|
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
|
|
|
CLIN TETRACAINE OPTH 0.5% 4ML
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
CLIN TETRACAINE OPTH 0.5% 4ML
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
CLIN TRIAMCINOLONE INJ [40 MG/ML]
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
CLIN TRIAMCINOLONE INJ [40 MG/ML]
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
CLOBETASOL PROPIONATE CREAM [0.05%] NF
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$301.70 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: AETNA Commercial |
$409.45
|
| Rate for Payer: AETNA Medicare |
$387.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$409.45
|
| Rate for Payer: BCBS Healthlink |
$387.90
|
| Rate for Payer: BCBS HMK CHIP |
$387.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$387.90
|
| Rate for Payer: BCBS POS |
$409.45
|
| Rate for Payer: BCBS Traditional |
$431.00
|
| Rate for Payer: CASH_PRICE |
$344.80
|
| Rate for Payer: CIGNA Commercial |
$409.45
|
| Rate for Payer: CIGNA Medicare |
$387.90
|
| Rate for Payer: HUMANA Commercial |
$387.90
|
| Rate for Payer: MEDICAID Medicaid |
$396.52
|
| Rate for Payer: MEDICARE Medicare |
$301.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$409.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$418.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$409.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$409.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$366.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$344.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$344.80
|
|
|
CLOBETASOL PROPIONATE CREAM [0.05%] NF
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$301.70 |
| Max. Negotiated Rate |
$431.00 |
| Rate for Payer: AETNA Commercial |
$409.45
|
| Rate for Payer: AETNA Medicare |
$387.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$409.45
|
| Rate for Payer: BCBS Healthlink |
$387.90
|
| Rate for Payer: BCBS HMK CHIP |
$387.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$387.90
|
| Rate for Payer: BCBS POS |
$409.45
|
| Rate for Payer: BCBS Traditional |
$431.00
|
| Rate for Payer: CASH_PRICE |
$344.80
|
| Rate for Payer: CIGNA Commercial |
$409.45
|
| Rate for Payer: CIGNA Medicare |
$387.90
|
| Rate for Payer: HUMANA Commercial |
$387.90
|
| Rate for Payer: MEDICAID Medicaid |
$396.52
|
| Rate for Payer: MEDICARE Medicare |
$301.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$409.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$418.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$409.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$409.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$366.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$344.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$344.80
|
|
|
CLONAZEPAM TAB [1 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CLONAZEPAM TAB [1 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CLONIDINE PATCH [0.1 MG/24 HR]
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: AETNA Commercial |
$105.45
|
| Rate for Payer: AETNA Medicare |
$99.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$105.45
|
| Rate for Payer: BCBS Healthlink |
$99.90
|
| Rate for Payer: BCBS HMK CHIP |
$99.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$99.90
|
| Rate for Payer: BCBS POS |
$105.45
|
| Rate for Payer: BCBS Traditional |
$111.00
|
| Rate for Payer: CASH_PRICE |
$88.80
|
| Rate for Payer: CIGNA Commercial |
$105.45
|
| Rate for Payer: CIGNA Medicare |
$99.90
|
| Rate for Payer: HUMANA Commercial |
$99.90
|
| Rate for Payer: MEDICAID Medicaid |
$102.12
|
| Rate for Payer: MEDICARE Medicare |
$77.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$105.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$107.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$105.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$105.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$94.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$88.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$88.80
|
|
|
CLONIDINE PATCH [0.1 MG/24 HR]
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: AETNA Commercial |
$105.45
|
| Rate for Payer: AETNA Medicare |
$99.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$105.45
|
| Rate for Payer: BCBS Healthlink |
$99.90
|
| Rate for Payer: BCBS HMK CHIP |
$99.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$99.90
|
| Rate for Payer: BCBS POS |
$105.45
|
| Rate for Payer: BCBS Traditional |
$111.00
|
| Rate for Payer: CASH_PRICE |
$88.80
|
| Rate for Payer: CIGNA Commercial |
$105.45
|
| Rate for Payer: CIGNA Medicare |
$99.90
|
| Rate for Payer: HUMANA Commercial |
$99.90
|
| Rate for Payer: MEDICAID Medicaid |
$102.12
|
| Rate for Payer: MEDICARE Medicare |
$77.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$105.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$107.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$105.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$105.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$94.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$88.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$88.80
|
|
|
CLONIDINE PATCH [0.2 MG/24 HR]
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
CLONIDINE PATCH [0.2 MG/24 HR]
|
Facility
IP
|
$187.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: BCBS HMK CHIP |
$168.30
|
| Rate for Payer: AETNA Commercial |
$177.65
|
| Rate for Payer: AETNA Medicare |
$168.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$177.65
|
| Rate for Payer: BCBS Healthlink |
$168.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$168.30
|
| Rate for Payer: BCBS POS |
$177.65
|
| Rate for Payer: BCBS Traditional |
$187.00
|
| Rate for Payer: CASH_PRICE |
$149.60
|
| Rate for Payer: CIGNA Commercial |
$177.65
|
| Rate for Payer: CIGNA Medicare |
$168.30
|
| Rate for Payer: HUMANA Commercial |
$168.30
|
| Rate for Payer: MEDICAID Medicaid |
$172.04
|
| Rate for Payer: MEDICARE Medicare |
$130.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$177.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$181.39
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$177.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$177.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$158.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$149.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$149.60
|
|
|
CLONIDINE TAB [0.1 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CLONIDINE TAB [0.1 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CLOPIDOGREL TAB [75 MG]
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
CLOPIDOGREL TAB [75 MG]
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
CLOSED TREAT RADIAL HEAD W/O MANI
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: AETNA Commercial |
$584.25
|
| Rate for Payer: AETNA Medicare |
$553.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$584.25
|
| Rate for Payer: BCBS Healthlink |
$553.50
|
| Rate for Payer: BCBS HMK CHIP |
$553.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$553.50
|
| Rate for Payer: BCBS POS |
$584.25
|
| Rate for Payer: BCBS Traditional |
$615.00
|
| Rate for Payer: CASH_PRICE |
$492.00
|
| Rate for Payer: CIGNA Commercial |
$584.25
|
| Rate for Payer: CIGNA Medicare |
$553.50
|
| Rate for Payer: HUMANA Commercial |
$553.50
|
| Rate for Payer: MEDICAID Medicaid |
$565.80
|
| Rate for Payer: MEDICARE Medicare |
$430.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$584.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$596.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$584.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$584.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$522.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$492.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$492.00
|
|
|
CLOSED TREAT RADIAL HEAD W/O MANI
|
Facility
OP
|
$615.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: AETNA Commercial |
$584.25
|
| Rate for Payer: AETNA Medicare |
$553.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$584.25
|
| Rate for Payer: BCBS Healthlink |
$553.50
|
| Rate for Payer: BCBS HMK CHIP |
$553.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$553.50
|
| Rate for Payer: BCBS POS |
$584.25
|
| Rate for Payer: BCBS Traditional |
$615.00
|
| Rate for Payer: CASH_PRICE |
$492.00
|
| Rate for Payer: CIGNA Commercial |
$584.25
|
| Rate for Payer: CIGNA Medicare |
$553.50
|
| Rate for Payer: HUMANA Commercial |
$553.50
|
| Rate for Payer: MEDICAID Medicaid |
$565.80
|
| Rate for Payer: MEDICARE Medicare |
$430.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$584.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$596.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$584.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$584.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$522.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$492.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$492.00
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
OP
|
$623.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: AETNA Commercial |
$591.85
|
| Rate for Payer: AETNA Medicare |
$560.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$591.85
|
| Rate for Payer: BCBS Healthlink |
$560.70
|
| Rate for Payer: BCBS HMK CHIP |
$560.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$560.70
|
| Rate for Payer: BCBS POS |
$591.85
|
| Rate for Payer: BCBS Traditional |
$623.00
|
| Rate for Payer: CASH_PRICE |
$498.40
|
| Rate for Payer: CIGNA Commercial |
$591.85
|
| Rate for Payer: CIGNA Medicare |
$560.70
|
| Rate for Payer: HUMANA Commercial |
$560.70
|
| Rate for Payer: MEDICAID Medicaid |
$573.16
|
| Rate for Payer: MEDICARE Medicare |
$436.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$591.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$604.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$591.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$591.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$529.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$498.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$498.40
|
|
|
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
Facility
IP
|
$623.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: BCBS HMK CHIP |
$560.70
|
| Rate for Payer: AETNA Commercial |
$591.85
|
| Rate for Payer: AETNA Medicare |
$560.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$591.85
|
| Rate for Payer: BCBS Healthlink |
$560.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$560.70
|
| Rate for Payer: BCBS POS |
$591.85
|
| Rate for Payer: BCBS Traditional |
$623.00
|
| Rate for Payer: CASH_PRICE |
$498.40
|
| Rate for Payer: CIGNA Commercial |
$591.85
|
| Rate for Payer: CIGNA Medicare |
$560.70
|
| Rate for Payer: HUMANA Commercial |
$560.70
|
| Rate for Payer: MEDICAID Medicaid |
$573.16
|
| Rate for Payer: MEDICARE Medicare |
$436.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$591.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$604.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$591.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$591.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$529.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$498.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$498.40
|
|
|
CMV ANTIBODIES, IGG (006494)
|
Facility
OP
|
$37.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
CMV ANTIBODIES, IGG (006494)
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: AETNA Commercial |
$35.15
|
| Rate for Payer: AETNA Medicare |
$33.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$35.15
|
| Rate for Payer: BCBS Healthlink |
$33.30
|
| Rate for Payer: BCBS HMK CHIP |
$33.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$33.30
|
| Rate for Payer: BCBS POS |
$35.15
|
| Rate for Payer: BCBS Traditional |
$37.00
|
| Rate for Payer: CASH_PRICE |
$29.60
|
| Rate for Payer: CIGNA Commercial |
$35.15
|
| Rate for Payer: CIGNA Medicare |
$33.30
|
| Rate for Payer: HUMANA Commercial |
$33.30
|
| Rate for Payer: MEDICAID Medicaid |
$34.04
|
| Rate for Payer: MEDICARE Medicare |
$25.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$35.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$35.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$35.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$35.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$31.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$29.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$29.60
|
|
|
CMV ANTIBODIES, IGM (096727)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
|
CMV ANTIBODIES, IGM (096727)
|
Facility
IP
|
$39.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: BCBS HMK CHIP |
$35.10
|
| Rate for Payer: AETNA Commercial |
$37.05
|
| Rate for Payer: AETNA Medicare |
$35.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$37.05
|
| Rate for Payer: BCBS Healthlink |
$35.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$35.10
|
| Rate for Payer: BCBS POS |
$37.05
|
| Rate for Payer: BCBS Traditional |
$39.00
|
| Rate for Payer: CASH_PRICE |
$31.20
|
| Rate for Payer: CIGNA Commercial |
$37.05
|
| Rate for Payer: CIGNA Medicare |
$35.10
|
| Rate for Payer: HUMANA Commercial |
$35.10
|
| Rate for Payer: MEDICAID Medicaid |
$35.88
|
| Rate for Payer: MEDICARE Medicare |
$27.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$37.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$37.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$37.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$37.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$33.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$31.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$31.20
|
|
