|
FLUCONAZOLE TAB [150 MG]
|
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
|
|
|
FLUCONAZOLE TAB [150 MG]
|
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
|
|
|
FLUDROCORTISONE TAB [0.1 MG]
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: BCBS HMK CHIP |
$5.40
|
| Rate for Payer: AETNA Commercial |
$5.70
|
| Rate for Payer: AETNA Medicare |
$5.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$5.70
|
| Rate for Payer: BCBS Healthlink |
$5.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$5.40
|
| Rate for Payer: BCBS POS |
$5.70
|
| Rate for Payer: BCBS Traditional |
$6.00
|
| Rate for Payer: CASH_PRICE |
$4.80
|
| Rate for Payer: CIGNA Commercial |
$5.70
|
| Rate for Payer: CIGNA Medicare |
$5.40
|
| Rate for Payer: HUMANA Commercial |
$5.40
|
| Rate for Payer: MEDICAID Medicaid |
$5.52
|
| Rate for Payer: MEDICARE Medicare |
$4.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$5.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$5.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$5.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$5.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.80
|
|
|
FLUDROCORTISONE TAB [0.1 MG]
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: AETNA Commercial |
$5.70
|
| Rate for Payer: AETNA Medicare |
$5.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$5.70
|
| Rate for Payer: BCBS Healthlink |
$5.40
|
| Rate for Payer: BCBS HMK CHIP |
$5.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$5.40
|
| Rate for Payer: BCBS POS |
$5.70
|
| Rate for Payer: BCBS Traditional |
$6.00
|
| Rate for Payer: CASH_PRICE |
$4.80
|
| Rate for Payer: CIGNA Commercial |
$5.70
|
| Rate for Payer: CIGNA Medicare |
$5.40
|
| Rate for Payer: HUMANA Commercial |
$5.40
|
| Rate for Payer: MEDICAID Medicaid |
$5.52
|
| Rate for Payer: MEDICARE Medicare |
$4.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$5.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$5.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$5.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$5.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$5.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.80
|
|
|
FLUMAZENIL INJ [0.5 MG/5 ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J3490
|
| 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
|
|
|
FLUMAZENIL INJ [0.5 MG/5 ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J3490
|
| 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
|
|
|
FLUOXETINE CAP [10 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
FLUOXETINE CAP [10 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
FLUTICASONE NASAL SPRAY [50 MCG]
|
Facility
OP
|
$272.85
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$272.85 |
| Rate for Payer: AETNA Commercial |
$259.21
|
| Rate for Payer: AETNA Medicare |
$245.57
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.21
|
| Rate for Payer: BCBS Healthlink |
$245.57
|
| Rate for Payer: BCBS HMK CHIP |
$245.57
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.57
|
| Rate for Payer: BCBS POS |
$259.21
|
| Rate for Payer: BCBS Traditional |
$272.85
|
| Rate for Payer: CASH_PRICE |
$218.28
|
| Rate for Payer: CIGNA Commercial |
$259.21
|
| Rate for Payer: CIGNA Medicare |
$245.57
|
| Rate for Payer: HUMANA Commercial |
$245.57
|
| Rate for Payer: MEDICAID Medicaid |
$251.02
|
| Rate for Payer: MEDICARE Medicare |
$191.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.21
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.21
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.21
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$231.92
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.28
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.28
|
|
|
FLUTICASONE NASAL SPRAY [50 MCG]
|
Facility
IP
|
$272.85
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$191.00 |
| Max. Negotiated Rate |
$272.85 |
| Rate for Payer: BCBS HMK CHIP |
$245.57
|
| Rate for Payer: AETNA Commercial |
$259.21
|
| Rate for Payer: AETNA Medicare |
$245.57
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.21
|
| Rate for Payer: BCBS Healthlink |
$245.57
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.57
|
| Rate for Payer: BCBS POS |
$259.21
|
| Rate for Payer: BCBS Traditional |
$272.85
|
| Rate for Payer: CASH_PRICE |
$218.28
|
| Rate for Payer: CIGNA Commercial |
$259.21
|
| Rate for Payer: CIGNA Medicare |
$245.57
|
| Rate for Payer: HUMANA Commercial |
$245.57
|
| Rate for Payer: MEDICAID Medicaid |
$251.02
|
| Rate for Payer: MEDICARE Medicare |
$191.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.21
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.21
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.21
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$231.92
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.28
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.28
|
|
|
FLUTICASONE/SALMET DISKUS [100-50 MCG]
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: AETNA Commercial |
$678.30
|
| Rate for Payer: AETNA Medicare |
$642.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$678.30
|
| Rate for Payer: BCBS Healthlink |
$642.60
|
| Rate for Payer: BCBS HMK CHIP |
$642.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$642.60
|
| Rate for Payer: BCBS POS |
$678.30
|
| Rate for Payer: BCBS Traditional |
$714.00
|
| Rate for Payer: CASH_PRICE |
$571.20
|
| Rate for Payer: CIGNA Commercial |
$678.30
|
| Rate for Payer: CIGNA Medicare |
$642.60
|
| Rate for Payer: HUMANA Commercial |
$642.60
|
| Rate for Payer: MEDICAID Medicaid |
$656.88
|
| Rate for Payer: MEDICARE Medicare |
$499.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$678.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$692.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$678.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$678.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$606.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$571.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$571.20
|
|
|
FLUTICASONE/SALMET DISKUS [100-50 MCG]
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: AETNA Commercial |
$678.30
|
| Rate for Payer: AETNA Medicare |
$642.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$678.30
|
| Rate for Payer: BCBS Healthlink |
$642.60
|
| Rate for Payer: BCBS HMK CHIP |
$642.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$642.60
|
| Rate for Payer: BCBS POS |
$678.30
|
| Rate for Payer: BCBS Traditional |
$714.00
|
| Rate for Payer: CASH_PRICE |
$571.20
|
| Rate for Payer: CIGNA Commercial |
$678.30
|
| Rate for Payer: CIGNA Medicare |
$642.60
|
| Rate for Payer: HUMANA Commercial |
$642.60
|
| Rate for Payer: MEDICAID Medicaid |
$656.88
|
| Rate for Payer: MEDICARE Medicare |
$499.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$678.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$692.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$678.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$678.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$606.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$571.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$571.20
|
|
|
FLUTICASONE/SALMET DISKUS [250-50 MCG]
|
Facility
IP
|
$802.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$561.40 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: BCBS HMK CHIP |
$721.80
|
| Rate for Payer: AETNA Commercial |
$761.90
|
| Rate for Payer: AETNA Medicare |
$721.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$761.90
|
| Rate for Payer: BCBS Healthlink |
$721.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$721.80
|
| Rate for Payer: BCBS POS |
$761.90
|
| Rate for Payer: BCBS Traditional |
$802.00
|
| Rate for Payer: CASH_PRICE |
$641.60
|
| Rate for Payer: CIGNA Commercial |
$761.90
|
| Rate for Payer: CIGNA Medicare |
$721.80
|
| Rate for Payer: HUMANA Commercial |
$721.80
|
| Rate for Payer: MEDICAID Medicaid |
$737.84
|
| Rate for Payer: MEDICARE Medicare |
$561.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$761.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$777.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$761.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$761.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$681.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$641.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$641.60
|
|
|
FLUTICASONE/SALMET DISKUS [250-50 MCG]
|
Facility
OP
|
$802.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$561.40 |
| Max. Negotiated Rate |
$802.00 |
| Rate for Payer: AETNA Commercial |
$761.90
|
| Rate for Payer: AETNA Medicare |
$721.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$761.90
|
| Rate for Payer: BCBS Healthlink |
$721.80
|
| Rate for Payer: BCBS HMK CHIP |
$721.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$721.80
|
| Rate for Payer: BCBS POS |
$761.90
|
| Rate for Payer: BCBS Traditional |
$802.00
|
| Rate for Payer: CASH_PRICE |
$641.60
|
| Rate for Payer: CIGNA Commercial |
$761.90
|
| Rate for Payer: CIGNA Medicare |
$721.80
|
| Rate for Payer: HUMANA Commercial |
$721.80
|
| Rate for Payer: MEDICAID Medicaid |
$737.84
|
| Rate for Payer: MEDICARE Medicare |
$561.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$761.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$777.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$761.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$761.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$681.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$641.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$641.60
|
|
|
FLUTICASONE/SALMET DISKUS [500-50 MCG]
|
Facility
IP
|
$1,054.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$737.80 |
| Max. Negotiated Rate |
$1,054.00 |
| Rate for Payer: AETNA Commercial |
$1,001.30
|
| Rate for Payer: AETNA Medicare |
$948.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,001.30
|
| Rate for Payer: BCBS Healthlink |
$948.60
|
| Rate for Payer: BCBS HMK CHIP |
$948.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$948.60
|
| Rate for Payer: BCBS POS |
$1,001.30
|
| Rate for Payer: BCBS Traditional |
$1,054.00
|
| Rate for Payer: CASH_PRICE |
$843.20
|
| Rate for Payer: CIGNA Commercial |
$1,001.30
|
| Rate for Payer: CIGNA Medicare |
$948.60
|
| Rate for Payer: HUMANA Commercial |
$948.60
|
| Rate for Payer: MEDICAID Medicaid |
$969.68
|
| Rate for Payer: MEDICARE Medicare |
$737.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,001.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,022.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,001.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,001.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$895.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$843.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$843.20
|
|
|
FLUTICASONE/SALMET DISKUS [500-50 MCG]
|
Facility
OP
|
$1,054.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$737.80 |
| Max. Negotiated Rate |
$1,054.00 |
| Rate for Payer: AETNA Commercial |
$1,001.30
|
| Rate for Payer: AETNA Medicare |
$948.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,001.30
|
| Rate for Payer: BCBS Healthlink |
$948.60
|
| Rate for Payer: BCBS HMK CHIP |
$948.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$948.60
|
| Rate for Payer: BCBS POS |
$1,001.30
|
| Rate for Payer: BCBS Traditional |
$1,054.00
|
| Rate for Payer: CASH_PRICE |
$843.20
|
| Rate for Payer: CIGNA Commercial |
$1,001.30
|
| Rate for Payer: CIGNA Medicare |
$948.60
|
| Rate for Payer: HUMANA Commercial |
$948.60
|
| Rate for Payer: MEDICAID Medicaid |
$969.68
|
| Rate for Payer: MEDICARE Medicare |
$737.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,001.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,022.38
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,001.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,001.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$895.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$843.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$843.20
|
|
|
FLUTIC/UMECLID/VILAN 100/62.5/25MCG NF
|
Facility
OP
|
$691.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$483.70 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: AETNA Commercial |
$656.45
|
| Rate for Payer: AETNA Medicare |
$621.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$656.45
|
| Rate for Payer: BCBS Healthlink |
$621.90
|
| Rate for Payer: BCBS HMK CHIP |
$621.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.90
|
| Rate for Payer: BCBS POS |
$656.45
|
| Rate for Payer: BCBS Traditional |
$691.00
|
| Rate for Payer: CASH_PRICE |
$552.80
|
| Rate for Payer: CIGNA Commercial |
$656.45
|
| Rate for Payer: CIGNA Medicare |
$621.90
|
| Rate for Payer: HUMANA Commercial |
$621.90
|
| Rate for Payer: MEDICAID Medicaid |
$635.72
|
| Rate for Payer: MEDICARE Medicare |
$483.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$656.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$670.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$656.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$656.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$587.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.80
|
|
|
FLUTIC/UMECLID/VILAN 100/62.5/25MCG NF
|
Facility
IP
|
$691.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$483.70 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: AETNA Commercial |
$656.45
|
| Rate for Payer: AETNA Medicare |
$621.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$656.45
|
| Rate for Payer: BCBS Healthlink |
$621.90
|
| Rate for Payer: BCBS HMK CHIP |
$621.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$621.90
|
| Rate for Payer: BCBS POS |
$656.45
|
| Rate for Payer: BCBS Traditional |
$691.00
|
| Rate for Payer: CASH_PRICE |
$552.80
|
| Rate for Payer: CIGNA Commercial |
$656.45
|
| Rate for Payer: CIGNA Medicare |
$621.90
|
| Rate for Payer: HUMANA Commercial |
$621.90
|
| Rate for Payer: MEDICAID Medicaid |
$635.72
|
| Rate for Payer: MEDICARE Medicare |
$483.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$656.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$670.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$656.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$656.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$587.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$552.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$552.80
|
|
|
FLUVOXAMINE MALEATE 50MG TABLET-NF
|
Facility
IP
|
$9.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
FLUVOXAMINE MALEATE 50MG TABLET-NF
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
FOLATE (002014)
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
FOLATE (002014)
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: AETNA Commercial |
$19.00
|
| Rate for Payer: AETNA Medicare |
$18.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$19.00
|
| Rate for Payer: BCBS Healthlink |
$18.00
|
| Rate for Payer: BCBS HMK CHIP |
$18.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$18.00
|
| Rate for Payer: BCBS POS |
$19.00
|
| Rate for Payer: BCBS Traditional |
$20.00
|
| Rate for Payer: CASH_PRICE |
$16.00
|
| Rate for Payer: CIGNA Commercial |
$19.00
|
| Rate for Payer: CIGNA Medicare |
$18.00
|
| Rate for Payer: HUMANA Commercial |
$18.00
|
| Rate for Payer: MEDICAID Medicaid |
$18.40
|
| Rate for Payer: MEDICARE Medicare |
$14.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$19.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$19.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$19.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$19.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$17.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$16.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$16.00
|
|
|
FOLEY CATH TRAY (W/REG DRAIN B
|
Facility
IP
|
$59.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: BCBS HMK CHIP |
$53.10
|
| 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 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
|
|
|
FOLEY CATH TRAY (W/REG DRAIN B
|
Facility
OP
|
$59.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
FOLIC ACID INJ [5 MG/ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J3490
|
| 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
|
|
