|
ERPAK LISINOPRIL TAB [10 MG] 4 TAB PACK
|
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 LISINOPRIL TAB [10 MG] 4 TAB PACK
|
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 METOPROLOL TART TAB [50 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 METOPROLOL TART TAB [50 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 NITROFURANTOIN [100 MG] 4 CAP PACK
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
ERPAK NITROFURANTOIN [100 MG] 4 CAP PACK
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: AETNA Commercial |
$47.50
|
| Rate for Payer: AETNA Medicare |
$45.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$47.50
|
| Rate for Payer: BCBS Healthlink |
$45.00
|
| Rate for Payer: BCBS HMK CHIP |
$45.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$45.00
|
| Rate for Payer: BCBS POS |
$47.50
|
| Rate for Payer: BCBS Traditional |
$50.00
|
| Rate for Payer: CASH_PRICE |
$40.00
|
| Rate for Payer: CIGNA Commercial |
$47.50
|
| Rate for Payer: CIGNA Medicare |
$45.00
|
| Rate for Payer: HUMANA Commercial |
$45.00
|
| Rate for Payer: MEDICAID Medicaid |
$46.00
|
| Rate for Payer: MEDICARE Medicare |
$35.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$47.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$48.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$47.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$47.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$42.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$40.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$40.00
|
|
|
ERPAK ONDANSETRON ODT [4 MG] 6 TAB PACKS
|
Facility
IP
|
$368.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: BCBS HMK CHIP |
$331.20
|
| Rate for Payer: AETNA Commercial |
$349.60
|
| Rate for Payer: AETNA Medicare |
$331.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$349.60
|
| Rate for Payer: BCBS Healthlink |
$331.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$331.20
|
| Rate for Payer: BCBS POS |
$349.60
|
| Rate for Payer: BCBS Traditional |
$368.00
|
| Rate for Payer: CASH_PRICE |
$294.40
|
| Rate for Payer: CIGNA Commercial |
$349.60
|
| Rate for Payer: CIGNA Medicare |
$331.20
|
| Rate for Payer: HUMANA Commercial |
$331.20
|
| Rate for Payer: MEDICAID Medicaid |
$338.56
|
| Rate for Payer: MEDICARE Medicare |
$257.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$349.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$356.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$349.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$294.40
|
|
|
ERPAK ONDANSETRON ODT [4 MG] 6 TAB PACKS
|
Facility
OP
|
$368.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$257.60 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: AETNA Commercial |
$349.60
|
| Rate for Payer: AETNA Medicare |
$331.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$349.60
|
| Rate for Payer: BCBS Healthlink |
$331.20
|
| Rate for Payer: BCBS HMK CHIP |
$331.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$331.20
|
| Rate for Payer: BCBS POS |
$349.60
|
| Rate for Payer: BCBS Traditional |
$368.00
|
| Rate for Payer: CASH_PRICE |
$294.40
|
| Rate for Payer: CIGNA Commercial |
$349.60
|
| Rate for Payer: CIGNA Medicare |
$331.20
|
| Rate for Payer: HUMANA Commercial |
$331.20
|
| Rate for Payer: MEDICAID Medicaid |
$338.56
|
| Rate for Payer: MEDICARE Medicare |
$257.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$349.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$356.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$349.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$349.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$312.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$294.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$294.40
|
|
|
ERPAK PREDNISONE TAB [20 MG] 4 TAB PACK
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT J7512
|
| 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 PREDNISONE TAB [20 MG] 4 TAB PACK
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT J7512
|
| 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 SULFA/TRIMETH TAB [800/160MG]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 SULFA/TRIMETH TAB [800/160MG]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 TRAMADOL TAB [50 MG] 4 TAB PACK
|
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 TRAMADOL TAB [50 MG] 4 TAB PACK
|
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
|
|
|
ER PLACE NEEDLE INFUSION INTRAOSSEOUS
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: AETNA Commercial |
$336.30
|
| Rate for Payer: AETNA Medicare |
$318.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$336.30
|
| Rate for Payer: BCBS Healthlink |
$318.60
|
| Rate for Payer: BCBS HMK CHIP |
$318.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$318.60
|
| Rate for Payer: BCBS POS |
$336.30
|
| Rate for Payer: BCBS Traditional |
$354.00
|
| Rate for Payer: CASH_PRICE |
$283.20
|
| Rate for Payer: CIGNA Commercial |
$336.30
|
| Rate for Payer: CIGNA Medicare |
$318.60
|
| Rate for Payer: HUMANA Commercial |
$318.60
|
| Rate for Payer: MEDICAID Medicaid |
$325.68
|
| Rate for Payer: MEDICARE Medicare |
$247.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$336.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$343.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$336.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$336.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$283.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$283.20
|
|
|
ER PLACE NEEDLE INFUSION INTRAOSSEOUS
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: AETNA Commercial |
$336.30
|
| Rate for Payer: AETNA Medicare |
$318.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$336.30
|
| Rate for Payer: BCBS Healthlink |
$318.60
|
| Rate for Payer: BCBS HMK CHIP |
$318.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$318.60
|
| Rate for Payer: BCBS POS |
$336.30
|
| Rate for Payer: BCBS Traditional |
$354.00
|
| Rate for Payer: CASH_PRICE |
$283.20
|
| Rate for Payer: CIGNA Commercial |
$336.30
|
| Rate for Payer: CIGNA Medicare |
$318.60
|
| Rate for Payer: HUMANA Commercial |
$318.60
|
| Rate for Payer: MEDICAID Medicaid |
$325.68
|
| Rate for Payer: MEDICARE Medicare |
$247.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$336.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$343.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$336.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$336.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$300.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$283.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$283.20
|
|
|
ER REDUCTION OF RECTAL PROLAPSE
|
Facility
IP
|
$814.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$569.80 |
| Max. Negotiated Rate |
$814.00 |
| Rate for Payer: BCBS HMK CHIP |
$732.60
|
| Rate for Payer: AETNA Commercial |
$773.30
|
| Rate for Payer: AETNA Medicare |
$732.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$773.30
|
| Rate for Payer: BCBS Healthlink |
$732.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$732.60
|
| Rate for Payer: BCBS POS |
$773.30
|
| Rate for Payer: BCBS Traditional |
$814.00
|
| Rate for Payer: CASH_PRICE |
$651.20
|
| Rate for Payer: CIGNA Commercial |
$773.30
|
| Rate for Payer: CIGNA Medicare |
$732.60
|
| Rate for Payer: HUMANA Commercial |
$732.60
|
| Rate for Payer: MEDICAID Medicaid |
$748.88
|
| Rate for Payer: MEDICARE Medicare |
$569.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$773.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$789.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$773.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$773.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$691.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$651.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$651.20
|
|
|
ER REDUCTION OF RECTAL PROLAPSE
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$569.80 |
| Max. Negotiated Rate |
$814.00 |
| Rate for Payer: AETNA Commercial |
$773.30
|
| Rate for Payer: AETNA Medicare |
$732.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$773.30
|
| Rate for Payer: BCBS Healthlink |
$732.60
|
| Rate for Payer: BCBS HMK CHIP |
$732.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$732.60
|
| Rate for Payer: BCBS POS |
$773.30
|
| Rate for Payer: BCBS Traditional |
$814.00
|
| Rate for Payer: CASH_PRICE |
$651.20
|
| Rate for Payer: CIGNA Commercial |
$773.30
|
| Rate for Payer: CIGNA Medicare |
$732.60
|
| Rate for Payer: HUMANA Commercial |
$732.60
|
| Rate for Payer: MEDICAID Medicaid |
$748.88
|
| Rate for Payer: MEDICARE Medicare |
$569.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$773.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$789.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$773.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$773.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$691.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$651.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$651.20
|
|
|
ER REMOVAL OF NAIL PLATE
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
ER REMOVAL OF NAIL PLATE
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: AETNA Commercial |
$269.80
|
| Rate for Payer: AETNA Medicare |
$255.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$269.80
|
| Rate for Payer: BCBS Healthlink |
$255.60
|
| Rate for Payer: BCBS HMK CHIP |
$255.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$255.60
|
| Rate for Payer: BCBS POS |
$269.80
|
| Rate for Payer: BCBS Traditional |
$284.00
|
| Rate for Payer: CASH_PRICE |
$227.20
|
| Rate for Payer: CIGNA Commercial |
$269.80
|
| Rate for Payer: CIGNA Medicare |
$255.60
|
| Rate for Payer: HUMANA Commercial |
$255.60
|
| Rate for Payer: MEDICAID Medicaid |
$261.28
|
| Rate for Payer: MEDICARE Medicare |
$198.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$269.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$275.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$269.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$269.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$241.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$227.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$227.20
|
|
|
ER REMOVE FB DEEP OR COMLICATED
|
Facility
IP
|
$3,577.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,503.90 |
| Max. Negotiated Rate |
$3,577.00 |
| Rate for Payer: AETNA Commercial |
$3,398.15
|
| Rate for Payer: AETNA Medicare |
$3,219.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,398.15
|
| Rate for Payer: BCBS Healthlink |
$3,219.30
|
| Rate for Payer: BCBS HMK CHIP |
$3,219.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,219.30
|
| Rate for Payer: BCBS POS |
$3,398.15
|
| Rate for Payer: BCBS Traditional |
$3,577.00
|
| Rate for Payer: CASH_PRICE |
$2,861.60
|
| Rate for Payer: CIGNA Commercial |
$3,398.15
|
| Rate for Payer: CIGNA Medicare |
$3,219.30
|
| Rate for Payer: HUMANA Commercial |
$3,219.30
|
| Rate for Payer: MEDICAID Medicaid |
$3,290.84
|
| Rate for Payer: MEDICARE Medicare |
$2,503.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,469.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,398.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3,040.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,861.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,861.60
|
|
|
ER REMOVE FB DEEP OR COMLICATED
|
Facility
OP
|
$3,577.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,503.90 |
| Max. Negotiated Rate |
$3,577.00 |
| Rate for Payer: AETNA Commercial |
$3,398.15
|
| Rate for Payer: AETNA Medicare |
$3,219.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,398.15
|
| Rate for Payer: BCBS Healthlink |
$3,219.30
|
| Rate for Payer: BCBS HMK CHIP |
$3,219.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,219.30
|
| Rate for Payer: BCBS POS |
$3,398.15
|
| Rate for Payer: BCBS Traditional |
$3,577.00
|
| Rate for Payer: CASH_PRICE |
$2,861.60
|
| Rate for Payer: CIGNA Commercial |
$3,398.15
|
| Rate for Payer: CIGNA Medicare |
$3,219.30
|
| Rate for Payer: HUMANA Commercial |
$3,219.30
|
| Rate for Payer: MEDICAID Medicaid |
$3,290.84
|
| Rate for Payer: MEDICARE Medicare |
$2,503.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,469.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,398.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,398.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$3,040.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,861.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,861.60
|
|
|
ER REMOVE FB MUSCLE/TENDON SHEATH SIMPLE
|
Facility
OP
|
$1,742.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.40 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: AETNA Commercial |
$1,654.90
|
| Rate for Payer: AETNA Medicare |
$1,567.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,654.90
|
| Rate for Payer: BCBS Healthlink |
$1,567.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,567.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,567.80
|
| Rate for Payer: BCBS POS |
$1,654.90
|
| Rate for Payer: BCBS Traditional |
$1,742.00
|
| Rate for Payer: CASH_PRICE |
$1,393.60
|
| Rate for Payer: CIGNA Commercial |
$1,654.90
|
| Rate for Payer: CIGNA Medicare |
$1,567.80
|
| Rate for Payer: HUMANA Commercial |
$1,567.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,602.64
|
| Rate for Payer: MEDICARE Medicare |
$1,219.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,654.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,689.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,654.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,654.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,480.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,393.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,393.60
|
|
|
ER REMOVE FB MUSCLE/TENDON SHEATH SIMPLE
|
Facility
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.40 |
| Max. Negotiated Rate |
$1,742.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,567.80
|
| Rate for Payer: AETNA Commercial |
$1,654.90
|
| Rate for Payer: AETNA Medicare |
$1,567.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,654.90
|
| Rate for Payer: BCBS Healthlink |
$1,567.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,567.80
|
| Rate for Payer: BCBS POS |
$1,654.90
|
| Rate for Payer: BCBS Traditional |
$1,742.00
|
| Rate for Payer: CASH_PRICE |
$1,393.60
|
| Rate for Payer: CIGNA Commercial |
$1,654.90
|
| Rate for Payer: CIGNA Medicare |
$1,567.80
|
| Rate for Payer: HUMANA Commercial |
$1,567.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,602.64
|
| Rate for Payer: MEDICARE Medicare |
$1,219.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,654.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,689.74
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,654.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,654.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,480.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,393.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,393.60
|
|
|
ER REMOVE FB UPPER ARM ELBOW AREA
|
Facility
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$861.00 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: AETNA Commercial |
$1,168.50
|
| Rate for Payer: AETNA Medicare |
$1,107.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,168.50
|
| Rate for Payer: BCBS Healthlink |
$1,107.00
|
| Rate for Payer: BCBS HMK CHIP |
$1,107.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,107.00
|
| Rate for Payer: BCBS POS |
$1,168.50
|
| Rate for Payer: BCBS Traditional |
$1,230.00
|
| Rate for Payer: CASH_PRICE |
$984.00
|
| Rate for Payer: CIGNA Commercial |
$1,168.50
|
| Rate for Payer: CIGNA Medicare |
$1,107.00
|
| Rate for Payer: HUMANA Commercial |
$1,107.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,131.60
|
| Rate for Payer: MEDICARE Medicare |
$861.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,168.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,193.10
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,168.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,168.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,045.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$984.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$984.00
|
|
