|
CTA HEAD CIRCLE OF WILLIS
|
Facility
IP
|
$2,184.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,528.80 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: AETNA Commercial |
$2,074.80
|
| Rate for Payer: AETNA Medicare |
$1,965.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,074.80
|
| Rate for Payer: BCBS Healthlink |
$1,965.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,965.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,965.60
|
| Rate for Payer: BCBS POS |
$2,074.80
|
| Rate for Payer: BCBS Traditional |
$2,184.00
|
| Rate for Payer: CASH_PRICE |
$1,747.20
|
| Rate for Payer: CIGNA Commercial |
$2,074.80
|
| Rate for Payer: CIGNA Medicare |
$1,965.60
|
| Rate for Payer: HUMANA Commercial |
$1,965.60
|
| Rate for Payer: MEDICAID Medicaid |
$2,009.28
|
| Rate for Payer: MEDICARE Medicare |
$1,528.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,074.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,118.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,074.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,074.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,856.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,747.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,747.20
|
|
|
CTA HEAD CIRCLE OF WILLIS
|
Facility
OP
|
$2,184.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,528.80 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: AETNA Commercial |
$2,074.80
|
| Rate for Payer: AETNA Medicare |
$1,965.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,074.80
|
| Rate for Payer: BCBS Healthlink |
$1,965.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,965.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,965.60
|
| Rate for Payer: BCBS POS |
$2,074.80
|
| Rate for Payer: BCBS Traditional |
$2,184.00
|
| Rate for Payer: CASH_PRICE |
$1,747.20
|
| Rate for Payer: CIGNA Commercial |
$2,074.80
|
| Rate for Payer: CIGNA Medicare |
$1,965.60
|
| Rate for Payer: HUMANA Commercial |
$1,965.60
|
| Rate for Payer: MEDICAID Medicaid |
$2,009.28
|
| Rate for Payer: MEDICARE Medicare |
$1,528.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,074.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,118.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,074.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,074.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,856.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,747.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,747.20
|
|
|
CTA LOWER EXTREMITY BILAT W WO CONTRAST
|
Facility
IP
|
$2,092.00
|
|
|
Service Code
|
CPT 73706 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,464.40 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,882.80
|
| Rate for Payer: AETNA Commercial |
$1,987.40
|
| Rate for Payer: AETNA Medicare |
$1,882.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,987.40
|
| Rate for Payer: BCBS Healthlink |
$1,882.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,882.80
|
| Rate for Payer: BCBS POS |
$1,987.40
|
| Rate for Payer: BCBS Traditional |
$2,092.00
|
| Rate for Payer: CASH_PRICE |
$1,673.60
|
| Rate for Payer: CIGNA Commercial |
$1,987.40
|
| Rate for Payer: CIGNA Medicare |
$1,882.80
|
| Rate for Payer: HUMANA Commercial |
$1,882.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,924.64
|
| Rate for Payer: MEDICARE Medicare |
$1,464.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,987.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,029.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,987.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,987.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,778.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,673.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,673.60
|
|
|
CTA LOWER EXTREMITY BILAT W WO CONTRAST
|
Facility
OP
|
$2,092.00
|
|
|
Service Code
|
CPT 73706 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,464.40 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: AETNA Commercial |
$1,987.40
|
| Rate for Payer: AETNA Medicare |
$1,882.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,987.40
|
| Rate for Payer: BCBS Healthlink |
$1,882.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,882.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,882.80
|
| Rate for Payer: BCBS POS |
$1,987.40
|
| Rate for Payer: BCBS Traditional |
$2,092.00
|
| Rate for Payer: CASH_PRICE |
$1,673.60
|
| Rate for Payer: CIGNA Commercial |
$1,987.40
|
| Rate for Payer: CIGNA Medicare |
$1,882.80
|
| Rate for Payer: HUMANA Commercial |
$1,882.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,924.64
|
| Rate for Payer: MEDICARE Medicare |
$1,464.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,987.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,029.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,987.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,987.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,778.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,673.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,673.60
|
|
|
CTA ORBIT EAR FOSSA W CONTRAST
|
Facility
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,314.60 |
| Max. Negotiated Rate |
$1,878.00 |
| Rate for Payer: AETNA Commercial |
$1,784.10
|
| Rate for Payer: AETNA Medicare |
$1,690.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,784.10
|
| Rate for Payer: BCBS Healthlink |
$1,690.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,690.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,690.20
|
| Rate for Payer: BCBS POS |
$1,784.10
|
| Rate for Payer: BCBS Traditional |
$1,878.00
|
| Rate for Payer: CASH_PRICE |
$1,502.40
|
| Rate for Payer: CIGNA Commercial |
$1,784.10
|
| Rate for Payer: CIGNA Medicare |
$1,690.20
|
| Rate for Payer: HUMANA Commercial |
$1,690.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,727.76
|
| Rate for Payer: MEDICARE Medicare |
$1,314.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,784.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,821.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,784.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,784.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,596.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,502.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,502.40
|
|
|
CTA ORBIT EAR FOSSA W CONTRAST
|
Facility
IP
|
$1,878.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,314.60 |
| Max. Negotiated Rate |
$1,878.00 |
| Rate for Payer: AETNA Commercial |
$1,784.10
|
| Rate for Payer: AETNA Medicare |
$1,690.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,784.10
|
| Rate for Payer: BCBS Healthlink |
$1,690.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,690.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,690.20
|
| Rate for Payer: BCBS POS |
$1,784.10
|
| Rate for Payer: BCBS Traditional |
$1,878.00
|
| Rate for Payer: CASH_PRICE |
$1,502.40
|
| Rate for Payer: CIGNA Commercial |
$1,784.10
|
| Rate for Payer: CIGNA Medicare |
$1,690.20
|
| Rate for Payer: HUMANA Commercial |
$1,690.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,727.76
|
| Rate for Payer: MEDICARE Medicare |
$1,314.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,784.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,821.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,784.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,784.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,596.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,502.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,502.40
|
|
|
CTA PELVIS
|
Facility
IP
|
$2,031.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,421.70 |
| Max. Negotiated Rate |
$2,031.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,827.90
|
| Rate for Payer: AETNA Commercial |
$1,929.45
|
| Rate for Payer: AETNA Medicare |
$1,827.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,929.45
|
| Rate for Payer: BCBS Healthlink |
$1,827.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,827.90
|
| Rate for Payer: BCBS POS |
$1,929.45
|
| Rate for Payer: BCBS Traditional |
$2,031.00
|
| Rate for Payer: CASH_PRICE |
$1,624.80
|
| Rate for Payer: CIGNA Commercial |
$1,929.45
|
| Rate for Payer: CIGNA Medicare |
$1,827.90
|
| Rate for Payer: HUMANA Commercial |
$1,827.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,868.52
|
| Rate for Payer: MEDICARE Medicare |
$1,421.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,929.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,970.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,929.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,929.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,726.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,624.80
|
|
|
CTA PELVIS
|
Facility
OP
|
$2,031.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,421.70 |
| Max. Negotiated Rate |
$2,031.00 |
| Rate for Payer: AETNA Commercial |
$1,929.45
|
| Rate for Payer: AETNA Medicare |
$1,827.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,929.45
|
| Rate for Payer: BCBS Healthlink |
$1,827.90
|
| Rate for Payer: BCBS HMK CHIP |
$1,827.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,827.90
|
| Rate for Payer: BCBS POS |
$1,929.45
|
| Rate for Payer: BCBS Traditional |
$2,031.00
|
| Rate for Payer: CASH_PRICE |
$1,624.80
|
| Rate for Payer: CIGNA Commercial |
$1,929.45
|
| Rate for Payer: CIGNA Medicare |
$1,827.90
|
| Rate for Payer: HUMANA Commercial |
$1,827.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,868.52
|
| Rate for Payer: MEDICARE Medicare |
$1,421.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,929.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,970.07
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,929.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,929.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,726.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,624.80
|
|
|
CTA THORACIC AORTA
|
Facility
IP
|
$2,283.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,598.10 |
| Max. Negotiated Rate |
$2,283.00 |
| Rate for Payer: AETNA Commercial |
$2,168.85
|
| Rate for Payer: AETNA Medicare |
$2,054.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,168.85
|
| Rate for Payer: BCBS Healthlink |
$2,054.70
|
| Rate for Payer: BCBS HMK CHIP |
$2,054.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,054.70
|
| Rate for Payer: BCBS POS |
$2,168.85
|
| Rate for Payer: BCBS Traditional |
$2,283.00
|
| Rate for Payer: CASH_PRICE |
$1,826.40
|
| Rate for Payer: CIGNA Commercial |
$2,168.85
|
| Rate for Payer: CIGNA Medicare |
$2,054.70
|
| Rate for Payer: HUMANA Commercial |
$2,054.70
|
| Rate for Payer: MEDICAID Medicaid |
$2,100.36
|
| Rate for Payer: MEDICARE Medicare |
$1,598.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,214.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,168.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,940.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,826.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,826.40
|
|
|
CTA THORACIC AORTA
|
Facility
OP
|
$2,283.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,598.10 |
| Max. Negotiated Rate |
$2,283.00 |
| Rate for Payer: AETNA Commercial |
$2,168.85
|
| Rate for Payer: AETNA Medicare |
$2,054.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,168.85
|
| Rate for Payer: BCBS Healthlink |
$2,054.70
|
| Rate for Payer: BCBS HMK CHIP |
$2,054.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,054.70
|
| Rate for Payer: BCBS POS |
$2,168.85
|
| Rate for Payer: BCBS Traditional |
$2,283.00
|
| Rate for Payer: CASH_PRICE |
$1,826.40
|
| Rate for Payer: CIGNA Commercial |
$2,168.85
|
| Rate for Payer: CIGNA Medicare |
$2,054.70
|
| Rate for Payer: HUMANA Commercial |
$2,054.70
|
| Rate for Payer: MEDICAID Medicaid |
$2,100.36
|
| Rate for Payer: MEDICARE Medicare |
$1,598.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,214.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,168.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,940.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,826.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,826.40
|
|
|
CTA THORACIC PE STUDY
|
Facility
OP
|
$2,283.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,598.10 |
| Max. Negotiated Rate |
$2,283.00 |
| Rate for Payer: AETNA Commercial |
$2,168.85
|
| Rate for Payer: AETNA Medicare |
$2,054.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,168.85
|
| Rate for Payer: BCBS Healthlink |
$2,054.70
|
| Rate for Payer: BCBS HMK CHIP |
$2,054.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,054.70
|
| Rate for Payer: BCBS POS |
$2,168.85
|
| Rate for Payer: BCBS Traditional |
$2,283.00
|
| Rate for Payer: CASH_PRICE |
$1,826.40
|
| Rate for Payer: CIGNA Commercial |
$2,168.85
|
| Rate for Payer: CIGNA Medicare |
$2,054.70
|
| Rate for Payer: HUMANA Commercial |
$2,054.70
|
| Rate for Payer: MEDICAID Medicaid |
$2,100.36
|
| Rate for Payer: MEDICARE Medicare |
$1,598.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,214.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,168.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,940.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,826.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,826.40
|
|
|
CTA THORACIC PE STUDY
|
Facility
IP
|
$2,283.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,598.10 |
| Max. Negotiated Rate |
$2,283.00 |
| Rate for Payer: BCBS HMK CHIP |
$2,054.70
|
| Rate for Payer: AETNA Commercial |
$2,168.85
|
| Rate for Payer: AETNA Medicare |
$2,054.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,168.85
|
| Rate for Payer: BCBS Healthlink |
$2,054.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,054.70
|
| Rate for Payer: BCBS POS |
$2,168.85
|
| Rate for Payer: BCBS Traditional |
$2,283.00
|
| Rate for Payer: CASH_PRICE |
$1,826.40
|
| Rate for Payer: CIGNA Commercial |
$2,168.85
|
| Rate for Payer: CIGNA Medicare |
$2,054.70
|
| Rate for Payer: HUMANA Commercial |
$2,054.70
|
| Rate for Payer: MEDICAID Medicaid |
$2,100.36
|
| Rate for Payer: MEDICARE Medicare |
$1,598.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,214.51
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,168.85
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,168.85
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,940.55
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,826.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,826.40
|
|
|
CTA UPPER EXTREMITY LT W WO
|
Facility
IP
|
$2,025.00
|
|
|
Service Code
|
CPT 73206 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: AETNA Commercial |
$1,923.75
|
| Rate for Payer: AETNA Medicare |
$1,822.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,923.75
|
| Rate for Payer: BCBS Healthlink |
$1,822.50
|
| Rate for Payer: BCBS HMK CHIP |
$1,822.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,822.50
|
| Rate for Payer: BCBS POS |
$1,923.75
|
| Rate for Payer: BCBS Traditional |
$2,025.00
|
| Rate for Payer: CASH_PRICE |
$1,620.00
|
| Rate for Payer: CIGNA Commercial |
$1,923.75
|
| Rate for Payer: CIGNA Medicare |
$1,822.50
|
| Rate for Payer: HUMANA Commercial |
$1,822.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,863.00
|
| Rate for Payer: MEDICARE Medicare |
$1,417.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,964.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,923.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,721.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,620.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,620.00
|
|
|
CTA UPPER EXTREMITY LT W WO
|
Facility
OP
|
$2,025.00
|
|
|
Service Code
|
CPT 73206 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: AETNA Commercial |
$1,923.75
|
| Rate for Payer: AETNA Medicare |
$1,822.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,923.75
|
| Rate for Payer: BCBS Healthlink |
$1,822.50
|
| Rate for Payer: BCBS HMK CHIP |
$1,822.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,822.50
|
| Rate for Payer: BCBS POS |
$1,923.75
|
| Rate for Payer: BCBS Traditional |
$2,025.00
|
| Rate for Payer: CASH_PRICE |
$1,620.00
|
| Rate for Payer: CIGNA Commercial |
$1,923.75
|
| Rate for Payer: CIGNA Medicare |
$1,822.50
|
| Rate for Payer: HUMANA Commercial |
$1,822.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,863.00
|
| Rate for Payer: MEDICARE Medicare |
$1,417.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,964.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,923.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,721.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,620.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,620.00
|
|
|
CTA UPPER EXTREMITY RT W WO
|
Facility
IP
|
$2,025.00
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,822.50
|
| Rate for Payer: AETNA Commercial |
$1,923.75
|
| Rate for Payer: AETNA Medicare |
$1,822.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,923.75
|
| Rate for Payer: BCBS Healthlink |
$1,822.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,822.50
|
| Rate for Payer: BCBS POS |
$1,923.75
|
| Rate for Payer: BCBS Traditional |
$2,025.00
|
| Rate for Payer: CASH_PRICE |
$1,620.00
|
| Rate for Payer: CIGNA Commercial |
$1,923.75
|
| Rate for Payer: CIGNA Medicare |
$1,822.50
|
| Rate for Payer: HUMANA Commercial |
$1,822.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,863.00
|
| Rate for Payer: MEDICARE Medicare |
$1,417.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,964.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,923.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,721.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,620.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,620.00
|
|
|
CTA UPPER EXTREMITY RT W WO
|
Facility
OP
|
$2,025.00
|
|
|
Service Code
|
CPT 73206 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: AETNA Commercial |
$1,923.75
|
| Rate for Payer: AETNA Medicare |
$1,822.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,923.75
|
| Rate for Payer: BCBS Healthlink |
$1,822.50
|
| Rate for Payer: BCBS HMK CHIP |
$1,822.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,822.50
|
| Rate for Payer: BCBS POS |
$1,923.75
|
| Rate for Payer: BCBS Traditional |
$2,025.00
|
| Rate for Payer: CASH_PRICE |
$1,620.00
|
| Rate for Payer: CIGNA Commercial |
$1,923.75
|
| Rate for Payer: CIGNA Medicare |
$1,822.50
|
| Rate for Payer: HUMANA Commercial |
$1,822.50
|
| Rate for Payer: MEDICAID Medicaid |
$1,863.00
|
| Rate for Payer: MEDICARE Medicare |
$1,417.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,964.25
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,923.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,923.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,721.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,620.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,620.00
|
|
|
CT BONE DENSITY
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 77078 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: AETNA Commercial |
$332.50
|
| Rate for Payer: AETNA Medicare |
$315.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$332.50
|
| Rate for Payer: BCBS Healthlink |
$315.00
|
| Rate for Payer: BCBS HMK CHIP |
$315.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$315.00
|
| Rate for Payer: BCBS POS |
$332.50
|
| Rate for Payer: BCBS Traditional |
$350.00
|
| Rate for Payer: CASH_PRICE |
$280.00
|
| Rate for Payer: CIGNA Commercial |
$332.50
|
| Rate for Payer: CIGNA Medicare |
$315.00
|
| Rate for Payer: HUMANA Commercial |
$315.00
|
| Rate for Payer: MEDICAID Medicaid |
$322.00
|
| Rate for Payer: MEDICARE Medicare |
$245.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$332.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$339.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$332.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$332.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$297.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$280.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$280.00
|
|
|
CT BONE DENSITY
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 77078 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: BCBS HMK CHIP |
$315.00
|
| Rate for Payer: AETNA Commercial |
$332.50
|
| Rate for Payer: AETNA Medicare |
$315.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$332.50
|
| Rate for Payer: BCBS Healthlink |
$315.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$315.00
|
| Rate for Payer: BCBS POS |
$332.50
|
| Rate for Payer: BCBS Traditional |
$350.00
|
| Rate for Payer: CASH_PRICE |
$280.00
|
| Rate for Payer: CIGNA Commercial |
$332.50
|
| Rate for Payer: CIGNA Medicare |
$315.00
|
| Rate for Payer: HUMANA Commercial |
$315.00
|
| Rate for Payer: MEDICAID Medicaid |
$322.00
|
| Rate for Payer: MEDICARE Medicare |
$245.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$332.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$339.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$332.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$332.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$297.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$280.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$280.00
|
|
|
CT BONE LENGTH STUDY SCANOGRAM
|
Facility
IP
|
$617.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$431.90 |
| Max. Negotiated Rate |
$617.00 |
| Rate for Payer: AETNA Commercial |
$586.15
|
| Rate for Payer: AETNA Medicare |
$555.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$586.15
|
| Rate for Payer: BCBS Healthlink |
$555.30
|
| Rate for Payer: BCBS HMK CHIP |
$555.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$555.30
|
| Rate for Payer: BCBS POS |
$586.15
|
| Rate for Payer: BCBS Traditional |
$617.00
|
| Rate for Payer: CASH_PRICE |
$493.60
|
| Rate for Payer: CIGNA Commercial |
$586.15
|
| Rate for Payer: CIGNA Medicare |
$555.30
|
| Rate for Payer: HUMANA Commercial |
$555.30
|
| Rate for Payer: MEDICAID Medicaid |
$567.64
|
| Rate for Payer: MEDICARE Medicare |
$431.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$586.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$598.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$586.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$586.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$524.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$493.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$493.60
|
|
|
CT BONE LENGTH STUDY SCANOGRAM
|
Facility
OP
|
$617.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$431.90 |
| Max. Negotiated Rate |
$617.00 |
| Rate for Payer: AETNA Commercial |
$586.15
|
| Rate for Payer: AETNA Medicare |
$555.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$586.15
|
| Rate for Payer: BCBS Healthlink |
$555.30
|
| Rate for Payer: BCBS HMK CHIP |
$555.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$555.30
|
| Rate for Payer: BCBS POS |
$586.15
|
| Rate for Payer: BCBS Traditional |
$617.00
|
| Rate for Payer: CASH_PRICE |
$493.60
|
| Rate for Payer: CIGNA Commercial |
$586.15
|
| Rate for Payer: CIGNA Medicare |
$555.30
|
| Rate for Payer: HUMANA Commercial |
$555.30
|
| Rate for Payer: MEDICAID Medicaid |
$567.64
|
| Rate for Payer: MEDICARE Medicare |
$431.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$586.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$598.49
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$586.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$586.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$524.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$493.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$493.60
|
|
|
CT CERVICAL SPINE W CONTRAST
|
Facility
OP
|
$2,020.00
|
|
|
Service Code
|
CPT 72126 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,414.00 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: AETNA Commercial |
$1,919.00
|
| Rate for Payer: AETNA Medicare |
$1,818.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,919.00
|
| Rate for Payer: BCBS Healthlink |
$1,818.00
|
| Rate for Payer: BCBS HMK CHIP |
$1,818.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,818.00
|
| Rate for Payer: BCBS POS |
$1,919.00
|
| Rate for Payer: BCBS Traditional |
$2,020.00
|
| Rate for Payer: CASH_PRICE |
$1,616.00
|
| Rate for Payer: CIGNA Commercial |
$1,919.00
|
| Rate for Payer: CIGNA Medicare |
$1,818.00
|
| Rate for Payer: HUMANA Commercial |
$1,818.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,858.40
|
| Rate for Payer: MEDICARE Medicare |
$1,414.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,919.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,959.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,919.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,919.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,717.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,616.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,616.00
|
|
|
CT CERVICAL SPINE W CONTRAST
|
Facility
IP
|
$2,020.00
|
|
|
Service Code
|
CPT 72126 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,414.00 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,818.00
|
| Rate for Payer: AETNA Commercial |
$1,919.00
|
| Rate for Payer: AETNA Medicare |
$1,818.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,919.00
|
| Rate for Payer: BCBS Healthlink |
$1,818.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,818.00
|
| Rate for Payer: BCBS POS |
$1,919.00
|
| Rate for Payer: BCBS Traditional |
$2,020.00
|
| Rate for Payer: CASH_PRICE |
$1,616.00
|
| Rate for Payer: CIGNA Commercial |
$1,919.00
|
| Rate for Payer: CIGNA Medicare |
$1,818.00
|
| Rate for Payer: HUMANA Commercial |
$1,818.00
|
| Rate for Payer: MEDICAID Medicaid |
$1,858.40
|
| Rate for Payer: MEDICARE Medicare |
$1,414.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,919.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,959.40
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,919.00
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,919.00
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,717.00
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,616.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,616.00
|
|
|
CT CERVICAL SPINE WO CONTRAST
|
Facility
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,127.70 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,449.90
|
| Rate for Payer: AETNA Commercial |
$1,530.45
|
| Rate for Payer: AETNA Medicare |
$1,449.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,530.45
|
| Rate for Payer: BCBS Healthlink |
$1,449.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,449.90
|
| Rate for Payer: BCBS POS |
$1,530.45
|
| Rate for Payer: BCBS Traditional |
$1,611.00
|
| Rate for Payer: CASH_PRICE |
$1,288.80
|
| Rate for Payer: CIGNA Commercial |
$1,530.45
|
| Rate for Payer: CIGNA Medicare |
$1,449.90
|
| Rate for Payer: HUMANA Commercial |
$1,449.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,482.12
|
| Rate for Payer: MEDICARE Medicare |
$1,127.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,530.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,562.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,530.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,530.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,369.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,288.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,288.80
|
|
|
CT CERVICAL SPINE WO CONTRAST
|
Facility
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,127.70 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: AETNA Commercial |
$1,530.45
|
| Rate for Payer: AETNA Medicare |
$1,449.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,530.45
|
| Rate for Payer: BCBS Healthlink |
$1,449.90
|
| Rate for Payer: BCBS HMK CHIP |
$1,449.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,449.90
|
| Rate for Payer: BCBS POS |
$1,530.45
|
| Rate for Payer: BCBS Traditional |
$1,611.00
|
| Rate for Payer: CASH_PRICE |
$1,288.80
|
| Rate for Payer: CIGNA Commercial |
$1,530.45
|
| Rate for Payer: CIGNA Medicare |
$1,449.90
|
| Rate for Payer: HUMANA Commercial |
$1,449.90
|
| Rate for Payer: MEDICAID Medicaid |
$1,482.12
|
| Rate for Payer: MEDICARE Medicare |
$1,127.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,530.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,562.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,530.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,530.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,369.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,288.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,288.80
|
|
|
CT CERVICAL SPINE W WO CONTRAST
|
Facility
OP
|
$2,261.00
|
|
|
Service Code
|
CPT 72127 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,582.70 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: AETNA Commercial |
$2,147.95
|
| Rate for Payer: AETNA Medicare |
$2,034.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,147.95
|
| Rate for Payer: BCBS Healthlink |
$2,034.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,034.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,034.90
|
| Rate for Payer: BCBS POS |
$2,147.95
|
| Rate for Payer: BCBS Traditional |
$2,261.00
|
| Rate for Payer: CASH_PRICE |
$1,808.80
|
| Rate for Payer: CIGNA Commercial |
$2,147.95
|
| Rate for Payer: CIGNA Medicare |
$2,034.90
|
| Rate for Payer: HUMANA Commercial |
$2,034.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,080.12
|
| Rate for Payer: MEDICARE Medicare |
$1,582.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,147.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,193.17
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,147.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,147.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,921.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,808.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,808.80
|
|
