare |
$457.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$482.60
|
| Rate for Payer: BCBS Healthlink |
$457.20
|
| Rate for Payer: BCBS HMK CHIP |
$457.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$457.20
|
| Rate for Payer: BCBS POS |
$482.60
|
| Rate for Payer: BCBS Traditional |
$508.00
|
| Rate for Payer: CASH_PRICE |
$406.40
|
| Rate for Payer: CIGNA Commercial |
$482.60
|
| Rate for Payer: CIGNA Medicare |
$457.20
|
| Rate for Payer: HUMANA Commercial |
$457.20
|
| Rate for Payer: MEDICAID Medicaid |
$467.36
|
| Rate for Payer: MEDICARE Medicare |
$355.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$482.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$492.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$482.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$482.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$431.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$406.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$406.40
|
|
|
VAC - DTaP-IPV-Hib-Hep B (VAXELIS)[0.5ML
|
Facility
OP
|
$508.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: AETNA Commercial |
$482.60
|
| Rate for Payer: AETNA Medicare |
$457.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$482.60
|
| Rate for Payer: BCBS Healthlink |
$457.20
|
| Rate for Payer: BCBS HMK CHIP |
$457.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$457.20
|
| Rate for Payer: BCBS POS |
$482.60
|
| Rate for Payer: BCBS Traditional |
$508.00
|
| Rate for Payer: CASH_PRICE |
$406.40
|
| Rate for Payer: CIGNA Commercial |
$482.60
|
| Rate for Payer: CIGNA Medicare |
$457.20
|
| Rate for Payer: HUMANA Commercial |
$457.20
|
| Rate for Payer: MEDICAID Medicaid |
$467.36
|
| Rate for Payer: MEDICARE Medicare |
$355.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$482.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$492.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$482.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$482.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$431.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$406.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$406.40
|
|
|
VAC - DTaP-IPV-Hib INJ [0.5 ML]
|
Facility
OP
|
$425.00
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: AETNA Commercial |
$403.75
|
| Rate for Payer: AETNA Medicare |
$382.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$403.75
|
| Rate for Payer: BCBS Healthlink |
$382.50
|
| Rate for Payer: BCBS HMK CHIP |
$382.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$382.50
|
| Rate for Payer: BCBS POS |
$403.75
|
| Rate for Payer: BCBS Traditional |
$425.00
|
| Rate for Payer: CASH_PRICE |
$340.00
|
| Rate for Payer: CIGNA Commercial |
$403.75
|
| Rate for Payer: CIGNA Medicare |
$382.50
|
| Rate for Payer: HUMANA Commercial |
$382.50
|
| Rate for Payer: MEDICAID Medicaid |
$391.00
|
| Rate for Payer: MEDICARE Medicare |
$297.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$403.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$412.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$403.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$361.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.00
|
|
|
VAC - DTaP-IPV-Hib INJ [0.5 ML]
|
Facility
IP
|
$425.00
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: AETNA Commercial |
$403.75
|
| Rate for Payer: AETNA Medicare |
$382.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$403.75
|
| Rate for Payer: BCBS Healthlink |
$382.50
|
| Rate for Payer: BCBS HMK CHIP |
$382.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$382.50
|
| Rate for Payer: BCBS POS |
$403.75
|
| Rate for Payer: BCBS Traditional |
$425.00
|
| Rate for Payer: CASH_PRICE |
$340.00
|
| Rate for Payer: CIGNA Commercial |
$403.75
|
| Rate for Payer: CIGNA Medicare |
$382.50
|
| Rate for Payer: HUMANA Commercial |
$382.50
|
| Rate for Payer: MEDICAID Medicaid |
$391.00
|
| Rate for Payer: MEDICARE Medicare |
$297.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$403.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$412.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$403.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$403.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$361.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$340.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$340.00
|
|
|
VAC - DTaP-IPV INJ KINRIX [0.5 ML]
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
VAC - DTaP-IPV INJ KINRIX [0.5 ML]
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
VAC - HAEMOPHILUS b CONJUGATE [0.5 ML]
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
VAC - HAEMOPHILUS b CONJUGATE [0.5 ML]
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 90648
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: AETNA Commercial |
$73.15
|
| Rate for Payer: AETNA Medicare |
$69.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$73.15
|
| Rate for Payer: BCBS Healthlink |
$69.30
|
| Rate for Payer: BCBS HMK CHIP |
$69.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$69.30
|
| Rate for Payer: BCBS POS |
$73.15
|
| Rate for Payer: BCBS Traditional |
$77.00
|
| Rate for Payer: CASH_PRICE |
$61.60
|
| Rate for Payer: CIGNA Commercial |
$73.15
|
| Rate for Payer: CIGNA Medicare |
$69.30
|
| Rate for Payer: HUMANA Commercial |
$69.30
|
| Rate for Payer: MEDICAID Medicaid |
$70.84
|
| Rate for Payer: MEDICARE Medicare |
$53.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$73.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$74.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$73.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$73.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$65.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$61.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$61.60
|
|
|
VAC - HEPATITIS A [720 U/0.5 ML] HAVRIX
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: AETNA Commercial |
$133.95
|
| Rate for Payer: AETNA Medicare |
$126.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$133.95
|
| Rate for Payer: BCBS Healthlink |
$126.90
|
| Rate for Payer: BCBS HMK CHIP |
$126.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$126.90
|
| Rate for Payer: BCBS POS |
$133.95
|
| Rate for Payer: BCBS Traditional |
$141.00
|
| Rate for Payer: CASH_PRICE |
$112.80
|
| Rate for Payer: CIGNA Commercial |
$133.95
|
| Rate for Payer: CIGNA Medicare |
$126.90
|
| Rate for Payer: HUMANA Commercial |
$126.90
|
| Rate for Payer: MEDICAID Medicaid |
$129.72
|
| Rate for Payer: MEDICARE Medicare |
$98.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$133.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$136.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$133.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$133.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$119.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$112.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$112.80
|
|
|
VAC - HEPATITIS A [720 U/0.5 ML] HAVRIX
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: AETNA Commercial |
$133.95
|
| Rate for Payer: AETNA Medicare |
$126.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$133.95
|
| Rate for Payer: BCBS Healthlink |
$126.90
|
| Rate for Payer: BCBS HMK CHIP |
$126.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$126.90
|
| Rate for Payer: BCBS POS |
$133.95
|
| Rate for Payer: BCBS Traditional |
$141.00
|
| Rate for Payer: CASH_PRICE |
$112.80
|
| Rate for Payer: CIGNA Commercial |
$133.95
|
| Rate for Payer: CIGNA Medicare |
$126.90
|
| Rate for Payer: HUMANA Commercial |
$126.90
|
| Rate for Payer: MEDICAID Medicaid |
$129.72
|
| Rate for Payer: MEDICARE Medicare |
$98.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$133.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$136.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$133.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$133.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$119.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$112.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$112.80
|
|
|
VAC - HEPATITIS B INJ [20 MCG/ML] ADULT
|
Facility
IP
|
$256.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: AETNA Commercial |
$243.20
|
| Rate for Payer: AETNA Medicare |
$230.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$243.20
|
| Rate for Payer: BCBS Healthlink |
$230.40
|
| Rate for Payer: BCBS HMK CHIP |
$230.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$230.40
|
| Rate for Payer: BCBS POS |
$243.20
|
| Rate for Payer: BCBS Traditional |
$256.00
|
| Rate for Payer: CASH_PRICE |
$204.80
|
| Rate for Payer: CIGNA Commercial |
$243.20
|
| Rate for Payer: CIGNA Medicare |
$230.40
|
| Rate for Payer: HUMANA Commercial |
$230.40
|
| Rate for Payer: MEDICAID Medicaid |
$235.52
|
| Rate for Payer: MEDICARE Medicare |
$179.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$243.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$248.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$243.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$243.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$217.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$204.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$204.80
|
|
|
VAC - HEPATITIS B INJ [20 MCG/ML] ADULT
|
Facility
OP
|
$256.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.20 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: AETNA Commercial |
$243.20
|
| Rate for Payer: AETNA Medicare |
$230.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$243.20
|
| Rate for Payer: BCBS Healthlink |
$230.40
|
| Rate for Payer: BCBS HMK CHIP |
$230.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$230.40
|
| Rate for Payer: BCBS POS |
$243.20
|
| Rate for Payer: BCBS Traditional |
$256.00
|
| Rate for Payer: CASH_PRICE |
$204.80
|
| Rate for Payer: CIGNA Commercial |
$243.20
|
| Rate for Payer: CIGNA Medicare |
$230.40
|
| Rate for Payer: HUMANA Commercial |
$230.40
|
| Rate for Payer: MEDICAID Medicaid |
$235.52
|
| Rate for Payer: MEDICARE Medicare |
$179.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$243.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$248.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$243.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$243.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$217.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$204.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$204.80
|
|
|
VAC - HEP B INJ 10MCG/0.5ml PEDIATRIC
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
VAC - HEP B INJ 10MCG/0.5ml PEDIATRIC
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: AETNA Commercial |
$99.75
|
| Rate for Payer: AETNA Medicare |
$94.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$99.75
|
| Rate for Payer: BCBS Healthlink |
$94.50
|
| Rate for Payer: BCBS HMK CHIP |
$94.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$94.50
|
| Rate for Payer: BCBS POS |
$99.75
|
| Rate for Payer: BCBS Traditional |
$105.00
|
| Rate for Payer: CASH_PRICE |
$84.00
|
| Rate for Payer: CIGNA Commercial |
$99.75
|
| Rate for Payer: CIGNA Medicare |
$94.50
|
| Rate for Payer: HUMANA Commercial |
$94.50
|
| Rate for Payer: MEDICAID Medicaid |
$96.60
|
| Rate for Payer: MEDICARE Medicare |
$73.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$99.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$101.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$99.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$99.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$89.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$84.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$84.00
|
|
|
VAC - HUMAN PAPILLOMAVIRUS RECOMBINANT 9
|
Facility
IP
|
$613.00
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$613.00 |
| Rate for Payer: AETNA Commercial |
$582.35
|
| Rate for Payer: AETNA Medicare |
$551.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$582.35
|
| Rate for Payer: BCBS Healthlink |
$551.70
|
| Rate for Payer: BCBS HMK CHIP |
$551.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$551.70
|
| Rate for Payer: BCBS POS |
$582.35
|
| Rate for Payer: BCBS Traditional |
$613.00
|
| Rate for Payer: CASH_PRICE |
$490.40
|
| Rate for Payer: CIGNA Commercial |
$582.35
|
| Rate for Payer: CIGNA Medicare |
$551.70
|
| Rate for Payer: HUMANA Commercial |
$551.70
|
| Rate for Payer: MEDICAID Medicaid |
$563.96
|
| Rate for Payer: MEDICARE Medicare |
$429.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$582.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$594.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$582.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$582.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$521.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$490.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$490.40
|
|
|
VAC - HUMAN PAPILLOMAVIRUS RECOMBINANT 9
|
Facility
OP
|
$613.00
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$613.00 |
| Rate for Payer: AETNA Commercial |
$582.35
|
| Rate for Payer: AETNA Medicare |
$551.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$582.35
|
| Rate for Payer: BCBS Healthlink |
$551.70
|
| Rate for Payer: BCBS HMK CHIP |
$551.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$551.70
|
| Rate for Payer: BCBS POS |
$582.35
|
| Rate for Payer: BCBS Traditional |
$613.00
|
| Rate for Payer: CASH_PRICE |
$490.40
|
| Rate for Payer: CIGNA Commercial |
$582.35
|
| Rate for Payer: CIGNA Medicare |
$551.70
|
| Rate for Payer: HUMANA Commercial |
$551.70
|
| Rate for Payer: MEDICAID Medicaid |
$563.96
|
| Rate for Payer: MEDICARE Medicare |
$429.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$582.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$594.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$582.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$582.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$521.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$490.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$490.40
|
|
|
VAC - INFLUENZA EGG FREE CLINIC
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
VAC - INFLUENZA EGG FREE CLINIC
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
VAC-INFLUENZA EGG FREE HOSPITAL
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
VAC-INFLUENZA EGG FREE HOSPITAL
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
VAC - INFLUENZA HD QUAD CLINIC
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
VAC - INFLUENZA HD QUAD CLINIC
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
VAC-INFLUENZA HD QUAD HOSPITAL
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
