|
MRA HEAD WO CONTRAST
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,513.40 |
| Max. Negotiated Rate |
$2,162.00 |
| Rate for Payer: AETNA Commercial |
$2,053.90
|
| Rate for Payer: AETNA Medicare |
$1,945.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,053.90
|
| Rate for Payer: BCBS Healthlink |
$1,945.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,945.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,945.80
|
| Rate for Payer: BCBS POS |
$2,053.90
|
| Rate for Payer: BCBS Traditional |
$2,162.00
|
| Rate for Payer: CASH_PRICE |
$1,729.60
|
| Rate for Payer: CIGNA Commercial |
$2,053.90
|
| Rate for Payer: CIGNA Medicare |
$1,945.80
|
| Rate for Payer: HUMANA Commercial |
$1,945.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,989.04
|
| Rate for Payer: MEDICARE Medicare |
$1,513.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,053.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,097.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,053.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,053.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,837.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,729.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,729.60
|
|
|
MRA HEAD WO CONTRAST
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,513.40 |
| Max. Negotiated Rate |
$2,162.00 |
| Rate for Payer: AETNA Commercial |
$2,053.90
|
| Rate for Payer: AETNA Medicare |
$1,945.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,053.90
|
| Rate for Payer: BCBS Healthlink |
$1,945.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,945.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,945.80
|
| Rate for Payer: BCBS POS |
$2,053.90
|
| Rate for Payer: BCBS Traditional |
$2,162.00
|
| Rate for Payer: CASH_PRICE |
$1,729.60
|
| Rate for Payer: CIGNA Commercial |
$2,053.90
|
| Rate for Payer: CIGNA Medicare |
$1,945.80
|
| Rate for Payer: HUMANA Commercial |
$1,945.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,989.04
|
| Rate for Payer: MEDICARE Medicare |
$1,513.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,053.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,097.14
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,053.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,053.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,837.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,729.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,729.60
|
|
|
MRA HEAD W WO CONTRAST
|
Facility
IP
|
$3,047.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,132.90 |
| Max. Negotiated Rate |
$3,047.00 |
| Rate for Payer: AETNA Commercial |
$2,894.65
|
| Rate for Payer: AETNA Medicare |
$2,742.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,894.65
|
| Rate for Payer: BCBS Healthlink |
$2,742.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,742.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,742.30
|
| Rate for Payer: BCBS POS |
$2,894.65
|
| Rate for Payer: BCBS Traditional |
$3,047.00
|
| Rate for Payer: CASH_PRICE |
$2,437.60
|
| Rate for Payer: CIGNA Commercial |
$2,894.65
|
| Rate for Payer: CIGNA Medicare |
$2,742.30
|
| Rate for Payer: HUMANA Commercial |
$2,742.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,803.24
|
| Rate for Payer: MEDICARE Medicare |
$2,132.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,955.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,894.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,589.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,437.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,437.60
|
|
|
MRA HEAD W WO CONTRAST
|
Facility
OP
|
$3,047.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,132.90 |
| Max. Negotiated Rate |
$3,047.00 |
| Rate for Payer: AETNA Commercial |
$2,894.65
|
| Rate for Payer: AETNA Medicare |
$2,742.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,894.65
|
| Rate for Payer: BCBS Healthlink |
$2,742.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,742.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,742.30
|
| Rate for Payer: BCBS POS |
$2,894.65
|
| Rate for Payer: BCBS Traditional |
$3,047.00
|
| Rate for Payer: CASH_PRICE |
$2,437.60
|
| Rate for Payer: CIGNA Commercial |
$2,894.65
|
| Rate for Payer: CIGNA Medicare |
$2,742.30
|
| Rate for Payer: HUMANA Commercial |
$2,742.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,803.24
|
| Rate for Payer: MEDICARE Medicare |
$2,132.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,955.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,894.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,589.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,437.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,437.60
|
|
|
MRA NECK W CONTRAST
|
Facility
OP
|
$2,413.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,689.10 |
| Max. Negotiated Rate |
$2,413.00 |
| Rate for Payer: AETNA Commercial |
$2,292.35
|
| Rate for Payer: AETNA Medicare |
$2,171.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,292.35
|
| Rate for Payer: BCBS Healthlink |
$2,171.70
|
| Rate for Payer: BCBS HMK CHIP |
$2,171.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,171.70
|
| Rate for Payer: BCBS POS |
$2,292.35
|
| Rate for Payer: BCBS Traditional |
$2,413.00
|
| Rate for Payer: CASH_PRICE |
$1,930.40
|
| Rate for Payer: CIGNA Commercial |
$2,292.35
|
| Rate for Payer: CIGNA Medicare |
$2,171.70
|
| Rate for Payer: HUMANA Commercial |
$2,171.70
|
| Rate for Payer: MEDICAID Medicaid |
$2,219.96
|
| Rate for Payer: MEDICARE Medicare |
$1,689.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,292.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,340.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,292.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,292.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,051.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,930.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,930.40
|
|
|
MRA NECK W CONTRAST
|
Facility
IP
|
$2,413.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,689.10 |
| Max. Negotiated Rate |
$2,413.00 |
| Rate for Payer: AETNA Commercial |
$2,292.35
|
| Rate for Payer: AETNA Medicare |
$2,171.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,292.35
|
| Rate for Payer: BCBS Healthlink |
$2,171.70
|
| Rate for Payer: BCBS HMK CHIP |
$2,171.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,171.70
|
| Rate for Payer: BCBS POS |
$2,292.35
|
| Rate for Payer: BCBS Traditional |
$2,413.00
|
| Rate for Payer: CASH_PRICE |
$1,930.40
|
| Rate for Payer: CIGNA Commercial |
$2,292.35
|
| Rate for Payer: CIGNA Medicare |
$2,171.70
|
| Rate for Payer: HUMANA Commercial |
$2,171.70
|
| Rate for Payer: MEDICAID Medicaid |
$2,219.96
|
| Rate for Payer: MEDICARE Medicare |
$1,689.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,292.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,340.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,292.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,292.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,051.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,930.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,930.40
|
|
|
MRA NECK WO CONTRAST
|
Facility
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,502.20 |
| Max. Negotiated Rate |
$2,146.00 |
| Rate for Payer: AETNA Commercial |
$2,038.70
|
| Rate for Payer: AETNA Medicare |
$1,931.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,038.70
|
| Rate for Payer: BCBS Healthlink |
$1,931.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,931.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,931.40
|
| Rate for Payer: BCBS POS |
$2,038.70
|
| Rate for Payer: BCBS Traditional |
$2,146.00
|
| Rate for Payer: CASH_PRICE |
$1,716.80
|
| Rate for Payer: CIGNA Commercial |
$2,038.70
|
| Rate for Payer: CIGNA Medicare |
$1,931.40
|
| Rate for Payer: HUMANA Commercial |
$1,931.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,974.32
|
| Rate for Payer: MEDICARE Medicare |
$1,502.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,038.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,081.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,038.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,038.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,824.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,716.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,716.80
|
|
|
MRA NECK WO CONTRAST
|
Facility
IP
|
$2,146.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,502.20 |
| Max. Negotiated Rate |
$2,146.00 |
| Rate for Payer: AETNA Commercial |
$2,038.70
|
| Rate for Payer: AETNA Medicare |
$1,931.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,038.70
|
| Rate for Payer: BCBS Healthlink |
$1,931.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,931.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,931.40
|
| Rate for Payer: BCBS POS |
$2,038.70
|
| Rate for Payer: BCBS Traditional |
$2,146.00
|
| Rate for Payer: CASH_PRICE |
$1,716.80
|
| Rate for Payer: CIGNA Commercial |
$2,038.70
|
| Rate for Payer: CIGNA Medicare |
$1,931.40
|
| Rate for Payer: HUMANA Commercial |
$1,931.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,974.32
|
| Rate for Payer: MEDICARE Medicare |
$1,502.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,038.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,081.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,038.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,038.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,824.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,716.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,716.80
|
|
|
MRA NECK W WO CONTRAST
|
Facility
IP
|
$3,047.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,132.90 |
| Max. Negotiated Rate |
$3,047.00 |
| Rate for Payer: AETNA Commercial |
$2,894.65
|
| Rate for Payer: AETNA Medicare |
$2,742.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,894.65
|
| Rate for Payer: BCBS Healthlink |
$2,742.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,742.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,742.30
|
| Rate for Payer: BCBS POS |
$2,894.65
|
| Rate for Payer: BCBS Traditional |
$3,047.00
|
| Rate for Payer: CASH_PRICE |
$2,437.60
|
| Rate for Payer: CIGNA Commercial |
$2,894.65
|
| Rate for Payer: CIGNA Medicare |
$2,742.30
|
| Rate for Payer: HUMANA Commercial |
$2,742.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,803.24
|
| Rate for Payer: MEDICARE Medicare |
$2,132.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,955.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,894.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,589.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,437.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,437.60
|
|
|
MRA NECK W WO CONTRAST
|
Facility
OP
|
$3,047.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,132.90 |
| Max. Negotiated Rate |
$3,047.00 |
| Rate for Payer: AETNA Commercial |
$2,894.65
|
| Rate for Payer: AETNA Medicare |
$2,742.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,894.65
|
| Rate for Payer: BCBS Healthlink |
$2,742.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,742.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,742.30
|
| Rate for Payer: BCBS POS |
$2,894.65
|
| Rate for Payer: BCBS Traditional |
$3,047.00
|
| Rate for Payer: CASH_PRICE |
$2,437.60
|
| Rate for Payer: CIGNA Commercial |
$2,894.65
|
| Rate for Payer: CIGNA Medicare |
$2,742.30
|
| Rate for Payer: HUMANA Commercial |
$2,742.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,803.24
|
| Rate for Payer: MEDICARE Medicare |
$2,132.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,955.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,894.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,894.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,589.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,437.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,437.60
|
|
|
MR ANKLE LT W CONTRAST
|
Facility
IP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR ANKLE LT W CONTRAST
|
Facility
OP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR ANKLE LT WO CONTRAST
|
Facility
IP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR ANKLE LT WO CONTRAST
|
Facility
OP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR ANKLE LT W WO CONTRAST
|
Facility
OP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR ANKLE LT W WO CONTRAST
|
Facility
IP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR ANKLE RT W CONTRAST
|
Facility
OP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR ANKLE RT W CONTRAST
|
Facility
IP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR ANKLE RT WO CONTRAST
|
Facility
OP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR ANKLE RT WO CONTRAST
|
Facility
IP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR ANKLE RT W WO CONTRAST
|
Facility
OP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR ANKLE RT W WO CONTRAST
|
Facility
IP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR BRAIN W CONTRAST
|
Facility
IP
|
$2,692.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,884.40 |
| Max. Negotiated Rate |
$2,692.00 |
| Rate for Payer: AETNA Commercial |
$2,557.40
|
| Rate for Payer: AETNA Medicare |
$2,422.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,557.40
|
| Rate for Payer: BCBS Healthlink |
$2,422.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,422.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,422.80
|
| Rate for Payer: BCBS POS |
$2,557.40
|
| Rate for Payer: BCBS Traditional |
$2,692.00
|
| Rate for Payer: CASH_PRICE |
$2,153.60
|
| Rate for Payer: CIGNA Commercial |
$2,557.40
|
| Rate for Payer: CIGNA Medicare |
$2,422.80
|
| Rate for Payer: HUMANA Commercial |
$2,422.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,476.64
|
| Rate for Payer: MEDICARE Medicare |
$1,884.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,557.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,611.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,557.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,557.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,288.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,153.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,153.60
|
|
|
MR BRAIN W CONTRAST
|
Facility
OP
|
$2,692.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,884.40 |
| Max. Negotiated Rate |
$2,692.00 |
| Rate for Payer: AETNA Commercial |
$2,557.40
|
| Rate for Payer: AETNA Medicare |
$2,422.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,557.40
|
| Rate for Payer: BCBS Healthlink |
$2,422.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,422.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,422.80
|
| Rate for Payer: BCBS POS |
$2,557.40
|
| Rate for Payer: BCBS Traditional |
$2,692.00
|
| Rate for Payer: CASH_PRICE |
$2,153.60
|
| Rate for Payer: CIGNA Commercial |
$2,557.40
|
| Rate for Payer: CIGNA Medicare |
$2,422.80
|
| Rate for Payer: HUMANA Commercial |
$2,422.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,476.64
|
| Rate for Payer: MEDICARE Medicare |
$1,884.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,557.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,611.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,557.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,557.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,288.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,153.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,153.60
|
|
|
MR BRAIN WO CONTRAST
|
Facility
OP
|
$2,321.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,624.70 |
| Max. Negotiated Rate |
$2,321.00 |
| Rate for Payer: AETNA Commercial |
$2,204.95
|
| Rate for Payer: AETNA Medicare |
$2,088.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,204.95
|
| Rate for Payer: BCBS Healthlink |
$2,088.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,088.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,088.90
|
| Rate for Payer: BCBS POS |
$2,204.95
|
| Rate for Payer: BCBS Traditional |
$2,321.00
|
| Rate for Payer: CASH_PRICE |
$1,856.80
|
| Rate for Payer: CIGNA Commercial |
$2,204.95
|
| Rate for Payer: CIGNA Medicare |
$2,088.90
|
| Rate for Payer: HUMANA Commercial |
$2,088.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,135.32
|
| Rate for Payer: MEDICARE Medicare |
$1,624.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,204.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,251.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,204.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,204.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,972.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,856.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,856.80
|
|
