|
ENOXAPARIN INJ [100 MG/1 ML] - NONFORM
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: BCBS HMK CHIP |
$71.10
|
| Rate for Payer: AETNA Commercial |
$75.05
|
| Rate for Payer: AETNA Medicare |
$71.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$75.05
|
| Rate for Payer: BCBS Healthlink |
$71.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$71.10
|
| Rate for Payer: BCBS POS |
$75.05
|
| Rate for Payer: BCBS Traditional |
$79.00
|
| Rate for Payer: CASH_PRICE |
$63.20
|
| Rate for Payer: CIGNA Commercial |
$75.05
|
| Rate for Payer: CIGNA Medicare |
$71.10
|
| Rate for Payer: HUMANA Commercial |
$71.10
|
| Rate for Payer: MEDICAID Medicaid |
$72.68
|
| Rate for Payer: MEDICARE Medicare |
$55.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$75.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$76.63
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$75.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$75.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$67.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$63.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$63.20
|
|
|
ENOXAPARIN INJ [30 MG/0.3 ML]
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ENOXAPARIN INJ [30 MG/0.3 ML]
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ENOXAPARIN INJ [40 MG/0.4 ML]
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ENOXAPARIN INJ [40 MG/0.4 ML]
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: AETNA Commercial |
$30.40
|
| Rate for Payer: AETNA Medicare |
$28.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$30.40
|
| Rate for Payer: BCBS Healthlink |
$28.80
|
| Rate for Payer: BCBS HMK CHIP |
$28.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$28.80
|
| Rate for Payer: BCBS POS |
$30.40
|
| Rate for Payer: BCBS Traditional |
$32.00
|
| Rate for Payer: CASH_PRICE |
$25.60
|
| Rate for Payer: CIGNA Commercial |
$30.40
|
| Rate for Payer: CIGNA Medicare |
$28.80
|
| Rate for Payer: HUMANA Commercial |
$28.80
|
| Rate for Payer: MEDICAID Medicaid |
$29.44
|
| Rate for Payer: MEDICARE Medicare |
$22.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$30.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$31.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$30.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$27.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$25.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$25.60
|
|
|
ENOXAPARIN INJ [60 MG/0.6ML]-NONFORMULAR
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
ENOXAPARIN INJ [60 MG/0.6ML]-NONFORMULAR
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT J1650
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
.ENTEROVIRUS ANTIBODIES
|
Facility
OP
|
$7.09
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
20220501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: AETNA Commercial |
$6.74
|
| Rate for Payer: AETNA Medicare |
$6.38
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6.74
|
| Rate for Payer: BCBS Healthlink |
$6.38
|
| Rate for Payer: BCBS HMK CHIP |
$6.38
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6.38
|
| Rate for Payer: BCBS POS |
$6.74
|
| Rate for Payer: BCBS Traditional |
$7.09
|
| Rate for Payer: CASH_PRICE |
$5.67
|
| Rate for Payer: CIGNA Commercial |
$6.74
|
| Rate for Payer: CIGNA Medicare |
$6.38
|
| Rate for Payer: HUMANA Commercial |
$6.38
|
| Rate for Payer: MEDICAID Medicaid |
$6.52
|
| Rate for Payer: MEDICARE Medicare |
$4.96
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6.74
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6.74
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6.74
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.03
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5.67
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5.67
|
|
|
.ENTEROVIRUS ANTIBODIES
|
Facility
IP
|
$7.09
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
20220501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: AETNA Commercial |
$6.74
|
| Rate for Payer: AETNA Medicare |
$6.38
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$6.74
|
| Rate for Payer: BCBS Healthlink |
$6.38
|
| Rate for Payer: BCBS HMK CHIP |
$6.38
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$6.38
|
| Rate for Payer: BCBS POS |
$6.74
|
| Rate for Payer: BCBS Traditional |
$7.09
|
| Rate for Payer: CASH_PRICE |
$5.67
|
| Rate for Payer: CIGNA Commercial |
$6.74
|
| Rate for Payer: CIGNA Medicare |
$6.38
|
| Rate for Payer: HUMANA Commercial |
$6.38
|
| Rate for Payer: MEDICAID Medicaid |
$6.52
|
| Rate for Payer: MEDICARE Medicare |
$4.96
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$6.74
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$6.88
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$6.74
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$6.74
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.03
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$5.67
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$5.67
|
|
|
ePHEDrine INJ [50 MG/ML]
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: AETNA Commercial |
$106.40
|
| Rate for Payer: AETNA Medicare |
$100.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$106.40
|
| Rate for Payer: BCBS Healthlink |
$100.80
|
| Rate for Payer: BCBS HMK CHIP |
$100.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$100.80
|
| Rate for Payer: BCBS POS |
$106.40
|
| Rate for Payer: BCBS Traditional |
$112.00
|
| Rate for Payer: CASH_PRICE |
$89.60
|
| Rate for Payer: CIGNA Commercial |
$106.40
|
| Rate for Payer: CIGNA Medicare |
$100.80
|
| Rate for Payer: HUMANA Commercial |
$100.80
|
| Rate for Payer: MEDICAID Medicaid |
$103.04
|
| Rate for Payer: MEDICARE Medicare |
$78.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$106.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$108.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$106.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$89.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$89.60
|
|
|
ePHEDrine INJ [50 MG/ML]
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: BCBS HMK CHIP |
$100.80
|
| Rate for Payer: AETNA Commercial |
$106.40
|
| Rate for Payer: AETNA Medicare |
$100.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$106.40
|
| Rate for Payer: BCBS Healthlink |
$100.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$100.80
|
| Rate for Payer: BCBS POS |
$106.40
|
| Rate for Payer: BCBS Traditional |
$112.00
|
| Rate for Payer: CASH_PRICE |
$89.60
|
| Rate for Payer: CIGNA Commercial |
$106.40
|
| Rate for Payer: CIGNA Medicare |
$100.80
|
| Rate for Payer: HUMANA Commercial |
$100.80
|
| Rate for Payer: MEDICAID Medicaid |
$103.04
|
| Rate for Payer: MEDICARE Medicare |
$78.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$106.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$108.64
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$106.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$106.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$95.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$89.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$89.60
|
|
|
EPINEPHRINE 1MG/ML 10ML VIAL
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
EPINEPHRINE 1MG/ML 10ML VIAL
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AETNA Commercial |
$56.05
|
| Rate for Payer: AETNA Medicare |
$53.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$56.05
|
| Rate for Payer: BCBS Healthlink |
$53.10
|
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$53.10
|
| Rate for Payer: BCBS POS |
$56.05
|
| Rate for Payer: BCBS Traditional |
$59.00
|
| Rate for Payer: CASH_PRICE |
$47.20
|
| Rate for Payer: CIGNA Commercial |
$56.05
|
| Rate for Payer: CIGNA Medicare |
$53.10
|
| Rate for Payer: HUMANA Commercial |
$53.10
|
| Rate for Payer: MEDICAID Medicaid |
$54.28
|
| Rate for Payer: MEDICARE Medicare |
$41.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$56.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$57.23
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$56.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$56.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$50.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$47.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$47.20
|
|
|
EPINEPHRINE HCL INJ PEN [0.15 MG]
|
Facility
IP
|
$571.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
EPINEPHRINE HCL INJ PEN [0.15 MG]
|
Facility
OP
|
$571.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
EPINEPHRINE HCL INJ PEN [0.3 MG]
|
Facility
OP
|
$571.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
EPINEPHRINE HCL INJ PEN [0.3 MG]
|
Facility
IP
|
$571.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$399.70 |
| Max. Negotiated Rate |
$571.00 |
| Rate for Payer: AETNA Commercial |
$542.45
|
| Rate for Payer: AETNA Medicare |
$513.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$542.45
|
| Rate for Payer: BCBS Healthlink |
$513.90
|
| Rate for Payer: BCBS HMK CHIP |
$513.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$513.90
|
| Rate for Payer: BCBS POS |
$542.45
|
| Rate for Payer: BCBS Traditional |
$571.00
|
| Rate for Payer: CASH_PRICE |
$456.80
|
| Rate for Payer: CIGNA Commercial |
$542.45
|
| Rate for Payer: CIGNA Medicare |
$513.90
|
| Rate for Payer: HUMANA Commercial |
$513.90
|
| Rate for Payer: MEDICAID Medicaid |
$525.32
|
| Rate for Payer: MEDICARE Medicare |
$399.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$542.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$553.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$542.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$542.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$485.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$456.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$456.80
|
|
|
EPINEPHRINE INJ [1 MG/ML]
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
EPINEPHRINE INJ [1 MG/ML]
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: BCBS HMK CHIP |
$54.00
|
| Rate for Payer: AETNA Commercial |
$57.00
|
| Rate for Payer: AETNA Medicare |
$54.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$57.00
|
| Rate for Payer: BCBS Healthlink |
$54.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$54.00
|
| Rate for Payer: BCBS POS |
$57.00
|
| Rate for Payer: BCBS Traditional |
$60.00
|
| Rate for Payer: CASH_PRICE |
$48.00
|
| Rate for Payer: CIGNA Commercial |
$57.00
|
| Rate for Payer: CIGNA Medicare |
$54.00
|
| Rate for Payer: HUMANA Commercial |
$54.00
|
| Rate for Payer: MEDICAID Medicaid |
$55.20
|
| Rate for Payer: MEDICARE Medicare |
$42.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$57.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$58.20
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$57.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$57.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$51.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$48.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$48.00
|
|
|
EPINEPHRINE INJ SYR [1 MG/10 ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J0171
|
| 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
|
|
|
EPINEPHRINE INJ SYR [1 MG/10 ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J0171
|
| 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
|
|
|
EPISTAXIS COMPLEX- ER
|
Facility
IP
|
$461.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
20230317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$461.00 |
| Rate for Payer: BCBS HMK CHIP |
$414.90
|
| Rate for Payer: AETNA Commercial |
$437.95
|
| Rate for Payer: AETNA Medicare |
$414.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$437.95
|
| Rate for Payer: BCBS Healthlink |
$414.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$414.90
|
| Rate for Payer: BCBS POS |
$437.95
|
| Rate for Payer: BCBS Traditional |
$461.00
|
| Rate for Payer: CASH_PRICE |
$368.80
|
| Rate for Payer: CIGNA Commercial |
$437.95
|
| Rate for Payer: CIGNA Medicare |
$414.90
|
| Rate for Payer: HUMANA Commercial |
$414.90
|
| Rate for Payer: MEDICAID Medicaid |
$424.12
|
| Rate for Payer: MEDICARE Medicare |
$322.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$437.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$447.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$437.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$437.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$391.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$368.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$368.80
|
|
|
EPISTAXIS COMPLEX- ER
|
Facility
OP
|
$461.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
20230317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$461.00 |
| Rate for Payer: AETNA Commercial |
$437.95
|
| Rate for Payer: AETNA Medicare |
$414.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$437.95
|
| Rate for Payer: BCBS Healthlink |
$414.90
|
| Rate for Payer: BCBS HMK CHIP |
$414.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$414.90
|
| Rate for Payer: BCBS POS |
$437.95
|
| Rate for Payer: BCBS Traditional |
$461.00
|
| Rate for Payer: CASH_PRICE |
$368.80
|
| Rate for Payer: CIGNA Commercial |
$437.95
|
| Rate for Payer: CIGNA Medicare |
$414.90
|
| Rate for Payer: HUMANA Commercial |
$414.90
|
| Rate for Payer: MEDICAID Medicaid |
$424.12
|
| Rate for Payer: MEDICARE Medicare |
$322.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$437.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$447.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$437.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$437.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$391.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$368.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$368.80
|
|
|
EPISTAXIS INITIAL- ER
|
Facility
IP
|
$337.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.90 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: AETNA Commercial |
$320.15
|
| Rate for Payer: AETNA Medicare |
$303.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$320.15
|
| Rate for Payer: BCBS Healthlink |
$303.30
|
| Rate for Payer: BCBS HMK CHIP |
$303.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$303.30
|
| Rate for Payer: BCBS POS |
$320.15
|
| Rate for Payer: BCBS Traditional |
$337.00
|
| Rate for Payer: CASH_PRICE |
$269.60
|
| Rate for Payer: CIGNA Commercial |
$320.15
|
| Rate for Payer: CIGNA Medicare |
$303.30
|
| Rate for Payer: HUMANA Commercial |
$303.30
|
| Rate for Payer: MEDICAID Medicaid |
$310.04
|
| Rate for Payer: MEDICARE Medicare |
$235.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$320.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$326.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$320.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$320.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$286.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$269.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$269.60
|
|
|
EPISTAXIS INITIAL- ER
|
Facility
OP
|
$337.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.90 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: AETNA Commercial |
$320.15
|
| Rate for Payer: AETNA Medicare |
$303.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$320.15
|
| Rate for Payer: BCBS Healthlink |
$303.30
|
| Rate for Payer: BCBS HMK CHIP |
$303.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$303.30
|
| Rate for Payer: BCBS POS |
$320.15
|
| Rate for Payer: BCBS Traditional |
$337.00
|
| Rate for Payer: CASH_PRICE |
$269.60
|
| Rate for Payer: CIGNA Commercial |
$320.15
|
| Rate for Payer: CIGNA Medicare |
$303.30
|
| Rate for Payer: HUMANA Commercial |
$303.30
|
| Rate for Payer: MEDICAID Medicaid |
$310.04
|
| Rate for Payer: MEDICARE Medicare |
$235.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$320.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$326.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$320.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$320.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$286.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$269.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$269.60
|
|
