|
IBUPROFEN ORAL SUSP [100 MG/5 ML] BTL
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
IBUPROFEN ORAL SUSP [100 MG/5 ML] BTL
|
Facility
IP
|
$28.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: BCBS HMK CHIP |
$25.20
|
| Rate for Payer: AETNA Commercial |
$26.60
|
| Rate for Payer: AETNA Medicare |
$25.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$26.60
|
| Rate for Payer: BCBS Healthlink |
$25.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$25.20
|
| Rate for Payer: BCBS POS |
$26.60
|
| Rate for Payer: BCBS Traditional |
$28.00
|
| Rate for Payer: CASH_PRICE |
$22.40
|
| Rate for Payer: CIGNA Commercial |
$26.60
|
| Rate for Payer: CIGNA Medicare |
$25.20
|
| Rate for Payer: HUMANA Commercial |
$25.20
|
| Rate for Payer: MEDICAID Medicaid |
$25.76
|
| Rate for Payer: MEDICARE Medicare |
$19.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$26.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$27.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$26.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$26.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$23.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$22.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$22.40
|
|
|
IBUPROFEN TAB [200 MG]
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
IBUPROFEN TAB [200 MG]
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: AETNA Commercial |
$4.75
|
| Rate for Payer: AETNA Medicare |
$4.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4.75
|
| Rate for Payer: BCBS Healthlink |
$4.50
|
| Rate for Payer: BCBS HMK CHIP |
$4.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4.50
|
| Rate for Payer: BCBS POS |
$4.75
|
| Rate for Payer: BCBS Traditional |
$5.00
|
| Rate for Payer: CASH_PRICE |
$4.00
|
| Rate for Payer: CIGNA Commercial |
$4.75
|
| Rate for Payer: CIGNA Medicare |
$4.50
|
| Rate for Payer: HUMANA Commercial |
$4.50
|
| Rate for Payer: MEDICAID Medicaid |
$4.60
|
| Rate for Payer: MEDICARE Medicare |
$3.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4.00
|
|
|
ICE PACK SECURE-ALL LG
|
Facility
OP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
ICE PACK SECURE-ALL LG
|
Facility
IP
|
$13.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
I D ABSCESS/CYST COMPLICATED
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
|
I D ABSCESS/CYST COMPLICATED
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: BCBS HMK CHIP |
$472.50
|
| Rate for Payer: AETNA Commercial |
$498.75
|
| Rate for Payer: AETNA Medicare |
$472.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$498.75
|
| Rate for Payer: BCBS Healthlink |
$472.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$472.50
|
| Rate for Payer: BCBS POS |
$498.75
|
| Rate for Payer: BCBS Traditional |
$525.00
|
| Rate for Payer: CASH_PRICE |
$420.00
|
| Rate for Payer: CIGNA Commercial |
$498.75
|
| Rate for Payer: CIGNA Medicare |
$472.50
|
| Rate for Payer: HUMANA Commercial |
$472.50
|
| Rate for Payer: MEDICAID Medicaid |
$483.00
|
| Rate for Payer: MEDICARE Medicare |
$367.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$498.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$509.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$498.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$498.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$446.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$420.00
|
|
|
I D ABSCESS/CYST SIMPLE
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
I D ABSCESS/CYST SIMPLE
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: AETNA Commercial |
$275.50
|
| Rate for Payer: AETNA Medicare |
$261.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$275.50
|
| Rate for Payer: BCBS Healthlink |
$261.00
|
| Rate for Payer: BCBS HMK CHIP |
$261.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$261.00
|
| Rate for Payer: BCBS POS |
$275.50
|
| Rate for Payer: BCBS Traditional |
$290.00
|
| Rate for Payer: CASH_PRICE |
$232.00
|
| Rate for Payer: CIGNA Commercial |
$275.50
|
| Rate for Payer: CIGNA Medicare |
$261.00
|
| Rate for Payer: HUMANA Commercial |
$261.00
|
| Rate for Payer: MEDICAID Medicaid |
$266.80
|
| Rate for Payer: MEDICARE Medicare |
$203.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$275.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$281.30
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$275.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$275.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$246.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$232.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$232.00
|
|
|
I&D ARM BURSA
|
Facility
IP
|
$651.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: BCBS HMK CHIP |
$585.90
|
| Rate for Payer: AETNA Commercial |
$618.45
|
| Rate for Payer: AETNA Medicare |
$585.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$618.45
|
| Rate for Payer: BCBS Healthlink |
$585.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$585.90
|
| Rate for Payer: BCBS POS |
$618.45
|
| Rate for Payer: BCBS Traditional |
$651.00
|
| Rate for Payer: CASH_PRICE |
$520.80
|
| Rate for Payer: CIGNA Commercial |
$618.45
|
| Rate for Payer: CIGNA Medicare |
$585.90
|
| Rate for Payer: HUMANA Commercial |
$585.90
|
| Rate for Payer: MEDICAID Medicaid |
$598.92
|
| Rate for Payer: MEDICARE Medicare |
$455.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$618.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$631.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$618.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$618.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$553.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$520.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$520.80
|
|
|
I&D ARM BURSA
|
Facility
OP
|
$651.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: AETNA Commercial |
$618.45
|
| Rate for Payer: AETNA Medicare |
$585.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$618.45
|
| Rate for Payer: BCBS Healthlink |
$585.90
|
| Rate for Payer: BCBS HMK CHIP |
$585.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$585.90
|
| Rate for Payer: BCBS POS |
$618.45
|
| Rate for Payer: BCBS Traditional |
$651.00
|
| Rate for Payer: CASH_PRICE |
$520.80
|
| Rate for Payer: CIGNA Commercial |
$618.45
|
| Rate for Payer: CIGNA Medicare |
$585.90
|
| Rate for Payer: HUMANA Commercial |
$585.90
|
| Rate for Payer: MEDICAID Medicaid |
$598.92
|
| Rate for Payer: MEDICARE Medicare |
$455.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$618.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$631.47
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$618.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$618.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$553.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$520.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$520.80
|
|
|
I D HEMATOMA SEROMA OR FLUID COLLEC
|
Facility
IP
|
$467.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$467.00 |
| Rate for Payer: BCBS HMK CHIP |
$420.30
|
| Rate for Payer: AETNA Commercial |
$443.65
|
| Rate for Payer: AETNA Medicare |
$420.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$443.65
|
| Rate for Payer: BCBS Healthlink |
$420.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$420.30
|
| Rate for Payer: BCBS POS |
$443.65
|
| Rate for Payer: BCBS Traditional |
$467.00
|
| Rate for Payer: CASH_PRICE |
$373.60
|
| Rate for Payer: CIGNA Commercial |
$443.65
|
| Rate for Payer: CIGNA Medicare |
$420.30
|
| Rate for Payer: HUMANA Commercial |
$420.30
|
| Rate for Payer: MEDICAID Medicaid |
$429.64
|
| Rate for Payer: MEDICARE Medicare |
$326.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$443.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$452.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$443.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$443.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$396.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$373.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$373.60
|
|
|
I D HEMATOMA SEROMA OR FLUID COLLEC
|
Facility
OP
|
$467.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$467.00 |
| Rate for Payer: AETNA Commercial |
$443.65
|
| Rate for Payer: AETNA Medicare |
$420.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$443.65
|
| Rate for Payer: BCBS Healthlink |
$420.30
|
| Rate for Payer: BCBS HMK CHIP |
$420.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$420.30
|
| Rate for Payer: BCBS POS |
$443.65
|
| Rate for Payer: BCBS Traditional |
$467.00
|
| Rate for Payer: CASH_PRICE |
$373.60
|
| Rate for Payer: CIGNA Commercial |
$443.65
|
| Rate for Payer: CIGNA Medicare |
$420.30
|
| Rate for Payer: HUMANA Commercial |
$420.30
|
| Rate for Payer: MEDICAID Medicaid |
$429.64
|
| Rate for Payer: MEDICARE Medicare |
$326.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$443.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$452.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$443.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$443.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$396.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$373.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$373.60
|
|
|
I D WOUND COMPLEX
|
Facility
OP
|
$718.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$502.60 |
| Max. Negotiated Rate |
$718.00 |
| Rate for Payer: AETNA Commercial |
$682.10
|
| Rate for Payer: AETNA Medicare |
$646.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$682.10
|
| Rate for Payer: BCBS Healthlink |
$646.20
|
| Rate for Payer: BCBS HMK CHIP |
$646.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$646.20
|
| Rate for Payer: BCBS POS |
$682.10
|
| Rate for Payer: BCBS Traditional |
$718.00
|
| Rate for Payer: CASH_PRICE |
$574.40
|
| Rate for Payer: CIGNA Commercial |
$682.10
|
| Rate for Payer: CIGNA Medicare |
$646.20
|
| Rate for Payer: HUMANA Commercial |
$646.20
|
| Rate for Payer: MEDICAID Medicaid |
$660.56
|
| Rate for Payer: MEDICARE Medicare |
$502.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$682.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$696.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$682.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$682.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$610.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$574.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$574.40
|
|
|
I D WOUND COMPLEX
|
Facility
IP
|
$718.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$502.60 |
| Max. Negotiated Rate |
$718.00 |
| Rate for Payer: AETNA Commercial |
$682.10
|
| Rate for Payer: AETNA Medicare |
$646.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$682.10
|
| Rate for Payer: BCBS Healthlink |
$646.20
|
| Rate for Payer: BCBS HMK CHIP |
$646.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$646.20
|
| Rate for Payer: BCBS POS |
$682.10
|
| Rate for Payer: BCBS Traditional |
$718.00
|
| Rate for Payer: CASH_PRICE |
$574.40
|
| Rate for Payer: CIGNA Commercial |
$682.10
|
| Rate for Payer: CIGNA Medicare |
$646.20
|
| Rate for Payer: HUMANA Commercial |
$646.20
|
| Rate for Payer: MEDICAID Medicaid |
$660.56
|
| Rate for Payer: MEDICARE Medicare |
$502.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$682.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$696.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$682.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$682.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$610.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$574.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$574.40
|
|
|
IMMUHOHISTO ANTB ADDL SLIDE
|
Facility
OP
|
$191.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
IMMUHOHISTO ANTB ADDL SLIDE
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: AETNA Commercial |
$181.45
|
| Rate for Payer: AETNA Medicare |
$171.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$181.45
|
| Rate for Payer: BCBS Healthlink |
$171.90
|
| Rate for Payer: BCBS HMK CHIP |
$171.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$171.90
|
| Rate for Payer: BCBS POS |
$181.45
|
| Rate for Payer: BCBS Traditional |
$191.00
|
| Rate for Payer: CASH_PRICE |
$152.80
|
| Rate for Payer: CIGNA Commercial |
$181.45
|
| Rate for Payer: CIGNA Medicare |
$171.90
|
| Rate for Payer: HUMANA Commercial |
$171.90
|
| Rate for Payer: MEDICAID Medicaid |
$175.72
|
| Rate for Payer: MEDICARE Medicare |
$133.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$181.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$185.27
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$181.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$181.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$162.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$152.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$152.80
|
|
|
IMMUNE GLOBULIN [20 G] 10% 200ML SDV
|
Facility
IP
|
$5,116.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20211027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,581.20 |
| Max. Negotiated Rate |
$5,116.00 |
| Rate for Payer: BCBS HMK CHIP |
$4,604.40
|
| Rate for Payer: AETNA Commercial |
$4,860.20
|
| Rate for Payer: AETNA Medicare |
$4,604.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4,860.20
|
| Rate for Payer: BCBS Healthlink |
$4,604.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4,604.40
|
| Rate for Payer: BCBS POS |
$4,860.20
|
| Rate for Payer: BCBS Traditional |
$5,116.00
|
| Rate for Payer: CASH_PRICE |
$4,092.80
|
| Rate for Payer: CIGNA Commercial |
$4,860.20
|
| Rate for Payer: CIGNA Medicare |
$4,604.40
|
| Rate for Payer: HUMANA Commercial |
$4,604.40
|
| Rate for Payer: MEDICAID Medicaid |
$4,706.72
|
| Rate for Payer: MEDICARE Medicare |
$3,581.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4,860.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4,962.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4,860.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4,860.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4,348.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4,092.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4,092.80
|
|
|
IMMUNE GLOBULIN [20 G] 10% 200ML SDV
|
Facility
OP
|
$5,116.00
|
|
|
Service Code
|
CPT J1459
|
| Hospital Charge Code |
20211027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,581.20 |
| Max. Negotiated Rate |
$5,116.00 |
| Rate for Payer: AETNA Commercial |
$4,860.20
|
| Rate for Payer: AETNA Medicare |
$4,604.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$4,860.20
|
| Rate for Payer: BCBS Healthlink |
$4,604.40
|
| Rate for Payer: BCBS HMK CHIP |
$4,604.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$4,604.40
|
| Rate for Payer: BCBS POS |
$4,860.20
|
| Rate for Payer: BCBS Traditional |
$5,116.00
|
| Rate for Payer: CASH_PRICE |
$4,092.80
|
| Rate for Payer: CIGNA Commercial |
$4,860.20
|
| Rate for Payer: CIGNA Medicare |
$4,604.40
|
| Rate for Payer: HUMANA Commercial |
$4,604.40
|
| Rate for Payer: MEDICAID Medicaid |
$4,706.72
|
| Rate for Payer: MEDICARE Medicare |
$3,581.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$4,860.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$4,962.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$4,860.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$4,860.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$4,348.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$4,092.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$4,092.80
|
|
|
IMMUNIZATION ADMIN ADDITIONAL VACCINE
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
IMMUNIZATION ADMIN ADDITIONAL VACCINE
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: AETNA Commercial |
$36.10
|
| Rate for Payer: AETNA Medicare |
$34.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$36.10
|
| Rate for Payer: BCBS Healthlink |
$34.20
|
| Rate for Payer: BCBS HMK CHIP |
$34.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$34.20
|
| Rate for Payer: BCBS POS |
$36.10
|
| Rate for Payer: BCBS Traditional |
$38.00
|
| Rate for Payer: CASH_PRICE |
$30.40
|
| Rate for Payer: CIGNA Commercial |
$36.10
|
| Rate for Payer: CIGNA Medicare |
$34.20
|
| Rate for Payer: HUMANA Commercial |
$34.20
|
| Rate for Payer: MEDICAID Medicaid |
$34.96
|
| Rate for Payer: MEDICARE Medicare |
$26.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$36.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$36.86
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$36.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$36.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$32.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$30.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$30.40
|
|
|
IMMUNIZATION ADMIN ADDTNL VAC W/ NASAL
|
Facility
OP
|
$13.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
IMMUNIZATION ADMIN ADDTNL VAC W/ NASAL
|
Facility
IP
|
$13.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: BCBS HMK CHIP |
$11.70
|
| Rate for Payer: AETNA Commercial |
$12.35
|
| Rate for Payer: AETNA Medicare |
$11.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$12.35
|
| Rate for Payer: BCBS Healthlink |
$11.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$11.70
|
| Rate for Payer: BCBS POS |
$12.35
|
| Rate for Payer: BCBS Traditional |
$13.00
|
| Rate for Payer: CASH_PRICE |
$10.40
|
| Rate for Payer: CIGNA Commercial |
$12.35
|
| Rate for Payer: CIGNA Medicare |
$11.70
|
| Rate for Payer: HUMANA Commercial |
$11.70
|
| Rate for Payer: MEDICAID Medicaid |
$11.96
|
| Rate for Payer: MEDICARE Medicare |
$9.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$12.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$12.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$12.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$12.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$10.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$10.40
|
|
|
IMMUNIZATION ADMIN INTRANASAL OR ORAL
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: AETNA Commercial |
$34.20
|
| Rate for Payer: AETNA Medicare |
$32.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$34.20
|
| Rate for Payer: BCBS Healthlink |
$32.40
|
| Rate for Payer: BCBS HMK CHIP |
$32.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$32.40
|
| Rate for Payer: BCBS POS |
$34.20
|
| Rate for Payer: BCBS Traditional |
$36.00
|
| Rate for Payer: CASH_PRICE |
$28.80
|
| Rate for Payer: CIGNA Commercial |
$34.20
|
| Rate for Payer: CIGNA Medicare |
$32.40
|
| Rate for Payer: HUMANA Commercial |
$32.40
|
| Rate for Payer: MEDICAID Medicaid |
$33.12
|
| Rate for Payer: MEDICARE Medicare |
$25.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$34.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$34.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$34.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$34.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$30.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$28.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$28.80
|
|
