|
AMBULANCE GROUND MILEAGE
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT A0425 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
AMBULANCE GROUND MILEAGE
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT A0425 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: AETNA Commercial |
$21.85
|
| Rate for Payer: AETNA Medicare |
$20.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$21.85
|
| Rate for Payer: BCBS Healthlink |
$20.70
|
| Rate for Payer: BCBS HMK CHIP |
$20.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$20.70
|
| Rate for Payer: BCBS POS |
$21.85
|
| Rate for Payer: BCBS Traditional |
$23.00
|
| Rate for Payer: CASH_PRICE |
$18.40
|
| Rate for Payer: CIGNA Commercial |
$21.85
|
| Rate for Payer: CIGNA Medicare |
$20.70
|
| Rate for Payer: HUMANA Commercial |
$20.70
|
| Rate for Payer: MEDICAID Medicaid |
$21.16
|
| Rate for Payer: MEDICARE Medicare |
$16.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$21.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$22.31
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$21.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$21.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$19.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$18.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$18.40
|
|
|
AMBULANCE INTRAOSSEOUS ACCESS
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
CPT A0999 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
AMBULANCE INTRAOSSEOUS ACCESS
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
CPT A0999 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS HMK CHIP |
$189.00
|
| Rate for Payer: AETNA Commercial |
$199.50
|
| Rate for Payer: AETNA Medicare |
$189.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$199.50
|
| Rate for Payer: BCBS Healthlink |
$189.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$189.00
|
| Rate for Payer: BCBS POS |
$199.50
|
| Rate for Payer: BCBS Traditional |
$210.00
|
| Rate for Payer: CASH_PRICE |
$168.00
|
| Rate for Payer: CIGNA Commercial |
$199.50
|
| Rate for Payer: CIGNA Medicare |
$189.00
|
| Rate for Payer: HUMANA Commercial |
$189.00
|
| Rate for Payer: MEDICAID Medicaid |
$193.20
|
| Rate for Payer: MEDICARE Medicare |
$147.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$199.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$203.70
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$199.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$199.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$178.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$168.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$168.00
|
|
|
AMBULANCE IV SUPPLIES
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT A0394 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
AMBULANCE IV SUPPLIES
|
Facility
OP
|
$42.00
|
|
|
Service Code
|
CPT A0394 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
AMBULANCE O2 LIFE SAVING PER 1/2 HR
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT A0422 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
AMBULANCE O2 LIFE SAVING PER 1/2 HR
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT A0422 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: BCBS HMK CHIP |
$47.70
|
| Rate for Payer: AETNA Commercial |
$50.35
|
| Rate for Payer: AETNA Medicare |
$47.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$50.35
|
| Rate for Payer: BCBS Healthlink |
$47.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$47.70
|
| Rate for Payer: BCBS POS |
$50.35
|
| Rate for Payer: BCBS Traditional |
$53.00
|
| Rate for Payer: CASH_PRICE |
$42.40
|
| Rate for Payer: CIGNA Commercial |
$50.35
|
| Rate for Payer: CIGNA Medicare |
$47.70
|
| Rate for Payer: HUMANA Commercial |
$47.70
|
| Rate for Payer: MEDICAID Medicaid |
$48.76
|
| Rate for Payer: MEDICARE Medicare |
$37.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$50.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$51.41
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$50.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$50.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$45.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$42.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$42.40
|
|
|
AMBULANCE RESPONSE & TREAT NO TRANSPORT
|
Facility
IP
|
$158.00
|
|
|
Service Code
|
CPT A0433 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: AETNA Commercial |
$150.10
|
| Rate for Payer: AETNA Medicare |
$142.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$150.10
|
| Rate for Payer: BCBS Healthlink |
$142.20
|
| Rate for Payer: BCBS HMK CHIP |
$142.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$142.20
|
| Rate for Payer: BCBS POS |
$150.10
|
| Rate for Payer: BCBS Traditional |
$158.00
|
| Rate for Payer: CASH_PRICE |
$126.40
|
| Rate for Payer: CIGNA Commercial |
$150.10
|
| Rate for Payer: CIGNA Medicare |
$142.20
|
| Rate for Payer: HUMANA Commercial |
$142.20
|
| Rate for Payer: MEDICAID Medicaid |
$145.36
|
| Rate for Payer: MEDICARE Medicare |
$110.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$150.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$153.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$150.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$150.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$134.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$126.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$126.40
|
|
|
AMBULANCE RESPONSE & TREAT NO TRANSPORT
|
Facility
OP
|
$158.00
|
|
|
Service Code
|
CPT A0433 QN
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$110.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: AETNA Commercial |
$150.10
|
| Rate for Payer: AETNA Medicare |
$142.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$150.10
|
| Rate for Payer: BCBS Healthlink |
$142.20
|
| Rate for Payer: BCBS HMK CHIP |
$142.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$142.20
|
| Rate for Payer: BCBS POS |
$150.10
|
| Rate for Payer: BCBS Traditional |
$158.00
|
| Rate for Payer: CASH_PRICE |
$126.40
|
| Rate for Payer: CIGNA Commercial |
$150.10
|
| Rate for Payer: CIGNA Medicare |
$142.20
|
| Rate for Payer: HUMANA Commercial |
$142.20
|
| Rate for Payer: MEDICAID Medicaid |
$145.36
|
| Rate for Payer: MEDICARE Medicare |
$110.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$150.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$153.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$150.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$150.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$134.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$126.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$126.40
|
|
|
AMIODARONE INJ [150 MG/3 ML]
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT J0282
|
| 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
|
|
|
AMIODARONE INJ [150 MG/3 ML]
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT J0282
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: BCBS HMK CHIP |
$23.40
|
| 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 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
|
|
|
AMIODARONE TAB [200 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: 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
|
|
|
AMIODARONE TAB [200 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
|
|
|
AMITRIPTYLINE TAB [25 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
|
|
|
AMITRIPTYLINE TAB [25 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
|
|
|
AMLODIPINE TAB [5 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: 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
|
|
|
AMLODIPINE TAB [5 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
|
|
|
AMMONIA (007054)
|
Facility
OP
|
$43.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
AMMONIA (007054)
|
Facility
IP
|
$43.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: BCBS HMK CHIP |
$38.70
|
| Rate for Payer: AETNA Commercial |
$40.85
|
| Rate for Payer: AETNA Medicare |
$38.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$40.85
|
| Rate for Payer: BCBS Healthlink |
$38.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$38.70
|
| Rate for Payer: BCBS POS |
$40.85
|
| Rate for Payer: BCBS Traditional |
$43.00
|
| Rate for Payer: CASH_PRICE |
$34.40
|
| Rate for Payer: CIGNA Commercial |
$40.85
|
| Rate for Payer: CIGNA Medicare |
$38.70
|
| Rate for Payer: HUMANA Commercial |
$38.70
|
| Rate for Payer: MEDICAID Medicaid |
$39.56
|
| Rate for Payer: MEDICARE Medicare |
$30.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$40.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$41.71
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$40.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$40.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$36.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$34.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$34.40
|
|
|
AMOX/CLAV 250/62.5MG 5 ML (150ML)
|
Facility
IP
|
$406.40
|
|
| Hospital Charge Code |
20221207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$406.40 |
| Rate for Payer: AETNA Commercial |
$386.08
|
| Rate for Payer: AETNA Medicare |
$365.76
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.08
|
| Rate for Payer: BCBS Healthlink |
$365.76
|
| Rate for Payer: BCBS HMK CHIP |
$365.76
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$365.76
|
| Rate for Payer: BCBS POS |
$386.08
|
| Rate for Payer: BCBS Traditional |
$406.40
|
| Rate for Payer: CASH_PRICE |
$325.12
|
| Rate for Payer: CIGNA Commercial |
$386.08
|
| Rate for Payer: CIGNA Medicare |
$365.76
|
| Rate for Payer: HUMANA Commercial |
$365.76
|
| Rate for Payer: MEDICAID Medicaid |
$373.89
|
| Rate for Payer: MEDICARE Medicare |
$284.48
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.08
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.08
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.08
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.44
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.12
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.12
|
|
|
AMOX/CLAV 250/62.5MG 5 ML (150ML)
|
Facility
OP
|
$406.40
|
|
| Hospital Charge Code |
20221207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$406.40 |
| Rate for Payer: AETNA Commercial |
$386.08
|
| Rate for Payer: AETNA Medicare |
$365.76
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$386.08
|
| Rate for Payer: BCBS Healthlink |
$365.76
|
| Rate for Payer: BCBS HMK CHIP |
$365.76
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$365.76
|
| Rate for Payer: BCBS POS |
$386.08
|
| Rate for Payer: BCBS Traditional |
$406.40
|
| Rate for Payer: CASH_PRICE |
$325.12
|
| Rate for Payer: CIGNA Commercial |
$386.08
|
| Rate for Payer: CIGNA Medicare |
$365.76
|
| Rate for Payer: HUMANA Commercial |
$365.76
|
| Rate for Payer: MEDICAID Medicaid |
$373.89
|
| Rate for Payer: MEDICARE Medicare |
$284.48
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$386.08
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$394.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$386.08
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$386.08
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$345.44
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$325.12
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$325.12
|
|
|
AMOX/CLAV SUSP 250/62.5MG 5ML (75ML)
|
Facility
IP
|
$207.15
|
|
| Hospital Charge Code |
20221207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$207.15 |
| Rate for Payer: BCBS HMK CHIP |
$186.44
|
| Rate for Payer: AETNA Commercial |
$196.79
|
| Rate for Payer: AETNA Medicare |
$186.44
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.79
|
| Rate for Payer: BCBS Healthlink |
$186.44
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.44
|
| Rate for Payer: BCBS POS |
$196.79
|
| Rate for Payer: BCBS Traditional |
$207.15
|
| Rate for Payer: CASH_PRICE |
$165.72
|
| Rate for Payer: CIGNA Commercial |
$196.79
|
| Rate for Payer: CIGNA Medicare |
$186.44
|
| Rate for Payer: HUMANA Commercial |
$186.44
|
| Rate for Payer: MEDICAID Medicaid |
$190.58
|
| Rate for Payer: MEDICARE Medicare |
$145.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.79
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.79
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.79
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.08
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.72
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.72
|
|
|
AMOX/CLAV SUSP 250/62.5MG 5ML (75ML)
|
Facility
OP
|
$207.15
|
|
| Hospital Charge Code |
20221207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$207.15 |
| Rate for Payer: AETNA Commercial |
$196.79
|
| Rate for Payer: AETNA Medicare |
$186.44
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$196.79
|
| Rate for Payer: BCBS Healthlink |
$186.44
|
| Rate for Payer: BCBS HMK CHIP |
$186.44
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$186.44
|
| Rate for Payer: BCBS POS |
$196.79
|
| Rate for Payer: BCBS Traditional |
$207.15
|
| Rate for Payer: CASH_PRICE |
$165.72
|
| Rate for Payer: CIGNA Commercial |
$196.79
|
| Rate for Payer: CIGNA Medicare |
$186.44
|
| Rate for Payer: HUMANA Commercial |
$186.44
|
| Rate for Payer: MEDICAID Medicaid |
$190.58
|
| Rate for Payer: MEDICARE Medicare |
$145.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$196.79
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$200.94
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$196.79
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$196.79
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$176.08
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$165.72
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$165.72
|
|
|
AMOXICILLIN 125MG/5ML SUSP (100ML)
|
Facility
IP
|
$15.00
|
|
| Hospital Charge Code |
20221207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: BCBS HMK CHIP |
$13.50
|
| Rate for Payer: AETNA Commercial |
$14.25
|
| Rate for Payer: AETNA Medicare |
$13.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$14.25
|
| Rate for Payer: BCBS Healthlink |
$13.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$13.50
|
| Rate for Payer: BCBS POS |
$14.25
|
| Rate for Payer: BCBS Traditional |
$15.00
|
| Rate for Payer: CASH_PRICE |
$12.00
|
| Rate for Payer: CIGNA Commercial |
$14.25
|
| Rate for Payer: CIGNA Medicare |
$13.50
|
| Rate for Payer: HUMANA Commercial |
$13.50
|
| Rate for Payer: MEDICAID Medicaid |
$13.80
|
| Rate for Payer: MEDICARE Medicare |
$10.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$14.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$14.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$14.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$14.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$12.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.00
|
|
