|
CLIN DIPHENHYDRAMINE LIQUID 12.5MG / 5ML
|
Facility
IP
|
$7.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS HMK CHIP |
$6.30
|
| Rate for Payer: AETNA Commercial |
$6.65
|
| Rate for Payer: AETNA Medicare |
$6.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6.65
|
| Rate for Payer: BCBS Healthlink |
$6.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6.30
|
| Rate for Payer: BCBS POS |
$6.65
|
| Rate for Payer: BCBS Traditional |
$7.00
|
| Rate for Payer: CASH_PRICE |
$5.60
|
| Rate for Payer: CIGNA Commercial |
$6.65
|
| Rate for Payer: CIGNA Medicare |
$6.30
|
| Rate for Payer: HUMANA Commercial |
$6.30
|
| Rate for Payer: MEDICAID Medicaid |
$6.44
|
| Rate for Payer: MEDICARE Medicare |
$4.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5.60
|
|
|
CLIN DIPHENHYDRAMINE LIQUID 12.5MG / 5ML
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: AETNA Commercial |
$6.65
|
| Rate for Payer: AETNA Medicare |
$6.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6.65
|
| Rate for Payer: BCBS Healthlink |
$6.30
|
| Rate for Payer: BCBS HMK CHIP |
$6.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6.30
|
| Rate for Payer: BCBS POS |
$6.65
|
| Rate for Payer: BCBS Traditional |
$7.00
|
| Rate for Payer: CASH_PRICE |
$5.60
|
| Rate for Payer: CIGNA Commercial |
$6.65
|
| Rate for Payer: CIGNA Medicare |
$6.30
|
| Rate for Payer: HUMANA Commercial |
$6.30
|
| Rate for Payer: MEDICAID Medicaid |
$6.44
|
| Rate for Payer: MEDICARE Medicare |
$4.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5.60
|
|
|
CLIN DOCUSATE LIQUID [50 MG/5 ML] CUP
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CLIN DOCUSATE LIQUID [50 MG/5 ML] CUP
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CLIN IBUPROFEN LIQUID 100MG / 5ML
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
CLIN IBUPROFEN LIQUID 100MG / 5ML
|
Facility
IP
|
$22.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: BCBS HMK CHIP |
$19.80
|
| Rate for Payer: AETNA Commercial |
$20.90
|
| Rate for Payer: AETNA Medicare |
$19.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$20.90
|
| Rate for Payer: BCBS Healthlink |
$19.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$19.80
|
| Rate for Payer: BCBS POS |
$20.90
|
| Rate for Payer: BCBS Traditional |
$22.00
|
| Rate for Payer: CASH_PRICE |
$17.60
|
| Rate for Payer: CIGNA Commercial |
$20.90
|
| Rate for Payer: CIGNA Medicare |
$19.80
|
| Rate for Payer: HUMANA Commercial |
$19.80
|
| Rate for Payer: MEDICAID Medicaid |
$20.24
|
| Rate for Payer: MEDICARE Medicare |
$15.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$20.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$21.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$20.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$20.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$18.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$17.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$17.60
|
|
|
CLINIC - ED PRO FEE BRIEF
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
CLINIC - ED PRO FEE BRIEF
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: AETNA Commercial |
$80.75
|
| Rate for Payer: AETNA Medicare |
$76.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$80.75
|
| Rate for Payer: BCBS Healthlink |
$76.50
|
| Rate for Payer: BCBS HMK CHIP |
$76.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$76.50
|
| Rate for Payer: BCBS POS |
$80.75
|
| Rate for Payer: BCBS Traditional |
$85.00
|
| Rate for Payer: CASH_PRICE |
$68.00
|
| Rate for Payer: CIGNA Commercial |
$80.75
|
| Rate for Payer: CIGNA Medicare |
$76.50
|
| Rate for Payer: HUMANA Commercial |
$76.50
|
| Rate for Payer: MEDICAID Medicaid |
$78.20
|
| Rate for Payer: MEDICARE Medicare |
$59.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$80.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$82.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$80.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$72.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$68.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$68.00
|
|
|
CLINIC - PRO FEE ED COMPREHENSIVE
|
Facility
IP
|
$385.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: BCBS HMK CHIP |
$346.50
|
| Rate for Payer: AETNA Commercial |
$365.75
|
| Rate for Payer: AETNA Medicare |
$346.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$365.75
|
| Rate for Payer: BCBS Healthlink |
$346.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$346.50
|
| Rate for Payer: BCBS POS |
$365.75
|
| Rate for Payer: BCBS Traditional |
$385.00
|
| Rate for Payer: CASH_PRICE |
$308.00
|
| Rate for Payer: CIGNA Commercial |
$365.75
|
| Rate for Payer: CIGNA Medicare |
$346.50
|
| Rate for Payer: HUMANA Commercial |
$346.50
|
| Rate for Payer: MEDICAID Medicaid |
$354.20
|
| Rate for Payer: MEDICARE Medicare |
$269.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$365.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$373.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$365.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$365.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$327.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$308.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$308.00
|
|
|
CLINIC - PRO FEE ED COMPREHENSIVE
|
Facility
OP
|
$385.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: AETNA Commercial |
$365.75
|
| Rate for Payer: AETNA Medicare |
$346.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$365.75
|
| Rate for Payer: BCBS Healthlink |
$346.50
|
| Rate for Payer: BCBS HMK CHIP |
$346.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$346.50
|
| Rate for Payer: BCBS POS |
$365.75
|
| Rate for Payer: BCBS Traditional |
$385.00
|
| Rate for Payer: CASH_PRICE |
$308.00
|
| Rate for Payer: CIGNA Commercial |
$365.75
|
| Rate for Payer: CIGNA Medicare |
$346.50
|
| Rate for Payer: HUMANA Commercial |
$346.50
|
| Rate for Payer: MEDICAID Medicaid |
$354.20
|
| Rate for Payer: MEDICARE Medicare |
$269.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$365.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$373.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$365.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$365.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$327.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$308.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$308.00
|
|
|
CLINIC - PRO FEE ED CRITICAL CARE 1ST HR
|
Facility
IP
|
$572.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: AETNA Commercial |
$543.40
|
| Rate for Payer: AETNA Medicare |
$514.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$543.40
|
| Rate for Payer: BCBS Healthlink |
$514.80
|
| Rate for Payer: BCBS HMK CHIP |
$514.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$514.80
|
| Rate for Payer: BCBS POS |
$543.40
|
| Rate for Payer: BCBS Traditional |
$572.00
|
| Rate for Payer: CASH_PRICE |
$457.60
|
| Rate for Payer: CIGNA Commercial |
$543.40
|
| Rate for Payer: CIGNA Medicare |
$514.80
|
| Rate for Payer: HUMANA Commercial |
$514.80
|
| Rate for Payer: MEDICAID Medicaid |
$526.24
|
| Rate for Payer: MEDICARE Medicare |
$400.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$543.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$554.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$543.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$543.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$486.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$457.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$457.60
|
|
|
CLINIC - PRO FEE ED CRITICAL CARE 1ST HR
|
Facility
OP
|
$572.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: AETNA Commercial |
$543.40
|
| Rate for Payer: AETNA Medicare |
$514.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$543.40
|
| Rate for Payer: BCBS Healthlink |
$514.80
|
| Rate for Payer: BCBS HMK CHIP |
$514.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$514.80
|
| Rate for Payer: BCBS POS |
$543.40
|
| Rate for Payer: BCBS Traditional |
$572.00
|
| Rate for Payer: CASH_PRICE |
$457.60
|
| Rate for Payer: CIGNA Commercial |
$543.40
|
| Rate for Payer: CIGNA Medicare |
$514.80
|
| Rate for Payer: HUMANA Commercial |
$514.80
|
| Rate for Payer: MEDICAID Medicaid |
$526.24
|
| Rate for Payer: MEDICARE Medicare |
$400.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$543.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$554.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$543.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$543.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$486.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$457.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$457.60
|
|
|
CLINIC - PRO FEE ED EXTENDED
|
Facility
OP
|
$261.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: AETNA Commercial |
$247.95
|
| Rate for Payer: AETNA Medicare |
$234.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$247.95
|
| Rate for Payer: BCBS Healthlink |
$234.90
|
| Rate for Payer: BCBS HMK CHIP |
$234.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$234.90
|
| Rate for Payer: BCBS POS |
$247.95
|
| Rate for Payer: BCBS Traditional |
$261.00
|
| Rate for Payer: CASH_PRICE |
$208.80
|
| Rate for Payer: CIGNA Commercial |
$247.95
|
| Rate for Payer: CIGNA Medicare |
$234.90
|
| Rate for Payer: HUMANA Commercial |
$234.90
|
| Rate for Payer: MEDICAID Medicaid |
$240.12
|
| Rate for Payer: MEDICARE Medicare |
$182.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$247.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$253.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$247.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$247.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$221.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$208.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$208.80
|
|
|
CLINIC - PRO FEE ED EXTENDED
|
Facility
IP
|
$261.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: BCBS HMK CHIP |
$234.90
|
| Rate for Payer: AETNA Commercial |
$247.95
|
| Rate for Payer: AETNA Medicare |
$234.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$247.95
|
| Rate for Payer: BCBS Healthlink |
$234.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$234.90
|
| Rate for Payer: BCBS POS |
$247.95
|
| Rate for Payer: BCBS Traditional |
$261.00
|
| Rate for Payer: CASH_PRICE |
$208.80
|
| Rate for Payer: CIGNA Commercial |
$247.95
|
| Rate for Payer: CIGNA Medicare |
$234.90
|
| Rate for Payer: HUMANA Commercial |
$234.90
|
| Rate for Payer: MEDICAID Medicaid |
$240.12
|
| Rate for Payer: MEDICARE Medicare |
$182.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$247.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$253.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$247.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$247.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$221.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$208.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$208.80
|
|
|
CLINIC - PRO FEE ED INTERMEDIATE
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: AETNA Commercial |
$132.05
|
| Rate for Payer: AETNA Medicare |
$125.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$132.05
|
| Rate for Payer: BCBS Healthlink |
$125.10
|
| Rate for Payer: BCBS HMK CHIP |
$125.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$125.10
|
| Rate for Payer: BCBS POS |
$132.05
|
| Rate for Payer: BCBS Traditional |
$139.00
|
| Rate for Payer: CASH_PRICE |
$111.20
|
| Rate for Payer: CIGNA Commercial |
$132.05
|
| Rate for Payer: CIGNA Medicare |
$125.10
|
| Rate for Payer: HUMANA Commercial |
$125.10
|
| Rate for Payer: MEDICAID Medicaid |
$127.88
|
| Rate for Payer: MEDICARE Medicare |
$97.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$132.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$134.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$132.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$132.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
|
CLINIC - PRO FEE ED INTERMEDIATE
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: AETNA Commercial |
$132.05
|
| Rate for Payer: AETNA Medicare |
$125.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$132.05
|
| Rate for Payer: BCBS Healthlink |
$125.10
|
| Rate for Payer: BCBS HMK CHIP |
$125.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$125.10
|
| Rate for Payer: BCBS POS |
$132.05
|
| Rate for Payer: BCBS Traditional |
$139.00
|
| Rate for Payer: CASH_PRICE |
$111.20
|
| Rate for Payer: CIGNA Commercial |
$132.05
|
| Rate for Payer: CIGNA Medicare |
$125.10
|
| Rate for Payer: HUMANA Commercial |
$125.10
|
| Rate for Payer: MEDICAID Medicaid |
$127.88
|
| Rate for Payer: MEDICARE Medicare |
$97.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$132.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$134.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$132.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$132.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$118.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$111.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$111.20
|
|
|
CLINIC - PRO FEE ED LIMITED
|
Facility
IP
|
$95.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
CLINIC - PRO FEE ED LIMITED
|
Facility
OP
|
$95.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
CLIN LIDOCAINE VISCOUS 2% ORAL SLN UD
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CLIN LIDOCAINE VISCOUS 2% ORAL SLN UD
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CLIN NITROGLYCERIN OINT 2% 1G PACKET
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
CLIN NITROGLYCERIN OINT 2% 1G PACKET
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
CLIN NITROGLYCERIN SL TAB [0.4 MG]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CLIN NITROGLYCERIN SL TAB [0.4 MG]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
CLIN ONDANSETRON ODT [4 MG]
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT Q0162
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: BCBS HMK CHIP |
$70.20
|
| Rate for Payer: AETNA Commercial |
$74.10
|
| Rate for Payer: AETNA Medicare |
$70.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$74.10
|
| Rate for Payer: BCBS Healthlink |
$70.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$70.20
|
| Rate for Payer: BCBS POS |
$74.10
|
| Rate for Payer: BCBS Traditional |
$78.00
|
| Rate for Payer: CASH_PRICE |
$62.40
|
| Rate for Payer: CIGNA Commercial |
$74.10
|
| Rate for Payer: CIGNA Medicare |
$70.20
|
| Rate for Payer: HUMANA Commercial |
$70.20
|
| Rate for Payer: MEDICAID Medicaid |
$71.76
|
| Rate for Payer: MEDICARE Medicare |
$54.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$74.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$75.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$74.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$74.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$66.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$62.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$62.40
|
|
