|
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
|
|
|
CT CHEST W CONTRAST
|
Facility
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,391.60 |
| Max. Negotiated Rate |
$1,988.00 |
| Rate for Payer: AETNA Commercial |
$1,888.60
|
| Rate for Payer: AETNA Medicare |
$1,789.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,888.60
|
| Rate for Payer: BCBS Healthlink |
$1,789.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,789.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,789.20
|
| Rate for Payer: BCBS POS |
$1,888.60
|
| Rate for Payer: BCBS Traditional |
$1,988.00
|
| Rate for Payer: CASH_PRICE |
$1,590.40
|
| Rate for Payer: CIGNA Commercial |
$1,888.60
|
| Rate for Payer: CIGNA Medicare |
$1,789.20
|
| Rate for Payer: HUMANA Commercial |
$1,789.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,828.96
|
| Rate for Payer: MEDICARE Medicare |
$1,391.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,888.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,928.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,888.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,888.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,689.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,590.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,590.40
|
|
|
CT CHEST W CONTRAST
|
Facility
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,391.60 |
| Max. Negotiated Rate |
$1,988.00 |
| Rate for Payer: AETNA Commercial |
$1,888.60
|
| Rate for Payer: AETNA Medicare |
$1,789.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,888.60
|
| Rate for Payer: BCBS Healthlink |
$1,789.20
|
| Rate for Payer: BCBS HMK CHIP |
$1,789.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,789.20
|
| Rate for Payer: BCBS POS |
$1,888.60
|
| Rate for Payer: BCBS Traditional |
$1,988.00
|
| Rate for Payer: CASH_PRICE |
$1,590.40
|
| Rate for Payer: CIGNA Commercial |
$1,888.60
|
| Rate for Payer: CIGNA Medicare |
$1,789.20
|
| Rate for Payer: HUMANA Commercial |
$1,789.20
|
| Rate for Payer: MEDICAID Medicaid |
$1,828.96
|
| Rate for Payer: MEDICARE Medicare |
$1,391.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,888.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,928.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,888.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,888.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,689.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,590.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,590.40
|
|
|
CT CHEST WO CONTRAST
|
Facility
OP
|
$1,507.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,054.90 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: AETNA Commercial |
$1,431.65
|
| Rate for Payer: AETNA Medicare |
$1,356.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,431.65
|
| Rate for Payer: BCBS Healthlink |
$1,356.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,356.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,356.30
|
| Rate for Payer: BCBS POS |
$1,431.65
|
| Rate for Payer: BCBS Traditional |
$1,507.00
|
| Rate for Payer: CASH_PRICE |
$1,205.60
|
| Rate for Payer: CIGNA Commercial |
$1,431.65
|
| Rate for Payer: CIGNA Medicare |
$1,356.30
|
| Rate for Payer: HUMANA Commercial |
$1,356.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,386.44
|
| Rate for Payer: MEDICARE Medicare |
$1,054.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,461.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,431.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,280.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,205.60
|
|
|
CT CHEST WO CONTRAST
|
Facility
IP
|
$1,507.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,054.90 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: AETNA Commercial |
$1,431.65
|
| Rate for Payer: AETNA Medicare |
$1,356.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,431.65
|
| Rate for Payer: BCBS Healthlink |
$1,356.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,356.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,356.30
|
| Rate for Payer: BCBS POS |
$1,431.65
|
| Rate for Payer: BCBS Traditional |
$1,507.00
|
| Rate for Payer: CASH_PRICE |
$1,205.60
|
| Rate for Payer: CIGNA Commercial |
$1,431.65
|
| Rate for Payer: CIGNA Medicare |
$1,356.30
|
| Rate for Payer: HUMANA Commercial |
$1,356.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,386.44
|
| Rate for Payer: MEDICARE Medicare |
$1,054.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,461.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,431.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,280.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,205.60
|
|
|
CT CHEST W WO CONTRAST
|
Facility
IP
|
$2,321.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,624.70 |
| Max. Negotiated Rate |
$2,321.00 |
| Rate for Payer: BCBS HMK CHIP |
$2,088.90
|
| 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 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
|
|
|
CT CHEST W WO CONTRAST
|
Facility
OP
|
$2,321.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| 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
|
|
|
CT CONTRAST BOTTLE ISOVUE 250 200ML
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT Q9967 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: AETNA Commercial |
$171.95
|
| Rate for Payer: AETNA Medicare |
$162.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$171.95
|
| Rate for Payer: BCBS Healthlink |
$162.90
|
| Rate for Payer: BCBS HMK CHIP |
$162.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$162.90
|
| Rate for Payer: BCBS POS |
$171.95
|
| Rate for Payer: BCBS Traditional |
$181.00
|
| Rate for Payer: CASH_PRICE |
$144.80
|
| Rate for Payer: CIGNA Commercial |
$171.95
|
| Rate for Payer: CIGNA Medicare |
$162.90
|
| Rate for Payer: HUMANA Commercial |
$162.90
|
| Rate for Payer: MEDICAID Medicaid |
$166.52
|
| Rate for Payer: MEDICARE Medicare |
$126.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$171.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$175.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$171.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$171.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$153.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$144.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$144.80
|
|
|
CT CONTRAST BOTTLE ISOVUE 250 200ML
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT Q9967 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$181.00 |
| Rate for Payer: BCBS HMK CHIP |
$162.90
|
| Rate for Payer: AETNA Commercial |
$171.95
|
| Rate for Payer: AETNA Medicare |
$162.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$171.95
|
| Rate for Payer: BCBS Healthlink |
$162.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$162.90
|
| Rate for Payer: BCBS POS |
$171.95
|
| Rate for Payer: BCBS Traditional |
$181.00
|
| Rate for Payer: CASH_PRICE |
$144.80
|
| Rate for Payer: CIGNA Commercial |
$171.95
|
| Rate for Payer: CIGNA Medicare |
$162.90
|
| Rate for Payer: HUMANA Commercial |
$162.90
|
| Rate for Payer: MEDICAID Medicaid |
$166.52
|
| Rate for Payer: MEDICARE Medicare |
$126.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$171.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$175.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$171.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$171.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$153.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$144.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$144.80
|
|
|
CT CONTRAST BOTTLE ISOVUE 370 125ML
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
CPT Q9967 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: AETNA Commercial |
$214.70
|
| Rate for Payer: AETNA Medicare |
$203.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$214.70
|
| Rate for Payer: BCBS Healthlink |
$203.40
|
| Rate for Payer: BCBS HMK CHIP |
$203.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$203.40
|
| Rate for Payer: BCBS POS |
$214.70
|
| Rate for Payer: BCBS Traditional |
$226.00
|
| Rate for Payer: CASH_PRICE |
$180.80
|
| Rate for Payer: CIGNA Commercial |
$214.70
|
| Rate for Payer: CIGNA Medicare |
$203.40
|
| Rate for Payer: HUMANA Commercial |
$203.40
|
| Rate for Payer: MEDICAID Medicaid |
$207.92
|
| Rate for Payer: MEDICARE Medicare |
$158.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$214.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$219.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$214.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$214.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.80
|
|
|
CT CONTRAST BOTTLE ISOVUE 370 125ML
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
CPT Q9967 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: AETNA Commercial |
$214.70
|
| Rate for Payer: AETNA Medicare |
$203.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$214.70
|
| Rate for Payer: BCBS Healthlink |
$203.40
|
| Rate for Payer: BCBS HMK CHIP |
$203.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$203.40
|
| Rate for Payer: BCBS POS |
$214.70
|
| Rate for Payer: BCBS Traditional |
$226.00
|
| Rate for Payer: CASH_PRICE |
$180.80
|
| Rate for Payer: CIGNA Commercial |
$214.70
|
| Rate for Payer: CIGNA Medicare |
$203.40
|
| Rate for Payer: HUMANA Commercial |
$203.40
|
| Rate for Payer: MEDICAID Medicaid |
$207.92
|
| Rate for Payer: MEDICARE Medicare |
$158.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$214.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$219.22
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$214.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$214.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$192.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$180.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$180.80
|
|
|
CT FACIAL BONES W CONTRAST
|
Facility
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,292.20 |
| Max. Negotiated Rate |
$1,846.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,661.40
|
| Rate for Payer: AETNA Commercial |
$1,753.70
|
| Rate for Payer: AETNA Medicare |
$1,661.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,753.70
|
| Rate for Payer: BCBS Healthlink |
$1,661.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,661.40
|
| Rate for Payer: BCBS POS |
$1,753.70
|
| Rate for Payer: BCBS Traditional |
$1,846.00
|
| Rate for Payer: CASH_PRICE |
$1,476.80
|
| Rate for Payer: CIGNA Commercial |
$1,753.70
|
| Rate for Payer: CIGNA Medicare |
$1,661.40
|
| Rate for Payer: HUMANA Commercial |
$1,661.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,698.32
|
| Rate for Payer: MEDICARE Medicare |
$1,292.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,753.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,790.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,753.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,753.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,569.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,476.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,476.80
|
|
|
CT FACIAL BONES W CONTRAST
|
Facility
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,292.20 |
| Max. Negotiated Rate |
$1,846.00 |
| Rate for Payer: AETNA Commercial |
$1,753.70
|
| Rate for Payer: AETNA Medicare |
$1,661.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,753.70
|
| Rate for Payer: BCBS Healthlink |
$1,661.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,661.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,661.40
|
| Rate for Payer: BCBS POS |
$1,753.70
|
| Rate for Payer: BCBS Traditional |
$1,846.00
|
| Rate for Payer: CASH_PRICE |
$1,476.80
|
| Rate for Payer: CIGNA Commercial |
$1,753.70
|
| Rate for Payer: CIGNA Medicare |
$1,661.40
|
| Rate for Payer: HUMANA Commercial |
$1,661.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,698.32
|
| Rate for Payer: MEDICARE Medicare |
$1,292.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,753.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,790.62
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,753.70
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,753.70
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,569.10
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,476.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,476.80
|
|
|
CT FACIAL BONES WO CONTRAST
|
Facility
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,292.40
|
| Rate for Payer: AETNA Commercial |
$1,364.20
|
| Rate for Payer: AETNA Medicare |
$1,292.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,364.20
|
| Rate for Payer: BCBS Healthlink |
$1,292.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,292.40
|
| Rate for Payer: BCBS POS |
$1,364.20
|
| Rate for Payer: BCBS Traditional |
$1,436.00
|
| Rate for Payer: CASH_PRICE |
$1,148.80
|
| Rate for Payer: CIGNA Commercial |
$1,364.20
|
| Rate for Payer: CIGNA Medicare |
$1,292.40
|
| Rate for Payer: HUMANA Commercial |
$1,292.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,321.12
|
| Rate for Payer: MEDICARE Medicare |
$1,005.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,364.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,392.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,364.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,364.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,220.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,148.80
|
|
|
CT FACIAL BONES WO CONTRAST
|
Facility
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: AETNA Commercial |
$1,364.20
|
| Rate for Payer: AETNA Medicare |
$1,292.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,364.20
|
| Rate for Payer: BCBS Healthlink |
$1,292.40
|
| Rate for Payer: BCBS HMK CHIP |
$1,292.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,292.40
|
| Rate for Payer: BCBS POS |
$1,364.20
|
| Rate for Payer: BCBS Traditional |
$1,436.00
|
| Rate for Payer: CASH_PRICE |
$1,148.80
|
| Rate for Payer: CIGNA Commercial |
$1,364.20
|
| Rate for Payer: CIGNA Medicare |
$1,292.40
|
| Rate for Payer: HUMANA Commercial |
$1,292.40
|
| Rate for Payer: MEDICAID Medicaid |
$1,321.12
|
| Rate for Payer: MEDICARE Medicare |
$1,005.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,364.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,392.92
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,364.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,364.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,220.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,148.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,148.80
|
|
|
CT FACIAL BONES W WO CONTRAST
|
Facility
IP
|
$2,124.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,486.80 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: AETNA Commercial |
$2,017.80
|
| Rate for Payer: AETNA Medicare |
$1,911.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,017.80
|
| Rate for Payer: BCBS Healthlink |
$1,911.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,911.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,911.60
|
| Rate for Payer: BCBS POS |
$2,017.80
|
| Rate for Payer: BCBS Traditional |
$2,124.00
|
| Rate for Payer: CASH_PRICE |
$1,699.20
|
| Rate for Payer: CIGNA Commercial |
$2,017.80
|
| Rate for Payer: CIGNA Medicare |
$1,911.60
|
| Rate for Payer: HUMANA Commercial |
$1,911.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,954.08
|
| Rate for Payer: MEDICARE Medicare |
$1,486.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,017.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,060.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,017.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,017.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,805.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,699.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,699.20
|
|
|
CT FACIAL BONES W WO CONTRAST
|
Facility
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,486.80 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: AETNA Commercial |
$2,017.80
|
| Rate for Payer: AETNA Medicare |
$1,911.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,017.80
|
| Rate for Payer: BCBS Healthlink |
$1,911.60
|
| Rate for Payer: BCBS HMK CHIP |
$1,911.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,911.60
|
| Rate for Payer: BCBS POS |
$2,017.80
|
| Rate for Payer: BCBS Traditional |
$2,124.00
|
| Rate for Payer: CASH_PRICE |
$1,699.20
|
| Rate for Payer: CIGNA Commercial |
$2,017.80
|
| Rate for Payer: CIGNA Medicare |
$1,911.60
|
| Rate for Payer: HUMANA Commercial |
$1,911.60
|
| Rate for Payer: MEDICAID Medicaid |
$1,954.08
|
| Rate for Payer: MEDICARE Medicare |
$1,486.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,017.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,060.28
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,017.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,017.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,805.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,699.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,699.20
|
|
|
CT HEAD W CONTRAST
|
Facility
OP
|
$1,769.00
|
|
|
Service Code
|
CPT 70460 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,238.30 |
| Max. Negotiated Rate |
$1,769.00 |
| Rate for Payer: AETNA Commercial |
$1,680.55
|
| Rate for Payer: AETNA Medicare |
$1,592.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,680.55
|
| Rate for Payer: BCBS Healthlink |
$1,592.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,592.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,592.10
|
| Rate for Payer: BCBS POS |
$1,680.55
|
| Rate for Payer: BCBS Traditional |
$1,769.00
|
| Rate for Payer: CASH_PRICE |
$1,415.20
|
| Rate for Payer: CIGNA Commercial |
$1,680.55
|
| Rate for Payer: CIGNA Medicare |
$1,592.10
|
| Rate for Payer: HUMANA Commercial |
$1,592.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,627.48
|
| Rate for Payer: MEDICARE Medicare |
$1,238.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,715.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,680.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,503.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,415.20
|
|
|
CT HEAD W CONTRAST
|
Facility
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 70460 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,238.30 |
| Max. Negotiated Rate |
$1,769.00 |
| Rate for Payer: AETNA Commercial |
$1,680.55
|
| Rate for Payer: AETNA Medicare |
$1,592.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,680.55
|
| Rate for Payer: BCBS Healthlink |
$1,592.10
|
| Rate for Payer: BCBS HMK CHIP |
$1,592.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,592.10
|
| Rate for Payer: BCBS POS |
$1,680.55
|
| Rate for Payer: BCBS Traditional |
$1,769.00
|
| Rate for Payer: CASH_PRICE |
$1,415.20
|
| Rate for Payer: CIGNA Commercial |
$1,680.55
|
| Rate for Payer: CIGNA Medicare |
$1,592.10
|
| Rate for Payer: HUMANA Commercial |
$1,592.10
|
| Rate for Payer: MEDICAID Medicaid |
$1,627.48
|
| Rate for Payer: MEDICARE Medicare |
$1,238.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,715.93
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,680.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,680.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,503.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,415.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,415.20
|
|
|
CT HEAD WO CONTRAST
|
Facility
IP
|
$1,432.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,002.40 |
| Max. Negotiated Rate |
$1,432.00 |
| Rate for Payer: AETNA Commercial |
$1,360.40
|
| Rate for Payer: AETNA Medicare |
$1,288.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,360.40
|
| Rate for Payer: BCBS Healthlink |
$1,288.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,288.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,288.80
|
| Rate for Payer: BCBS POS |
$1,360.40
|
| Rate for Payer: BCBS Traditional |
$1,432.00
|
| Rate for Payer: CASH_PRICE |
$1,145.60
|
| Rate for Payer: CIGNA Commercial |
$1,360.40
|
| Rate for Payer: CIGNA Medicare |
$1,288.80
|
| Rate for Payer: HUMANA Commercial |
$1,288.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,317.44
|
| Rate for Payer: MEDICARE Medicare |
$1,002.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,360.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,389.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,360.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,360.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,217.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,145.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,145.60
|
|
|
CT HEAD WO CONTRAST
|
Facility
OP
|
$1,432.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,002.40 |
| Max. Negotiated Rate |
$1,432.00 |
| Rate for Payer: AETNA Commercial |
$1,360.40
|
| Rate for Payer: AETNA Medicare |
$1,288.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,360.40
|
| Rate for Payer: BCBS Healthlink |
$1,288.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,288.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,288.80
|
| Rate for Payer: BCBS POS |
$1,360.40
|
| Rate for Payer: BCBS Traditional |
$1,432.00
|
| Rate for Payer: CASH_PRICE |
$1,145.60
|
| Rate for Payer: CIGNA Commercial |
$1,360.40
|
| Rate for Payer: CIGNA Medicare |
$1,288.80
|
| Rate for Payer: HUMANA Commercial |
$1,288.80
|
| Rate for Payer: MEDICAID Medicaid |
$1,317.44
|
| Rate for Payer: MEDICARE Medicare |
$1,002.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,360.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,389.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,360.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,360.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,217.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,145.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,145.60
|
|
|
CT HEAD W WO CONTRAST
|
Facility
IP
|
$2,107.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,474.90 |
| Max. Negotiated Rate |
$2,107.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,896.30
|
| Rate for Payer: AETNA Commercial |
$2,001.65
|
| Rate for Payer: AETNA Medicare |
$1,896.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,001.65
|
| Rate for Payer: BCBS Healthlink |
$1,896.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,896.30
|
| Rate for Payer: BCBS POS |
$2,001.65
|
| Rate for Payer: BCBS Traditional |
$2,107.00
|
| Rate for Payer: CASH_PRICE |
$1,685.60
|
| Rate for Payer: CIGNA Commercial |
$2,001.65
|
| Rate for Payer: CIGNA Medicare |
$1,896.30
|
| Rate for Payer: HUMANA Commercial |
$1,896.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,938.44
|
| Rate for Payer: MEDICARE Medicare |
$1,474.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,001.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,043.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,001.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,001.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,790.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,685.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,685.60
|
|
|
CT HEAD W WO CONTRAST
|
Facility
OP
|
$2,107.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,474.90 |
| Max. Negotiated Rate |
$2,107.00 |
| Rate for Payer: AETNA Commercial |
$2,001.65
|
| Rate for Payer: AETNA Medicare |
$1,896.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,001.65
|
| Rate for Payer: BCBS Healthlink |
$1,896.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,896.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,896.30
|
| Rate for Payer: BCBS POS |
$2,001.65
|
| Rate for Payer: BCBS Traditional |
$2,107.00
|
| Rate for Payer: CASH_PRICE |
$1,685.60
|
| Rate for Payer: CIGNA Commercial |
$2,001.65
|
| Rate for Payer: CIGNA Medicare |
$1,896.30
|
| Rate for Payer: HUMANA Commercial |
$1,896.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,938.44
|
| Rate for Payer: MEDICARE Medicare |
$1,474.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,001.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,043.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,001.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,001.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,790.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,685.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,685.60
|
|
|
CT HIGH REZ CHEST
|
Facility
IP
|
$1,507.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,054.90 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,356.30
|
| Rate for Payer: AETNA Commercial |
$1,431.65
|
| Rate for Payer: AETNA Medicare |
$1,356.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,431.65
|
| Rate for Payer: BCBS Healthlink |
$1,356.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,356.30
|
| Rate for Payer: BCBS POS |
$1,431.65
|
| Rate for Payer: BCBS Traditional |
$1,507.00
|
| Rate for Payer: CASH_PRICE |
$1,205.60
|
| Rate for Payer: CIGNA Commercial |
$1,431.65
|
| Rate for Payer: CIGNA Medicare |
$1,356.30
|
| Rate for Payer: HUMANA Commercial |
$1,356.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,386.44
|
| Rate for Payer: MEDICARE Medicare |
$1,054.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,461.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,431.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,280.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,205.60
|
|
|
CT HIGH REZ CHEST
|
Facility
OP
|
$1,507.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,054.90 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: AETNA Commercial |
$1,431.65
|
| Rate for Payer: AETNA Medicare |
$1,356.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,431.65
|
| Rate for Payer: BCBS Healthlink |
$1,356.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,356.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,356.30
|
| Rate for Payer: BCBS POS |
$1,431.65
|
| Rate for Payer: BCBS Traditional |
$1,507.00
|
| Rate for Payer: CASH_PRICE |
$1,205.60
|
| Rate for Payer: CIGNA Commercial |
$1,431.65
|
| Rate for Payer: CIGNA Medicare |
$1,356.30
|
| Rate for Payer: HUMANA Commercial |
$1,356.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,386.44
|
| Rate for Payer: MEDICARE Medicare |
$1,054.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,461.79
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,431.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,431.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,280.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,205.60
|
|
