|
DHEA SULFATE (004020)
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: AETNA Commercial |
$62.70
|
| Rate for Payer: AETNA Medicare |
$59.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$62.70
|
| Rate for Payer: BCBS Healthlink |
$59.40
|
| Rate for Payer: BCBS HMK CHIP |
$59.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$59.40
|
| Rate for Payer: BCBS POS |
$62.70
|
| Rate for Payer: BCBS Traditional |
$66.00
|
| Rate for Payer: CASH_PRICE |
$52.80
|
| Rate for Payer: CIGNA Commercial |
$62.70
|
| Rate for Payer: CIGNA Medicare |
$59.40
|
| Rate for Payer: HUMANA Commercial |
$59.40
|
| Rate for Payer: MEDICAID Medicaid |
$60.72
|
| Rate for Payer: MEDICARE Medicare |
$46.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$62.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$64.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$62.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$62.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$56.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$52.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$52.80
|
|
|
DIAZEPAM INJ SYR [10 MG/2 ML]
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: BCBS HMK CHIP |
$55.80
|
| Rate for Payer: AETNA Commercial |
$58.90
|
| Rate for Payer: AETNA Medicare |
$55.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$58.90
|
| Rate for Payer: BCBS Healthlink |
$55.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$55.80
|
| Rate for Payer: BCBS POS |
$58.90
|
| Rate for Payer: BCBS Traditional |
$62.00
|
| Rate for Payer: CASH_PRICE |
$49.60
|
| Rate for Payer: CIGNA Commercial |
$58.90
|
| Rate for Payer: CIGNA Medicare |
$55.80
|
| Rate for Payer: HUMANA Commercial |
$55.80
|
| Rate for Payer: MEDICAID Medicaid |
$57.04
|
| Rate for Payer: MEDICARE Medicare |
$43.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$58.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$60.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$58.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$58.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$52.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$49.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$49.60
|
|
|
DIAZEPAM INJ SYR [10 MG/2 ML]
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: AETNA Commercial |
$58.90
|
| Rate for Payer: AETNA Medicare |
$55.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$58.90
|
| Rate for Payer: BCBS Healthlink |
$55.80
|
| Rate for Payer: BCBS HMK CHIP |
$55.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$55.80
|
| Rate for Payer: BCBS POS |
$58.90
|
| Rate for Payer: BCBS Traditional |
$62.00
|
| Rate for Payer: CASH_PRICE |
$49.60
|
| Rate for Payer: CIGNA Commercial |
$58.90
|
| Rate for Payer: CIGNA Medicare |
$55.80
|
| Rate for Payer: HUMANA Commercial |
$55.80
|
| Rate for Payer: MEDICAID Medicaid |
$57.04
|
| Rate for Payer: MEDICARE Medicare |
$43.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$58.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$60.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$58.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$58.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$52.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$49.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$49.60
|
|
|
DIAZEPAM TAB [5 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
|
|
|
DIAZEPAM TAB [5 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
|
|
|
DICLOFENAC TAB DR [75 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
|
|
|
DICLOFENAC TAB DR [75 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
|
|
|
DICLOFENAC TOPICAL GEL [1 %] 50GM
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
DICLOFENAC TOPICAL GEL [1 %] 50GM
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: AETNA Commercial |
$57.95
|
| Rate for Payer: AETNA Medicare |
$54.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.95
|
| Rate for Payer: BCBS Healthlink |
$54.90
|
| Rate for Payer: BCBS HMK CHIP |
$54.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.90
|
| Rate for Payer: BCBS POS |
$57.95
|
| Rate for Payer: BCBS Traditional |
$61.00
|
| Rate for Payer: CASH_PRICE |
$48.80
|
| Rate for Payer: CIGNA Commercial |
$57.95
|
| Rate for Payer: CIGNA Medicare |
$54.90
|
| Rate for Payer: HUMANA Commercial |
$54.90
|
| Rate for Payer: MEDICAID Medicaid |
$56.12
|
| Rate for Payer: MEDICARE Medicare |
$42.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$59.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.80
|
|
|
DICYCLOMINE CAP [10 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
|
|
|
DICYCLOMINE CAP [10 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
|
|
|
DICYCLOMINE LIQ [10 MG/5 ML]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
DICYCLOMINE LIQ [10 MG/5 ML]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
DIGITAL NERVE BLOCK PERIPHERAL NERVE
|
Facility
IP
|
$601.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$420.70 |
| Max. Negotiated Rate |
$601.00 |
| Rate for Payer: BCBS HMK CHIP |
$540.90
|
| Rate for Payer: AETNA Commercial |
$570.95
|
| Rate for Payer: AETNA Medicare |
$540.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$570.95
|
| Rate for Payer: BCBS Healthlink |
$540.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$540.90
|
| Rate for Payer: BCBS POS |
$570.95
|
| Rate for Payer: BCBS Traditional |
$601.00
|
| Rate for Payer: CASH_PRICE |
$480.80
|
| Rate for Payer: CIGNA Commercial |
$570.95
|
| Rate for Payer: CIGNA Medicare |
$540.90
|
| Rate for Payer: HUMANA Commercial |
$540.90
|
| Rate for Payer: MEDICAID Medicaid |
$552.92
|
| Rate for Payer: MEDICARE Medicare |
$420.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$570.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$582.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$570.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$570.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$510.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$480.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$480.80
|
|
|
DIGITAL NERVE BLOCK PERIPHERAL NERVE
|
Facility
OP
|
$601.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$420.70 |
| Max. Negotiated Rate |
$601.00 |
| Rate for Payer: AETNA Commercial |
$570.95
|
| Rate for Payer: AETNA Medicare |
$540.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$570.95
|
| Rate for Payer: BCBS Healthlink |
$540.90
|
| Rate for Payer: BCBS HMK CHIP |
$540.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$540.90
|
| Rate for Payer: BCBS POS |
$570.95
|
| Rate for Payer: BCBS Traditional |
$601.00
|
| Rate for Payer: CASH_PRICE |
$480.80
|
| Rate for Payer: CIGNA Commercial |
$570.95
|
| Rate for Payer: CIGNA Medicare |
$540.90
|
| Rate for Payer: HUMANA Commercial |
$540.90
|
| Rate for Payer: MEDICAID Medicaid |
$552.92
|
| Rate for Payer: MEDICARE Medicare |
$420.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$570.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$582.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$570.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$570.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$510.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$480.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$480.80
|
|
|
DIGOXIN
|
Facility
IP
|
$144.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: AETNA Commercial |
$136.80
|
| Rate for Payer: AETNA Medicare |
$129.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$136.80
|
| Rate for Payer: BCBS Healthlink |
$129.60
|
| Rate for Payer: BCBS HMK CHIP |
$129.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$129.60
|
| Rate for Payer: BCBS POS |
$136.80
|
| Rate for Payer: BCBS Traditional |
$144.00
|
| Rate for Payer: CASH_PRICE |
$115.20
|
| Rate for Payer: CIGNA Commercial |
$136.80
|
| Rate for Payer: CIGNA Medicare |
$129.60
|
| Rate for Payer: HUMANA Commercial |
$129.60
|
| Rate for Payer: MEDICAID Medicaid |
$132.48
|
| Rate for Payer: MEDICARE Medicare |
$100.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$136.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$139.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$136.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$115.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$115.20
|
|
|
DIGOXIN
|
Facility
OP
|
$144.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: AETNA Commercial |
$136.80
|
| Rate for Payer: AETNA Medicare |
$129.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$136.80
|
| Rate for Payer: BCBS Healthlink |
$129.60
|
| Rate for Payer: BCBS HMK CHIP |
$129.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$129.60
|
| Rate for Payer: BCBS POS |
$136.80
|
| Rate for Payer: BCBS Traditional |
$144.00
|
| Rate for Payer: CASH_PRICE |
$115.20
|
| Rate for Payer: CIGNA Commercial |
$136.80
|
| Rate for Payer: CIGNA Medicare |
$129.60
|
| Rate for Payer: HUMANA Commercial |
$129.60
|
| Rate for Payer: MEDICAID Medicaid |
$132.48
|
| Rate for Payer: MEDICARE Medicare |
$100.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$136.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$139.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$136.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$136.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$122.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$115.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$115.20
|
|
|
DIGOXIN INJ [500 MCG/2 ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
DIGOXIN INJ [500 MCG/2 ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J1160
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| 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 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
|
|
|
DIGOXIN TAB [0.125 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
|
|
|
DIGOXIN TAB [0.125 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
|
|
|
DIHYDROTESTOSTERONE (500142)
|
Facility
IP
|
$236.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: BCBS HMK CHIP |
$212.40
|
| Rate for Payer: AETNA Commercial |
$224.20
|
| Rate for Payer: AETNA Medicare |
$212.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$224.20
|
| Rate for Payer: BCBS Healthlink |
$212.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$212.40
|
| Rate for Payer: BCBS POS |
$224.20
|
| Rate for Payer: BCBS Traditional |
$236.00
|
| Rate for Payer: CASH_PRICE |
$188.80
|
| Rate for Payer: CIGNA Commercial |
$224.20
|
| Rate for Payer: CIGNA Medicare |
$212.40
|
| Rate for Payer: HUMANA Commercial |
$212.40
|
| Rate for Payer: MEDICAID Medicaid |
$217.12
|
| Rate for Payer: MEDICARE Medicare |
$165.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$224.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$228.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$224.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$224.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$200.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.80
|
|
|
DIHYDROTESTOSTERONE (500142)
|
Facility
OP
|
$236.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: AETNA Commercial |
$224.20
|
| Rate for Payer: AETNA Medicare |
$212.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$224.20
|
| Rate for Payer: BCBS Healthlink |
$212.40
|
| Rate for Payer: BCBS HMK CHIP |
$212.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$212.40
|
| Rate for Payer: BCBS POS |
$224.20
|
| Rate for Payer: BCBS Traditional |
$236.00
|
| Rate for Payer: CASH_PRICE |
$188.80
|
| Rate for Payer: CIGNA Commercial |
$224.20
|
| Rate for Payer: CIGNA Medicare |
$212.40
|
| Rate for Payer: HUMANA Commercial |
$212.40
|
| Rate for Payer: MEDICAID Medicaid |
$217.12
|
| Rate for Payer: MEDICARE Medicare |
$165.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$224.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$228.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$224.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$224.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$200.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.80
|
|
|
DILTIAZEM 30MG TABLET-NF
|
Facility
IP
|
$8.00
|
|
| 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
|
|
|
DILTIAZEM 30MG TABLET-NF
|
Facility
OP
|
$8.00
|
|
| 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
|
|
