|
CRYOTHERAPY ACNE
|
Facility
IP
|
$185.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
CRYPTOSPORIDUM, EIA (183020)
|
Facility
OP
|
$206.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: AETNA Commercial |
$195.70
|
| Rate for Payer: AETNA Medicare |
$185.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$195.70
|
| Rate for Payer: BCBS Healthlink |
$185.40
|
| Rate for Payer: BCBS HMK CHIP |
$185.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$185.40
|
| Rate for Payer: BCBS POS |
$195.70
|
| Rate for Payer: BCBS Traditional |
$206.00
|
| Rate for Payer: CASH_PRICE |
$164.80
|
| Rate for Payer: CIGNA Commercial |
$195.70
|
| Rate for Payer: CIGNA Medicare |
$185.40
|
| Rate for Payer: HUMANA Commercial |
$185.40
|
| Rate for Payer: MEDICAID Medicaid |
$189.52
|
| Rate for Payer: MEDICARE Medicare |
$144.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$195.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$199.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$195.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$195.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.80
|
|
|
CRYPTOSPORIDUM, EIA (183020)
|
Facility
IP
|
$206.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: BCBS HMK CHIP |
$185.40
|
| Rate for Payer: AETNA Commercial |
$195.70
|
| Rate for Payer: AETNA Medicare |
$185.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$195.70
|
| Rate for Payer: BCBS Healthlink |
$185.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$185.40
|
| Rate for Payer: BCBS POS |
$195.70
|
| Rate for Payer: BCBS Traditional |
$206.00
|
| Rate for Payer: CASH_PRICE |
$164.80
|
| Rate for Payer: CIGNA Commercial |
$195.70
|
| Rate for Payer: CIGNA Medicare |
$185.40
|
| Rate for Payer: HUMANA Commercial |
$185.40
|
| Rate for Payer: MEDICAID Medicaid |
$189.52
|
| Rate for Payer: MEDICARE Medicare |
$144.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$195.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$199.82
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$195.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$195.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$175.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$164.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$164.80
|
|
|
CT 3D RECONSTRUCTION
|
Facility
IP
|
$365.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: AETNA Commercial |
$346.75
|
| Rate for Payer: AETNA Medicare |
$328.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$346.75
|
| Rate for Payer: BCBS Healthlink |
$328.50
|
| Rate for Payer: BCBS HMK CHIP |
$328.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$328.50
|
| Rate for Payer: BCBS POS |
$346.75
|
| Rate for Payer: BCBS Traditional |
$365.00
|
| Rate for Payer: CASH_PRICE |
$292.00
|
| Rate for Payer: CIGNA Commercial |
$346.75
|
| Rate for Payer: CIGNA Medicare |
$328.50
|
| Rate for Payer: HUMANA Commercial |
$328.50
|
| Rate for Payer: MEDICAID Medicaid |
$335.80
|
| Rate for Payer: MEDICARE Medicare |
$255.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$346.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$354.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$346.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$346.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$310.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$292.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$292.00
|
|
|
CT 3D RECONSTRUCTION
|
Facility
OP
|
$365.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: AETNA Commercial |
$346.75
|
| Rate for Payer: AETNA Medicare |
$328.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$346.75
|
| Rate for Payer: BCBS Healthlink |
$328.50
|
| Rate for Payer: BCBS HMK CHIP |
$328.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$328.50
|
| Rate for Payer: BCBS POS |
$346.75
|
| Rate for Payer: BCBS Traditional |
$365.00
|
| Rate for Payer: CASH_PRICE |
$292.00
|
| Rate for Payer: CIGNA Commercial |
$346.75
|
| Rate for Payer: CIGNA Medicare |
$328.50
|
| Rate for Payer: HUMANA Commercial |
$328.50
|
| Rate for Payer: MEDICAID Medicaid |
$335.80
|
| Rate for Payer: MEDICARE Medicare |
$255.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$346.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$354.05
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$346.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$346.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$310.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$292.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$292.00
|
|
|
CTA ABDOMEN GENERAL
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
CTA ABDOMEN GENERAL
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
CTA ABDOMEN PELVIS W WO CONTRAST
|
Facility
OP
|
$2,807.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,964.90 |
| Max. Negotiated Rate |
$2,807.00 |
| Rate for Payer: AETNA Commercial |
$2,666.65
|
| Rate for Payer: AETNA Medicare |
$2,526.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,666.65
|
| Rate for Payer: BCBS Healthlink |
$2,526.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,526.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,526.30
|
| Rate for Payer: BCBS POS |
$2,666.65
|
| Rate for Payer: BCBS Traditional |
$2,807.00
|
| Rate for Payer: CASH_PRICE |
$2,245.60
|
| Rate for Payer: CIGNA Commercial |
$2,666.65
|
| Rate for Payer: CIGNA Medicare |
$2,526.30
|
| Rate for Payer: HUMANA Commercial |
$2,526.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,582.44
|
| Rate for Payer: MEDICARE Medicare |
$1,964.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,666.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,722.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,666.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,666.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,385.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,245.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,245.60
|
|
|
CTA ABDOMEN PELVIS W WO CONTRAST
|
Facility
IP
|
$2,807.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,964.90 |
| Max. Negotiated Rate |
$2,807.00 |
| Rate for Payer: BCBS HMK CHIP |
$2,526.30
|
| Rate for Payer: AETNA Commercial |
$2,666.65
|
| Rate for Payer: AETNA Medicare |
$2,526.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,666.65
|
| Rate for Payer: BCBS Healthlink |
$2,526.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,526.30
|
| Rate for Payer: BCBS POS |
$2,666.65
|
| Rate for Payer: BCBS Traditional |
$2,807.00
|
| Rate for Payer: CASH_PRICE |
$2,245.60
|
| Rate for Payer: CIGNA Commercial |
$2,666.65
|
| Rate for Payer: CIGNA Medicare |
$2,526.30
|
| Rate for Payer: HUMANA Commercial |
$2,526.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,582.44
|
| Rate for Payer: MEDICARE Medicare |
$1,964.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,666.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,722.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,666.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,666.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,385.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,245.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,245.60
|
|
|
CTA AORTA ILIAC RUNOFF
|
Facility
IP
|
$2,228.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,559.60 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: AETNA Commercial |
$2,116.60
|
| Rate for Payer: AETNA Medicare |
$2,005.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,116.60
|
| Rate for Payer: BCBS Healthlink |
$2,005.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,005.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,005.20
|
| Rate for Payer: BCBS POS |
$2,116.60
|
| Rate for Payer: BCBS Traditional |
$2,228.00
|
| Rate for Payer: CASH_PRICE |
$1,782.40
|
| Rate for Payer: CIGNA Commercial |
$2,116.60
|
| Rate for Payer: CIGNA Medicare |
$2,005.20
|
| Rate for Payer: HUMANA Commercial |
$2,005.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,049.76
|
| Rate for Payer: MEDICARE Medicare |
$1,559.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,116.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,161.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,116.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,116.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,893.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,782.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,782.40
|
|
|
CTA AORTA ILIAC RUNOFF
|
Facility
OP
|
$2,228.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,559.60 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: AETNA Commercial |
$2,116.60
|
| Rate for Payer: AETNA Medicare |
$2,005.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,116.60
|
| Rate for Payer: BCBS Healthlink |
$2,005.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,005.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,005.20
|
| Rate for Payer: BCBS POS |
$2,116.60
|
| Rate for Payer: BCBS Traditional |
$2,228.00
|
| Rate for Payer: CASH_PRICE |
$1,782.40
|
| Rate for Payer: CIGNA Commercial |
$2,116.60
|
| Rate for Payer: CIGNA Medicare |
$2,005.20
|
| Rate for Payer: HUMANA Commercial |
$2,005.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,049.76
|
| Rate for Payer: MEDICARE Medicare |
$1,559.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,116.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,161.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,116.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,116.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,893.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,782.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,782.40
|
|
|
CT ABDOMEN PELVIS W CONTRAST
|
Facility
OP
|
$3,025.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,117.50 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: AETNA Commercial |
$2,873.75
|
| Rate for Payer: AETNA Medicare |
$2,722.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,873.75
|
| Rate for Payer: BCBS Healthlink |
$2,722.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,722.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,722.50
|
| Rate for Payer: BCBS POS |
$2,873.75
|
| Rate for Payer: BCBS Traditional |
$3,025.00
|
| Rate for Payer: CASH_PRICE |
$2,420.00
|
| Rate for Payer: CIGNA Commercial |
$2,873.75
|
| Rate for Payer: CIGNA Medicare |
$2,722.50
|
| Rate for Payer: HUMANA Commercial |
$2,722.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,783.00
|
| Rate for Payer: MEDICARE Medicare |
$2,117.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,873.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,934.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,873.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,873.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,571.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,420.00
|
|
|
CT ABDOMEN PELVIS W CONTRAST
|
Facility
IP
|
$3,025.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,117.50 |
| Max. Negotiated Rate |
$3,025.00 |
| Rate for Payer: BCBS HMK CHIP |
$2,722.50
|
| Rate for Payer: AETNA Commercial |
$2,873.75
|
| Rate for Payer: AETNA Medicare |
$2,722.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,873.75
|
| Rate for Payer: BCBS Healthlink |
$2,722.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,722.50
|
| Rate for Payer: BCBS POS |
$2,873.75
|
| Rate for Payer: BCBS Traditional |
$3,025.00
|
| Rate for Payer: CASH_PRICE |
$2,420.00
|
| Rate for Payer: CIGNA Commercial |
$2,873.75
|
| Rate for Payer: CIGNA Medicare |
$2,722.50
|
| Rate for Payer: HUMANA Commercial |
$2,722.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,783.00
|
| Rate for Payer: MEDICARE Medicare |
$2,117.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,873.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,934.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,873.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,873.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,571.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,420.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,420.00
|
|
|
CT ABDOMEN PELVIS WO CONTRAST
|
Facility
OP
|
$2,376.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,663.20 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: AETNA Commercial |
$2,257.20
|
| Rate for Payer: AETNA Medicare |
$2,138.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,257.20
|
| Rate for Payer: BCBS Healthlink |
$2,138.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,138.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,138.40
|
| Rate for Payer: BCBS POS |
$2,257.20
|
| Rate for Payer: BCBS Traditional |
$2,376.00
|
| Rate for Payer: CASH_PRICE |
$1,900.80
|
| Rate for Payer: CIGNA Commercial |
$2,257.20
|
| Rate for Payer: CIGNA Medicare |
$2,138.40
|
| Rate for Payer: HUMANA Commercial |
$2,138.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,185.92
|
| Rate for Payer: MEDICARE Medicare |
$1,663.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,257.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,304.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,257.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,257.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,019.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,900.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,900.80
|
|
|
CT ABDOMEN PELVIS WO CONTRAST
|
Facility
IP
|
$2,376.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,663.20 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: BCBS HMK CHIP |
$2,138.40
|
| Rate for Payer: AETNA Commercial |
$2,257.20
|
| Rate for Payer: AETNA Medicare |
$2,138.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,257.20
|
| Rate for Payer: BCBS Healthlink |
$2,138.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,138.40
|
| Rate for Payer: BCBS POS |
$2,257.20
|
| Rate for Payer: BCBS Traditional |
$2,376.00
|
| Rate for Payer: CASH_PRICE |
$1,900.80
|
| Rate for Payer: CIGNA Commercial |
$2,257.20
|
| Rate for Payer: CIGNA Medicare |
$2,138.40
|
| Rate for Payer: HUMANA Commercial |
$2,138.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,185.92
|
| Rate for Payer: MEDICARE Medicare |
$1,663.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,257.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,304.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,257.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,257.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,019.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,900.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,900.80
|
|
|
CT ABDOMEN PELVIS W WO CONTRAST
|
Facility
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,350.60 |
| Max. Negotiated Rate |
$3,358.00 |
| Rate for Payer: AETNA Commercial |
$3,190.10
|
| Rate for Payer: AETNA Medicare |
$3,022.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,190.10
|
| Rate for Payer: BCBS Healthlink |
$3,022.20
|
| Rate for Payer: BCBS HMK CHIP |
$3,022.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,022.20
|
| Rate for Payer: BCBS POS |
$3,190.10
|
| Rate for Payer: BCBS Traditional |
$3,358.00
|
| Rate for Payer: CASH_PRICE |
$2,686.40
|
| Rate for Payer: CIGNA Commercial |
$3,190.10
|
| Rate for Payer: CIGNA Medicare |
$3,022.20
|
| Rate for Payer: HUMANA Commercial |
$3,022.20
|
| Rate for Payer: MEDICAID Medicaid |
$3,089.36
|
| Rate for Payer: MEDICARE Medicare |
$2,350.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,190.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,257.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,190.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,190.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,854.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,686.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,686.40
|
|
|
CT ABDOMEN PELVIS W WO CONTRAST
|
Facility
IP
|
$3,358.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,350.60 |
| Max. Negotiated Rate |
$3,358.00 |
| Rate for Payer: AETNA Commercial |
$3,190.10
|
| Rate for Payer: AETNA Medicare |
$3,022.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,190.10
|
| Rate for Payer: BCBS Healthlink |
$3,022.20
|
| Rate for Payer: BCBS HMK CHIP |
$3,022.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,022.20
|
| Rate for Payer: BCBS POS |
$3,190.10
|
| Rate for Payer: BCBS Traditional |
$3,358.00
|
| Rate for Payer: CASH_PRICE |
$2,686.40
|
| Rate for Payer: CIGNA Commercial |
$3,190.10
|
| Rate for Payer: CIGNA Medicare |
$3,022.20
|
| Rate for Payer: HUMANA Commercial |
$3,022.20
|
| Rate for Payer: MEDICAID Medicaid |
$3,089.36
|
| Rate for Payer: MEDICARE Medicare |
$2,350.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,190.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,257.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,190.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,190.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,854.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,686.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,686.40
|
|
|
CT ABDOMEN W CONTRAST
|
Facility
IP
|
$1,966.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,376.20 |
| Max. Negotiated Rate |
$1,966.00 |
| Rate for Payer: AETNA Commercial |
$1,867.70
|
| Rate for Payer: AETNA Medicare |
$1,769.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,867.70
|
| Rate for Payer: BCBS Healthlink |
$1,769.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,769.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,769.40
|
| Rate for Payer: BCBS POS |
$1,867.70
|
| Rate for Payer: BCBS Traditional |
$1,966.00
|
| Rate for Payer: CASH_PRICE |
$1,572.80
|
| Rate for Payer: CIGNA Commercial |
$1,867.70
|
| Rate for Payer: CIGNA Medicare |
$1,769.40
|
| Rate for Payer: HUMANA Commercial |
$1,769.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,808.72
|
| Rate for Payer: MEDICARE Medicare |
$1,376.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,867.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,907.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,867.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,867.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,671.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,572.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,572.80
|
|
|
CT ABDOMEN W CONTRAST
|
Facility
OP
|
$1,966.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,376.20 |
| Max. Negotiated Rate |
$1,966.00 |
| Rate for Payer: AETNA Commercial |
$1,867.70
|
| Rate for Payer: AETNA Medicare |
$1,769.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,867.70
|
| Rate for Payer: BCBS Healthlink |
$1,769.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,769.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,769.40
|
| Rate for Payer: BCBS POS |
$1,867.70
|
| Rate for Payer: BCBS Traditional |
$1,966.00
|
| Rate for Payer: CASH_PRICE |
$1,572.80
|
| Rate for Payer: CIGNA Commercial |
$1,867.70
|
| Rate for Payer: CIGNA Medicare |
$1,769.40
|
| Rate for Payer: HUMANA Commercial |
$1,769.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,808.72
|
| Rate for Payer: MEDICARE Medicare |
$1,376.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,867.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,907.02
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,867.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,867.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,671.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,572.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,572.80
|
|
|
CT ABDOMEN WO CONTRAST
|
Facility
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,077.30 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: AETNA Commercial |
$1,462.05
|
| Rate for Payer: AETNA Medicare |
$1,385.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,462.05
|
| Rate for Payer: BCBS Healthlink |
$1,385.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,385.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,385.10
|
| Rate for Payer: BCBS POS |
$1,462.05
|
| Rate for Payer: BCBS Traditional |
$1,539.00
|
| Rate for Payer: CASH_PRICE |
$1,231.20
|
| Rate for Payer: CIGNA Commercial |
$1,462.05
|
| Rate for Payer: CIGNA Medicare |
$1,385.10
|
| Rate for Payer: HUMANA Commercial |
$1,385.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,415.88
|
| Rate for Payer: MEDICARE Medicare |
$1,077.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,462.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,492.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,462.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,462.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,308.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,231.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,231.20
|
|
|
CT ABDOMEN WO CONTRAST
|
Facility
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,077.30 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: AETNA Commercial |
$1,462.05
|
| Rate for Payer: AETNA Medicare |
$1,385.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,462.05
|
| Rate for Payer: BCBS Healthlink |
$1,385.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,385.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,385.10
|
| Rate for Payer: BCBS POS |
$1,462.05
|
| Rate for Payer: BCBS Traditional |
$1,539.00
|
| Rate for Payer: CASH_PRICE |
$1,231.20
|
| Rate for Payer: CIGNA Commercial |
$1,462.05
|
| Rate for Payer: CIGNA Medicare |
$1,385.10
|
| Rate for Payer: HUMANA Commercial |
$1,385.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,415.88
|
| Rate for Payer: MEDICARE Medicare |
$1,077.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,462.05
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,492.83
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,462.05
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,462.05
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,308.15
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,231.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,231.20
|
|
|
CT ABDOMEN W WO CONTRAST
|
Facility
IP
|
$2,315.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,620.50 |
| Max. Negotiated Rate |
$2,315.00 |
| Rate for Payer: BCBS HMK CHIP |
$2,083.50
|
| Rate for Payer: AETNA Commercial |
$2,199.25
|
| Rate for Payer: AETNA Medicare |
$2,083.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,199.25
|
| Rate for Payer: BCBS Healthlink |
$2,083.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,083.50
|
| Rate for Payer: BCBS POS |
$2,199.25
|
| Rate for Payer: BCBS Traditional |
$2,315.00
|
| Rate for Payer: CASH_PRICE |
$1,852.00
|
| Rate for Payer: CIGNA Commercial |
$2,199.25
|
| Rate for Payer: CIGNA Medicare |
$2,083.50
|
| Rate for Payer: HUMANA Commercial |
$2,083.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,129.80
|
| Rate for Payer: MEDICARE Medicare |
$1,620.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,199.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,245.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,199.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,199.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,967.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,852.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,852.00
|
|
|
CT ABDOMEN W WO CONTRAST
|
Facility
OP
|
$2,315.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,620.50 |
| Max. Negotiated Rate |
$2,315.00 |
| Rate for Payer: AETNA Commercial |
$2,199.25
|
| Rate for Payer: AETNA Medicare |
$2,083.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,199.25
|
| Rate for Payer: BCBS Healthlink |
$2,083.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,083.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,083.50
|
| Rate for Payer: BCBS POS |
$2,199.25
|
| Rate for Payer: BCBS Traditional |
$2,315.00
|
| Rate for Payer: CASH_PRICE |
$1,852.00
|
| Rate for Payer: CIGNA Commercial |
$2,199.25
|
| Rate for Payer: CIGNA Medicare |
$2,083.50
|
| Rate for Payer: HUMANA Commercial |
$2,083.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,129.80
|
| Rate for Payer: MEDICARE Medicare |
$1,620.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,199.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,245.55
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,199.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,199.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,967.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,852.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,852.00
|
|
|
CTA CAROTID ARTERIES
|
Facility
OP
|
$2,167.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,516.90 |
| Max. Negotiated Rate |
$2,167.00 |
| Rate for Payer: AETNA Commercial |
$2,058.65
|
| Rate for Payer: AETNA Medicare |
$1,950.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,058.65
|
| Rate for Payer: BCBS Healthlink |
$1,950.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,950.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,950.30
|
| Rate for Payer: BCBS POS |
$2,058.65
|
| Rate for Payer: BCBS Traditional |
$2,167.00
|
| Rate for Payer: CASH_PRICE |
$1,733.60
|
| Rate for Payer: CIGNA Commercial |
$2,058.65
|
| Rate for Payer: CIGNA Medicare |
$1,950.30
|
| Rate for Payer: HUMANA Commercial |
$1,950.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,993.64
|
| Rate for Payer: MEDICARE Medicare |
$1,516.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,058.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,101.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,058.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,058.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,841.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,733.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,733.60
|
|
|
CTA CAROTID ARTERIES
|
Facility
IP
|
$2,167.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,516.90 |
| Max. Negotiated Rate |
$2,167.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,950.30
|
| Rate for Payer: AETNA Commercial |
$2,058.65
|
| Rate for Payer: AETNA Medicare |
$1,950.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,058.65
|
| Rate for Payer: BCBS Healthlink |
$1,950.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,950.30
|
| Rate for Payer: BCBS POS |
$2,058.65
|
| Rate for Payer: BCBS Traditional |
$2,167.00
|
| Rate for Payer: CASH_PRICE |
$1,733.60
|
| Rate for Payer: CIGNA Commercial |
$2,058.65
|
| Rate for Payer: CIGNA Medicare |
$1,950.30
|
| Rate for Payer: HUMANA Commercial |
$1,950.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,993.64
|
| Rate for Payer: MEDICARE Medicare |
$1,516.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,058.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,101.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,058.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,058.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,841.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,733.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,733.60
|
|
