|
VAC-INFLUENZA HD QUAD HOSPITAL
|
Facility
OP
|
$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
|
|
|
VAC - INFLUENZA INTRANASAL 0.2 ML
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: AETNA Commercial |
$88.35
|
| Rate for Payer: AETNA Medicare |
$83.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$88.35
|
| Rate for Payer: BCBS Healthlink |
$83.70
|
| Rate for Payer: BCBS HMK CHIP |
$83.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$83.70
|
| Rate for Payer: BCBS POS |
$88.35
|
| Rate for Payer: BCBS Traditional |
$93.00
|
| Rate for Payer: CASH_PRICE |
$74.40
|
| Rate for Payer: CIGNA Commercial |
$88.35
|
| Rate for Payer: CIGNA Medicare |
$83.70
|
| Rate for Payer: HUMANA Commercial |
$83.70
|
| Rate for Payer: MEDICAID Medicaid |
$85.56
|
| Rate for Payer: MEDICARE Medicare |
$65.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$88.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$90.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$88.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$88.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$74.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$74.40
|
|
|
VAC - INFLUENZA INTRANASAL 0.2 ML
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: AETNA Commercial |
$88.35
|
| Rate for Payer: AETNA Medicare |
$83.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$88.35
|
| Rate for Payer: BCBS Healthlink |
$83.70
|
| Rate for Payer: BCBS HMK CHIP |
$83.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$83.70
|
| Rate for Payer: BCBS POS |
$88.35
|
| Rate for Payer: BCBS Traditional |
$93.00
|
| Rate for Payer: CASH_PRICE |
$74.40
|
| Rate for Payer: CIGNA Commercial |
$88.35
|
| Rate for Payer: CIGNA Medicare |
$83.70
|
| Rate for Payer: HUMANA Commercial |
$83.70
|
| Rate for Payer: MEDICAID Medicaid |
$85.56
|
| Rate for Payer: MEDICARE Medicare |
$65.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$88.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$90.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$88.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$88.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$79.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$74.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$74.40
|
|
|
VAC - INFLUENZA QUAD REGULAR DOSE CLINIC
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
VAC - INFLUENZA QUAD REGULAR DOSE CLINIC
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| 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
|
|
|
VAC-INFLUENZA QUAD REGULAR DOSE HOSPITAL
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
VAC-INFLUENZA QUAD REGULAR DOSE HOSPITAL
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
VAC - MEASLES, MUMPS & RUBELLA
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
VAC - MEASLES, MUMPS & RUBELLA
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS HMK CHIP |
$31.50
|
| Rate for Payer: AETNA Commercial |
$33.25
|
| Rate for Payer: AETNA Medicare |
$31.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$33.25
|
| Rate for Payer: BCBS Healthlink |
$31.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$31.50
|
| Rate for Payer: BCBS POS |
$33.25
|
| Rate for Payer: BCBS Traditional |
$35.00
|
| Rate for Payer: CASH_PRICE |
$28.00
|
| Rate for Payer: CIGNA Commercial |
$33.25
|
| Rate for Payer: CIGNA Medicare |
$31.50
|
| Rate for Payer: HUMANA Commercial |
$31.50
|
| Rate for Payer: MEDICAID Medicaid |
$32.20
|
| Rate for Payer: MEDICARE Medicare |
$24.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$33.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$33.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$33.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$33.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$29.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.00
|
|
|
VAC - MENINGOCOCCAL [0.5 ML] MENQUADFI
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$380.10 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: AETNA Commercial |
$515.85
|
| Rate for Payer: AETNA Medicare |
$488.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$515.85
|
| Rate for Payer: BCBS Healthlink |
$488.70
|
| Rate for Payer: BCBS HMK CHIP |
$488.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$488.70
|
| Rate for Payer: BCBS POS |
$515.85
|
| Rate for Payer: BCBS Traditional |
$543.00
|
| Rate for Payer: CASH_PRICE |
$434.40
|
| Rate for Payer: CIGNA Commercial |
$515.85
|
| Rate for Payer: CIGNA Medicare |
$488.70
|
| Rate for Payer: HUMANA Commercial |
$488.70
|
| Rate for Payer: MEDICAID Medicaid |
$499.56
|
| Rate for Payer: MEDICARE Medicare |
$380.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$515.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$526.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$515.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$515.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$461.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$434.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$434.40
|
|
|
VAC - MENINGOCOCCAL [0.5 ML] MENQUADFI
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$380.10 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: AETNA Commercial |
$515.85
|
| Rate for Payer: AETNA Medicare |
$488.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$515.85
|
| Rate for Payer: BCBS Healthlink |
$488.70
|
| Rate for Payer: BCBS HMK CHIP |
$488.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$488.70
|
| Rate for Payer: BCBS POS |
$515.85
|
| Rate for Payer: BCBS Traditional |
$543.00
|
| Rate for Payer: CASH_PRICE |
$434.40
|
| Rate for Payer: CIGNA Commercial |
$515.85
|
| Rate for Payer: CIGNA Medicare |
$488.70
|
| Rate for Payer: HUMANA Commercial |
$488.70
|
| Rate for Payer: MEDICAID Medicaid |
$499.56
|
| Rate for Payer: MEDICARE Medicare |
$380.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$515.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$526.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$515.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$515.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$461.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$434.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$434.40
|
|
|
VAC - MENINGOCOCCAL GROUP B [0.5 ML]
|
Facility
IP
|
$571.00
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
VAC - MENINGOCOCCAL GROUP B [0.5 ML]
|
Facility
OP
|
$571.00
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
VAC - MMR-VARICELLA [0.5 ML]
|
Facility
IP
|
$597.00
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$417.90 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: AETNA Commercial |
$567.15
|
| Rate for Payer: AETNA Medicare |
$537.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$567.15
|
| Rate for Payer: BCBS Healthlink |
$537.30
|
| Rate for Payer: BCBS HMK CHIP |
$537.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$537.30
|
| Rate for Payer: BCBS POS |
$567.15
|
| Rate for Payer: BCBS Traditional |
$597.00
|
| Rate for Payer: CASH_PRICE |
$477.60
|
| Rate for Payer: CIGNA Commercial |
$567.15
|
| Rate for Payer: CIGNA Medicare |
$537.30
|
| Rate for Payer: HUMANA Commercial |
$537.30
|
| Rate for Payer: MEDICAID Medicaid |
$549.24
|
| Rate for Payer: MEDICARE Medicare |
$417.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$567.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$579.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$567.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$567.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$507.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$477.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$477.60
|
|
|
VAC - MMR-VARICELLA [0.5 ML]
|
Facility
OP
|
$597.00
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$417.90 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: AETNA Commercial |
$567.15
|
| Rate for Payer: AETNA Medicare |
$537.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$567.15
|
| Rate for Payer: BCBS Healthlink |
$537.30
|
| Rate for Payer: BCBS HMK CHIP |
$537.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$537.30
|
| Rate for Payer: BCBS POS |
$567.15
|
| Rate for Payer: BCBS Traditional |
$597.00
|
| Rate for Payer: CASH_PRICE |
$477.60
|
| Rate for Payer: CIGNA Commercial |
$567.15
|
| Rate for Payer: CIGNA Medicare |
$537.30
|
| Rate for Payer: HUMANA Commercial |
$537.30
|
| Rate for Payer: MEDICAID Medicaid |
$549.24
|
| Rate for Payer: MEDICARE Medicare |
$417.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$567.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$579.09
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$567.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$567.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$507.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$477.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$477.60
|
|
|
VAC - PNEUMOCOCCAL 13 [1 ML]
|
Facility
OP
|
$625.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: AETNA Commercial |
$593.75
|
| Rate for Payer: AETNA Medicare |
$562.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$593.75
|
| Rate for Payer: BCBS Healthlink |
$562.50
|
| Rate for Payer: BCBS HMK CHIP |
$562.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$562.50
|
| Rate for Payer: BCBS POS |
$593.75
|
| Rate for Payer: BCBS Traditional |
$625.00
|
| Rate for Payer: CASH_PRICE |
$500.00
|
| Rate for Payer: CIGNA Commercial |
$593.75
|
| Rate for Payer: CIGNA Medicare |
$562.50
|
| Rate for Payer: HUMANA Commercial |
$562.50
|
| Rate for Payer: MEDICAID Medicaid |
$575.00
|
| Rate for Payer: MEDICARE Medicare |
$437.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$593.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$606.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$593.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$593.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$531.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$500.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$500.00
|
|
|
VAC - PNEUMOCOCCAL 13 [1 ML]
|
Facility
IP
|
$625.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: AETNA Commercial |
$593.75
|
| Rate for Payer: AETNA Medicare |
$562.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$593.75
|
| Rate for Payer: BCBS Healthlink |
$562.50
|
| Rate for Payer: BCBS HMK CHIP |
$562.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$562.50
|
| Rate for Payer: BCBS POS |
$593.75
|
| Rate for Payer: BCBS Traditional |
$625.00
|
| Rate for Payer: CASH_PRICE |
$500.00
|
| Rate for Payer: CIGNA Commercial |
$593.75
|
| Rate for Payer: CIGNA Medicare |
$562.50
|
| Rate for Payer: HUMANA Commercial |
$562.50
|
| Rate for Payer: MEDICAID Medicaid |
$575.00
|
| Rate for Payer: MEDICARE Medicare |
$437.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$593.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$606.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$593.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$593.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$531.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$500.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$500.00
|
|
|
VAC - PNEUMOCOCCAL 20 (0.5 ML)
|
Facility
OP
|
$579.00
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$405.30 |
| Max. Negotiated Rate |
$579.00 |
| Rate for Payer: AETNA Commercial |
$550.05
|
| Rate for Payer: AETNA Medicare |
$521.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$550.05
|
| Rate for Payer: BCBS Healthlink |
$521.10
|
| Rate for Payer: BCBS HMK CHIP |
$521.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$521.10
|
| Rate for Payer: BCBS POS |
$550.05
|
| Rate for Payer: BCBS Traditional |
$579.00
|
| Rate for Payer: CASH_PRICE |
$463.20
|
| Rate for Payer: CIGNA Commercial |
$550.05
|
| Rate for Payer: CIGNA Medicare |
$521.10
|
| Rate for Payer: HUMANA Commercial |
$521.10
|
| Rate for Payer: MEDICAID Medicaid |
$532.68
|
| Rate for Payer: MEDICARE Medicare |
$405.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$550.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$561.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$550.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$550.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$492.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$463.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$463.20
|
|
|
VAC - PNEUMOCOCCAL 20 (0.5 ML)
|
Facility
IP
|
$579.00
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$405.30 |
| Max. Negotiated Rate |
$579.00 |
| Rate for Payer: AETNA Commercial |
$550.05
|
| Rate for Payer: AETNA Medicare |
$521.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$550.05
|
| Rate for Payer: BCBS Healthlink |
$521.10
|
| Rate for Payer: BCBS HMK CHIP |
$521.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$521.10
|
| Rate for Payer: BCBS POS |
$550.05
|
| Rate for Payer: BCBS Traditional |
$579.00
|
| Rate for Payer: CASH_PRICE |
$463.20
|
| Rate for Payer: CIGNA Commercial |
$550.05
|
| Rate for Payer: CIGNA Medicare |
$521.10
|
| Rate for Payer: HUMANA Commercial |
$521.10
|
| Rate for Payer: MEDICAID Medicaid |
$532.68
|
| Rate for Payer: MEDICARE Medicare |
$405.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$550.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$561.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$550.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$550.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$492.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$463.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$463.20
|
|
|
VAC - PNEUMOVAX 23 INJ [0.5 ML]
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: AETNA Commercial |
$427.50
|
| Rate for Payer: AETNA Medicare |
$405.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$427.50
|
| Rate for Payer: BCBS Healthlink |
$405.00
|
| Rate for Payer: BCBS HMK CHIP |
$405.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$405.00
|
| Rate for Payer: BCBS POS |
$427.50
|
| Rate for Payer: BCBS Traditional |
$450.00
|
| Rate for Payer: CASH_PRICE |
$360.00
|
| Rate for Payer: CIGNA Commercial |
$427.50
|
| Rate for Payer: CIGNA Medicare |
$405.00
|
| Rate for Payer: HUMANA Commercial |
$405.00
|
| Rate for Payer: MEDICAID Medicaid |
$414.00
|
| Rate for Payer: MEDICARE Medicare |
$315.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$427.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$436.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$427.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$427.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$382.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$360.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$360.00
|
|
|
VAC - PNEUMOVAX 23 INJ [0.5 ML]
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: AETNA Commercial |
$427.50
|
| Rate for Payer: AETNA Medicare |
$405.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$427.50
|
| Rate for Payer: BCBS Healthlink |
$405.00
|
| Rate for Payer: BCBS HMK CHIP |
$405.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$405.00
|
| Rate for Payer: BCBS POS |
$427.50
|
| Rate for Payer: BCBS Traditional |
$450.00
|
| Rate for Payer: CASH_PRICE |
$360.00
|
| Rate for Payer: CIGNA Commercial |
$427.50
|
| Rate for Payer: CIGNA Medicare |
$405.00
|
| Rate for Payer: HUMANA Commercial |
$405.00
|
| Rate for Payer: MEDICAID Medicaid |
$414.00
|
| Rate for Payer: MEDICARE Medicare |
$315.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$427.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$436.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$427.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$427.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$382.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$360.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$360.00
|
|
|
VAC - ROTAVIRUS SUSP [1 ML] ROTATEQ
|
Facility
IP
|
$357.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: AETNA Commercial |
$339.15
|
| Rate for Payer: AETNA Medicare |
$321.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$339.15
|
| Rate for Payer: BCBS Healthlink |
$321.30
|
| Rate for Payer: BCBS HMK CHIP |
$321.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$321.30
|
| Rate for Payer: BCBS POS |
$339.15
|
| Rate for Payer: BCBS Traditional |
$357.00
|
| Rate for Payer: CASH_PRICE |
$285.60
|
| Rate for Payer: CIGNA Commercial |
$339.15
|
| Rate for Payer: CIGNA Medicare |
$321.30
|
| Rate for Payer: HUMANA Commercial |
$321.30
|
| Rate for Payer: MEDICAID Medicaid |
$328.44
|
| Rate for Payer: MEDICARE Medicare |
$249.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$339.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$346.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$339.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$339.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$303.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$285.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$285.60
|
|
|
VAC - ROTAVIRUS SUSP [1 ML] ROTATEQ
|
Facility
OP
|
$357.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: AETNA Commercial |
$339.15
|
| Rate for Payer: AETNA Medicare |
$321.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$339.15
|
| Rate for Payer: BCBS Healthlink |
$321.30
|
| Rate for Payer: BCBS HMK CHIP |
$321.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$321.30
|
| Rate for Payer: BCBS POS |
$339.15
|
| Rate for Payer: BCBS Traditional |
$357.00
|
| Rate for Payer: CASH_PRICE |
$285.60
|
| Rate for Payer: CIGNA Commercial |
$339.15
|
| Rate for Payer: CIGNA Medicare |
$321.30
|
| Rate for Payer: HUMANA Commercial |
$321.30
|
| Rate for Payer: MEDICAID Medicaid |
$328.44
|
| Rate for Payer: MEDICARE Medicare |
$249.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$339.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$346.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$339.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$339.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$303.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$285.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$285.60
|
|
|
VAC - TETANUS DIP PERTUSSIS - TDAP
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: AETNA Commercial |
$190.00
|
| Rate for Payer: AETNA Medicare |
$180.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.00
|
| Rate for Payer: BCBS Healthlink |
$180.00
|
| Rate for Payer: BCBS HMK CHIP |
$180.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.00
|
| Rate for Payer: BCBS POS |
$190.00
|
| Rate for Payer: BCBS Traditional |
$200.00
|
| Rate for Payer: CASH_PRICE |
$160.00
|
| Rate for Payer: CIGNA Commercial |
$190.00
|
| Rate for Payer: CIGNA Medicare |
$180.00
|
| Rate for Payer: HUMANA Commercial |
$180.00
|
| Rate for Payer: MEDICAID Medicaid |
$184.00
|
| Rate for Payer: MEDICARE Medicare |
$140.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.00
|
|
|
VAC - TETANUS DIP PERTUSSIS - TDAP
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
20230717
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: AETNA Commercial |
$190.00
|
| Rate for Payer: AETNA Medicare |
$180.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$190.00
|
| Rate for Payer: BCBS Healthlink |
$180.00
|
| Rate for Payer: BCBS HMK CHIP |
$180.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$180.00
|
| Rate for Payer: BCBS POS |
$190.00
|
| Rate for Payer: BCBS Traditional |
$200.00
|
| Rate for Payer: CASH_PRICE |
$160.00
|
| Rate for Payer: CIGNA Commercial |
$190.00
|
| Rate for Payer: CIGNA Medicare |
$180.00
|
| Rate for Payer: HUMANA Commercial |
$180.00
|
| Rate for Payer: MEDICAID Medicaid |
$184.00
|
| Rate for Payer: MEDICARE Medicare |
$140.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$190.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$194.00
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$190.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$190.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$170.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$160.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$160.00
|
|
