|
ALENDRONATE TAB [70 MG]
|
Facility
OP
|
$69.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
ALENDRONATE TAB [70 MG]
|
Facility
IP
|
$69.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: AETNA Commercial |
$65.55
|
| Rate for Payer: AETNA Medicare |
$62.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$65.55
|
| Rate for Payer: BCBS Healthlink |
$62.10
|
| Rate for Payer: BCBS HMK CHIP |
$62.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$62.10
|
| Rate for Payer: BCBS POS |
$65.55
|
| Rate for Payer: BCBS Traditional |
$69.00
|
| Rate for Payer: CASH_PRICE |
$55.20
|
| Rate for Payer: CIGNA Commercial |
$65.55
|
| Rate for Payer: CIGNA Medicare |
$62.10
|
| Rate for Payer: HUMANA Commercial |
$62.10
|
| Rate for Payer: MEDICAID Medicaid |
$63.48
|
| Rate for Payer: MEDICARE Medicare |
$48.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$65.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$66.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$65.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$65.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$58.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$55.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$55.20
|
|
|
ALFUZOSIN ER 10MG TAB NON FORMULARY
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
ALFUZOSIN ER 10MG TAB NON FORMULARY
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
.ALKALINE PHOS ISOENZYMES (001612)
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
.ALKALINE PHOS ISOENZYMES (001612)
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
ALKALINE PHOSPHATASE
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
ALKALINE PHOSPHATASE
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: AETNA Commercial |
$53.20
|
| Rate for Payer: AETNA Medicare |
$50.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$53.20
|
| Rate for Payer: BCBS Healthlink |
$50.40
|
| Rate for Payer: BCBS HMK CHIP |
$50.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$50.40
|
| Rate for Payer: BCBS POS |
$53.20
|
| Rate for Payer: BCBS Traditional |
$56.00
|
| Rate for Payer: CASH_PRICE |
$44.80
|
| Rate for Payer: CIGNA Commercial |
$53.20
|
| Rate for Payer: CIGNA Medicare |
$50.40
|
| Rate for Payer: HUMANA Commercial |
$50.40
|
| Rate for Payer: MEDICAID Medicaid |
$51.52
|
| Rate for Payer: MEDICARE Medicare |
$39.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$53.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$54.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$53.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$53.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$47.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$44.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$44.80
|
|
|
.ALKALINE PHOS TOTAL (001612)
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
.ALKALINE PHOS TOTAL (001612)
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: AETNA Commercial |
$16.15
|
| Rate for Payer: AETNA Medicare |
$15.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$16.15
|
| Rate for Payer: BCBS Healthlink |
$15.30
|
| Rate for Payer: BCBS HMK CHIP |
$15.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$15.30
|
| Rate for Payer: BCBS POS |
$16.15
|
| Rate for Payer: BCBS Traditional |
$17.00
|
| Rate for Payer: CASH_PRICE |
$13.60
|
| Rate for Payer: CIGNA Commercial |
$16.15
|
| Rate for Payer: CIGNA Medicare |
$15.30
|
| Rate for Payer: HUMANA Commercial |
$15.30
|
| Rate for Payer: MEDICAID Medicaid |
$15.64
|
| Rate for Payer: MEDICARE Medicare |
$11.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$16.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$16.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$16.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$16.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$14.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$13.60
|
|
|
.ALLERGEN SPECIFIC IGE
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
.ALLERGEN SPECIFIC IGE
|
Facility
IP
|
$16.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
ALLOPURINOL TAB [100 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
|
|
|
ALLOPURINOL TAB [100 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
|
|
|
.ALPHA-1-ANTITRYPSIN
|
Facility
OP
|
$81.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
|
|
.ALPHA-1-ANTITRYPSIN
|
Facility
IP
|
$81.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
|
|
.ALPHA-1-ANTITRYPSIN PHENOTYPE
|
Facility
OP
|
$81.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
|
|
.ALPHA-1-ANTITRYPSIN PHENOTYPE
|
Facility
IP
|
$81.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: AETNA Commercial |
$76.95
|
| Rate for Payer: AETNA Medicare |
$72.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$76.95
|
| Rate for Payer: BCBS Healthlink |
$72.90
|
| Rate for Payer: BCBS HMK CHIP |
$72.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$72.90
|
| Rate for Payer: BCBS POS |
$76.95
|
| Rate for Payer: BCBS Traditional |
$81.00
|
| Rate for Payer: CASH_PRICE |
$64.80
|
| Rate for Payer: CIGNA Commercial |
$76.95
|
| Rate for Payer: CIGNA Medicare |
$72.90
|
| Rate for Payer: HUMANA Commercial |
$72.90
|
| Rate for Payer: MEDICAID Medicaid |
$74.52
|
| Rate for Payer: MEDICARE Medicare |
$56.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$76.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$78.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$76.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$76.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$68.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$64.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$64.80
|
|
|
ALPRAZOLAM TAB [0.5MG]
|
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
|
|
|
ALPRAZOLAM TAB [0.5MG]
|
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
|
|
|
ALT
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
ALT
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: AETNA Commercial |
$59.85
|
| Rate for Payer: AETNA Medicare |
$56.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$59.85
|
| Rate for Payer: BCBS Healthlink |
$56.70
|
| Rate for Payer: BCBS HMK CHIP |
$56.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$56.70
|
| Rate for Payer: BCBS POS |
$59.85
|
| Rate for Payer: BCBS Traditional |
$63.00
|
| Rate for Payer: CASH_PRICE |
$50.40
|
| Rate for Payer: CIGNA Commercial |
$59.85
|
| Rate for Payer: CIGNA Medicare |
$56.70
|
| Rate for Payer: HUMANA Commercial |
$56.70
|
| Rate for Payer: MEDICAID Medicaid |
$57.96
|
| Rate for Payer: MEDICARE Medicare |
$44.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$59.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$61.11
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$59.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$59.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$53.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$50.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$50.40
|
|
|
ALTEPLASE INJ [100 MG]
|
Facility
IP
|
$15,524.00
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,866.80 |
| Max. Negotiated Rate |
$15,524.00 |
| Rate for Payer: AETNA Commercial |
$14,747.80
|
| Rate for Payer: AETNA Medicare |
$13,971.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14,747.80
|
| Rate for Payer: BCBS Healthlink |
$13,971.60
|
| Rate for Payer: BCBS HMK CHIP |
$13,971.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13,971.60
|
| Rate for Payer: BCBS POS |
$14,747.80
|
| Rate for Payer: BCBS Traditional |
$15,524.00
|
| Rate for Payer: CASH_PRICE |
$12,419.20
|
| Rate for Payer: CIGNA Commercial |
$14,747.80
|
| Rate for Payer: CIGNA Medicare |
$13,971.60
|
| Rate for Payer: HUMANA Commercial |
$13,971.60
|
| Rate for Payer: MEDICAID Medicaid |
$14,282.08
|
| Rate for Payer: MEDICARE Medicare |
$10,866.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14,747.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15,058.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14,747.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14,747.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13,195.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12,419.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12,419.20
|
|
|
ALTEPLASE INJ [100 MG]
|
Facility
OP
|
$15,524.00
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,866.80 |
| Max. Negotiated Rate |
$15,524.00 |
| Rate for Payer: AETNA Commercial |
$14,747.80
|
| Rate for Payer: AETNA Medicare |
$13,971.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14,747.80
|
| Rate for Payer: BCBS Healthlink |
$13,971.60
|
| Rate for Payer: BCBS HMK CHIP |
$13,971.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13,971.60
|
| Rate for Payer: BCBS POS |
$14,747.80
|
| Rate for Payer: BCBS Traditional |
$15,524.00
|
| Rate for Payer: CASH_PRICE |
$12,419.20
|
| Rate for Payer: CIGNA Commercial |
$14,747.80
|
| Rate for Payer: CIGNA Medicare |
$13,971.60
|
| Rate for Payer: HUMANA Commercial |
$13,971.60
|
| Rate for Payer: MEDICAID Medicaid |
$14,282.08
|
| Rate for Payer: MEDICARE Medicare |
$10,866.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14,747.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15,058.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14,747.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14,747.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13,195.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12,419.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12,419.20
|
|
|
ALTEPLASE INJ [2 MG/2 ML]
|
Facility
IP
|
$733.00
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$513.10 |
| Max. Negotiated Rate |
$733.00 |
| Rate for Payer: BCBS Healthlink |
$659.70
|
| Rate for Payer: BCBS HMK CHIP |
$659.70
|
| Rate for Payer: AETNA Commercial |
$696.35
|
| Rate for Payer: AETNA Medicare |
$659.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$696.35
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$659.70
|
| Rate for Payer: BCBS POS |
$696.35
|
| Rate for Payer: BCBS Traditional |
$733.00
|
| Rate for Payer: CASH_PRICE |
$586.40
|
| Rate for Payer: CIGNA Commercial |
$696.35
|
| Rate for Payer: CIGNA Medicare |
$659.70
|
| Rate for Payer: HUMANA Commercial |
$659.70
|
| Rate for Payer: MEDICAID Medicaid |
$674.36
|
| Rate for Payer: MEDICARE Medicare |
$513.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$696.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$711.01
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$696.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$696.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$623.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$586.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$586.40
|
|
