|
ER INSERTION OF CHEST TUBE
|
Facility
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$827.40 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: AETNA Commercial |
$1,122.90
|
| Rate for Payer: AETNA Medicare |
$1,063.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,122.90
|
| Rate for Payer: BCBS Healthlink |
$1,063.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,063.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,063.80
|
| Rate for Payer: BCBS POS |
$1,122.90
|
| Rate for Payer: BCBS Traditional |
$1,182.00
|
| Rate for Payer: CASH_PRICE |
$945.60
|
| Rate for Payer: CIGNA Commercial |
$1,122.90
|
| Rate for Payer: CIGNA Medicare |
$1,063.80
|
| Rate for Payer: HUMANA Commercial |
$1,063.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,087.44
|
| Rate for Payer: MEDICARE Medicare |
$827.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,122.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,146.54
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,122.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,122.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,004.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$945.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$945.60
|
|
|
ER MISCELLANEOUS
|
Facility
OP
|
$862.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.40 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: AETNA Commercial |
$818.90
|
| Rate for Payer: AETNA Medicare |
$775.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$818.90
|
| Rate for Payer: BCBS Healthlink |
$775.80
|
| Rate for Payer: BCBS HMK CHIP |
$775.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$775.80
|
| Rate for Payer: BCBS POS |
$818.90
|
| Rate for Payer: BCBS Traditional |
$862.00
|
| Rate for Payer: CASH_PRICE |
$689.60
|
| Rate for Payer: CIGNA Commercial |
$818.90
|
| Rate for Payer: CIGNA Medicare |
$775.80
|
| Rate for Payer: HUMANA Commercial |
$775.80
|
| Rate for Payer: MEDICAID Medicaid |
$793.04
|
| Rate for Payer: MEDICARE Medicare |
$603.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$818.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$836.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$818.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$818.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$732.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$689.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$689.60
|
|
|
ER MISCELLANEOUS
|
Facility
IP
|
$862.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.40 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: BCBS HMK CHIP |
$775.80
|
| Rate for Payer: AETNA Commercial |
$818.90
|
| Rate for Payer: AETNA Medicare |
$775.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$818.90
|
| Rate for Payer: BCBS Healthlink |
$775.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$775.80
|
| Rate for Payer: BCBS POS |
$818.90
|
| Rate for Payer: BCBS Traditional |
$862.00
|
| Rate for Payer: CASH_PRICE |
$689.60
|
| Rate for Payer: CIGNA Commercial |
$818.90
|
| Rate for Payer: CIGNA Medicare |
$775.80
|
| Rate for Payer: HUMANA Commercial |
$775.80
|
| Rate for Payer: MEDICAID Medicaid |
$793.04
|
| Rate for Payer: MEDICARE Medicare |
$603.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$818.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$836.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$818.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$818.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$732.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$689.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$689.60
|
|
|
ER MODERATE SEDATION SERVICES
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: AETNA Commercial |
$307.80
|
| Rate for Payer: AETNA Medicare |
$291.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$307.80
|
| Rate for Payer: BCBS Healthlink |
$291.60
|
| Rate for Payer: BCBS HMK CHIP |
$291.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$291.60
|
| Rate for Payer: BCBS POS |
$307.80
|
| Rate for Payer: BCBS Traditional |
$324.00
|
| Rate for Payer: CASH_PRICE |
$259.20
|
| Rate for Payer: CIGNA Commercial |
$307.80
|
| Rate for Payer: CIGNA Medicare |
$291.60
|
| Rate for Payer: HUMANA Commercial |
$291.60
|
| Rate for Payer: MEDICAID Medicaid |
$298.08
|
| Rate for Payer: MEDICARE Medicare |
$226.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$307.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$314.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$307.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$307.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$275.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$259.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$259.20
|
|
|
ER MODERATE SEDATION SERVICES
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: AETNA Commercial |
$307.80
|
| Rate for Payer: AETNA Medicare |
$291.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$307.80
|
| Rate for Payer: BCBS Healthlink |
$291.60
|
| Rate for Payer: BCBS HMK CHIP |
$291.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$291.60
|
| Rate for Payer: BCBS POS |
$307.80
|
| Rate for Payer: BCBS Traditional |
$324.00
|
| Rate for Payer: CASH_PRICE |
$259.20
|
| Rate for Payer: CIGNA Commercial |
$307.80
|
| Rate for Payer: CIGNA Medicare |
$291.60
|
| Rate for Payer: HUMANA Commercial |
$291.60
|
| Rate for Payer: MEDICAID Medicaid |
$298.08
|
| Rate for Payer: MEDICARE Medicare |
$226.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$307.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$314.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$307.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$307.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$275.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$259.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$259.20
|
|
|
ER N BLOCK OF PERIPHERAL BRANCH
|
Facility
OP
|
$853.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$597.10 |
| Max. Negotiated Rate |
$853.00 |
| Rate for Payer: AETNA Commercial |
$810.35
|
| Rate for Payer: AETNA Medicare |
$767.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$810.35
|
| Rate for Payer: BCBS Healthlink |
$767.70
|
| Rate for Payer: BCBS HMK CHIP |
$767.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$767.70
|
| Rate for Payer: BCBS POS |
$810.35
|
| Rate for Payer: BCBS Traditional |
$853.00
|
| Rate for Payer: CASH_PRICE |
$682.40
|
| Rate for Payer: CIGNA Commercial |
$810.35
|
| Rate for Payer: CIGNA Medicare |
$767.70
|
| Rate for Payer: HUMANA Commercial |
$767.70
|
| Rate for Payer: MEDICAID Medicaid |
$784.76
|
| Rate for Payer: MEDICARE Medicare |
$597.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$810.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$827.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$810.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$810.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$725.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$682.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$682.40
|
|
|
ER N BLOCK OF PERIPHERAL BRANCH
|
Facility
IP
|
$853.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$597.10 |
| Max. Negotiated Rate |
$853.00 |
| Rate for Payer: BCBS HMK CHIP |
$767.70
|
| Rate for Payer: AETNA Commercial |
$810.35
|
| Rate for Payer: AETNA Medicare |
$767.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$810.35
|
| Rate for Payer: BCBS Healthlink |
$767.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$767.70
|
| Rate for Payer: BCBS POS |
$810.35
|
| Rate for Payer: BCBS Traditional |
$853.00
|
| Rate for Payer: CASH_PRICE |
$682.40
|
| Rate for Payer: CIGNA Commercial |
$810.35
|
| Rate for Payer: CIGNA Medicare |
$767.70
|
| Rate for Payer: HUMANA Commercial |
$767.70
|
| Rate for Payer: MEDICAID Medicaid |
$784.76
|
| Rate for Payer: MEDICARE Medicare |
$597.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$810.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$827.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$810.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$810.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$725.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$682.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$682.40
|
|
|
ERPAK ACETAMINOPHEN TAB [325 MG] 6 TAB
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: AETNA Commercial |
$10.45
|
| Rate for Payer: AETNA Medicare |
$9.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10.45
|
| Rate for Payer: BCBS Healthlink |
$9.90
|
| Rate for Payer: BCBS HMK CHIP |
$9.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$9.90
|
| Rate for Payer: BCBS POS |
$10.45
|
| Rate for Payer: BCBS Traditional |
$11.00
|
| Rate for Payer: CASH_PRICE |
$8.80
|
| Rate for Payer: CIGNA Commercial |
$10.45
|
| Rate for Payer: CIGNA Medicare |
$9.90
|
| Rate for Payer: HUMANA Commercial |
$9.90
|
| Rate for Payer: MEDICAID Medicaid |
$10.12
|
| Rate for Payer: MEDICARE Medicare |
$7.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$10.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$8.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$8.80
|
|
|
ERPAK ACETAMINOPHEN TAB [325 MG] 6 TAB
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: BCBS HMK CHIP |
$9.90
|
| Rate for Payer: AETNA Commercial |
$10.45
|
| Rate for Payer: AETNA Medicare |
$9.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10.45
|
| Rate for Payer: BCBS Healthlink |
$9.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$9.90
|
| Rate for Payer: BCBS POS |
$10.45
|
| Rate for Payer: BCBS Traditional |
$11.00
|
| Rate for Payer: CASH_PRICE |
$8.80
|
| Rate for Payer: CIGNA Commercial |
$10.45
|
| Rate for Payer: CIGNA Medicare |
$9.90
|
| Rate for Payer: HUMANA Commercial |
$9.90
|
| Rate for Payer: MEDICAID Medicaid |
$10.12
|
| Rate for Payer: MEDICARE Medicare |
$7.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$10.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$8.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$8.80
|
|
|
ERPAK AMLODOPINE TAB [5 MG] 4 TAB PACK
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ERPAK AMLODOPINE TAB [5 MG] 4 TAB PACK
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ERPAK AMOX/CLAV TAB [875/125 MG] 6 TAB
|
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: BCBS HMK CHIP |
$62.10
|
| 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 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
|
|
|
ERPAK AMOX/CLAV TAB [875/125 MG] 6 TAB
|
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
|
|
|
ERPAK CEPHALEXIN CAP [250 MG] 8 CAP PACK
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
ERPAK CEPHALEXIN CAP [250 MG] 8 CAP PACK
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: AETNA Commercial |
$39.90
|
| Rate for Payer: AETNA Medicare |
$37.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$39.90
|
| Rate for Payer: BCBS Healthlink |
$37.80
|
| Rate for Payer: BCBS HMK CHIP |
$37.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$37.80
|
| Rate for Payer: BCBS POS |
$39.90
|
| Rate for Payer: BCBS Traditional |
$42.00
|
| Rate for Payer: CASH_PRICE |
$33.60
|
| Rate for Payer: CIGNA Commercial |
$39.90
|
| Rate for Payer: CIGNA Medicare |
$37.80
|
| Rate for Payer: HUMANA Commercial |
$37.80
|
| Rate for Payer: MEDICAID Medicaid |
$38.64
|
| Rate for Payer: MEDICARE Medicare |
$29.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$39.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$40.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$39.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$39.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$35.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$33.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$33.60
|
|
|
ERPAK CEPHALEXIN CAP [500 MG] 6 CAP PACK
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ERPAK CEPHALEXIN CAP [500 MG] 6 CAP PACK
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ERPAK CIPROFLOXACIN TAB [500 MG] 4 TABS
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
ERPAK CIPROFLOXACIN TAB [500 MG] 4 TABS
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
ERPAK CYCLOBENZAPRINE [10 MG] 4 TAB
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
ERPAK CYCLOBENZAPRINE [10 MG] 4 TAB
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS HMK CHIP |
$18.90
|
| Rate for Payer: AETNA Commercial |
$19.95
|
| Rate for Payer: AETNA Medicare |
$18.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.95
|
| Rate for Payer: BCBS Healthlink |
$18.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.90
|
| Rate for Payer: BCBS POS |
$19.95
|
| Rate for Payer: BCBS Traditional |
$21.00
|
| Rate for Payer: CASH_PRICE |
$16.80
|
| Rate for Payer: CIGNA Commercial |
$19.95
|
| Rate for Payer: CIGNA Medicare |
$18.90
|
| Rate for Payer: HUMANA Commercial |
$18.90
|
| Rate for Payer: MEDICAID Medicaid |
$19.32
|
| Rate for Payer: MEDICARE Medicare |
$14.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$20.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.80
|
|
|
ERPAK HYDROCODONE/APAP [5/325 MG]4 TAB
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20230314
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ERPAK HYDROCODONE/APAP [5/325 MG]4 TAB
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20230314
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ERPAK IBUPROFEN TAB [200 MG] 6 TAB PACK
|
Facility
IP
|
$11.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: BCBS HMK CHIP |
$9.90
|
| Rate for Payer: AETNA Commercial |
$10.45
|
| Rate for Payer: AETNA Medicare |
$9.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10.45
|
| Rate for Payer: BCBS Healthlink |
$9.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$9.90
|
| Rate for Payer: BCBS POS |
$10.45
|
| Rate for Payer: BCBS Traditional |
$11.00
|
| Rate for Payer: CASH_PRICE |
$8.80
|
| Rate for Payer: CIGNA Commercial |
$10.45
|
| Rate for Payer: CIGNA Medicare |
$9.90
|
| Rate for Payer: HUMANA Commercial |
$9.90
|
| Rate for Payer: MEDICAID Medicaid |
$10.12
|
| Rate for Payer: MEDICARE Medicare |
$7.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$10.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$8.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$8.80
|
|
|
ERPAK IBUPROFEN TAB [200 MG] 6 TAB PACK
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: AETNA Commercial |
$10.45
|
| Rate for Payer: AETNA Medicare |
$9.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$10.45
|
| Rate for Payer: BCBS Healthlink |
$9.90
|
| Rate for Payer: BCBS HMK CHIP |
$9.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$9.90
|
| Rate for Payer: BCBS POS |
$10.45
|
| Rate for Payer: BCBS Traditional |
$11.00
|
| Rate for Payer: CASH_PRICE |
$8.80
|
| Rate for Payer: CIGNA Commercial |
$10.45
|
| Rate for Payer: CIGNA Medicare |
$9.90
|
| Rate for Payer: HUMANA Commercial |
$9.90
|
| Rate for Payer: MEDICAID Medicaid |
$10.12
|
| Rate for Payer: MEDICARE Medicare |
$7.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$10.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$10.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$10.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$10.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$9.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$8.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$8.80
|
|
