|
CT THORACIC SPINE W WO CONTRAST
|
Facility
IP
|
$2,288.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,601.60 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: AETNA Commercial |
$2,173.60
|
| Rate for Payer: AETNA Medicare |
$2,059.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,173.60
|
| Rate for Payer: BCBS Healthlink |
$2,059.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,059.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,059.20
|
| Rate for Payer: BCBS POS |
$2,173.60
|
| Rate for Payer: BCBS Traditional |
$2,288.00
|
| Rate for Payer: CASH_PRICE |
$1,830.40
|
| Rate for Payer: CIGNA Commercial |
$2,173.60
|
| Rate for Payer: CIGNA Medicare |
$2,059.20
|
| Rate for Payer: HUMANA Commercial |
$2,059.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,104.96
|
| Rate for Payer: MEDICARE Medicare |
$1,601.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,219.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,173.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,944.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,830.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,830.40
|
|
|
CT THORACIC SPINE W WO CONTRAST
|
Facility
OP
|
$2,288.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,601.60 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: AETNA Commercial |
$2,173.60
|
| Rate for Payer: AETNA Medicare |
$2,059.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,173.60
|
| Rate for Payer: BCBS Healthlink |
$2,059.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,059.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,059.20
|
| Rate for Payer: BCBS POS |
$2,173.60
|
| Rate for Payer: BCBS Traditional |
$2,288.00
|
| Rate for Payer: CASH_PRICE |
$1,830.40
|
| Rate for Payer: CIGNA Commercial |
$2,173.60
|
| Rate for Payer: CIGNA Medicare |
$2,059.20
|
| Rate for Payer: HUMANA Commercial |
$2,059.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,104.96
|
| Rate for Payer: MEDICARE Medicare |
$1,601.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,219.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,173.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,944.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,830.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,830.40
|
|
|
CT UPPER EXTREMITY LT W CONTRAST
|
Facility
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,215.90 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: AETNA Commercial |
$1,650.15
|
| Rate for Payer: AETNA Medicare |
$1,563.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,650.15
|
| Rate for Payer: BCBS Healthlink |
$1,563.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,563.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,563.30
|
| Rate for Payer: BCBS POS |
$1,650.15
|
| Rate for Payer: BCBS Traditional |
$1,737.00
|
| Rate for Payer: CASH_PRICE |
$1,389.60
|
| Rate for Payer: CIGNA Commercial |
$1,650.15
|
| Rate for Payer: CIGNA Medicare |
$1,563.30
|
| Rate for Payer: HUMANA Commercial |
$1,563.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,598.04
|
| Rate for Payer: MEDICARE Medicare |
$1,215.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,684.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,650.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,476.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,389.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,389.60
|
|
|
CT UPPER EXTREMITY LT W CONTRAST
|
Facility
IP
|
$1,737.00
|
|
|
Service Code
|
CPT 73201 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,215.90 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: AETNA Commercial |
$1,650.15
|
| Rate for Payer: AETNA Medicare |
$1,563.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,650.15
|
| Rate for Payer: BCBS Healthlink |
$1,563.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,563.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,563.30
|
| Rate for Payer: BCBS POS |
$1,650.15
|
| Rate for Payer: BCBS Traditional |
$1,737.00
|
| Rate for Payer: CASH_PRICE |
$1,389.60
|
| Rate for Payer: CIGNA Commercial |
$1,650.15
|
| Rate for Payer: CIGNA Medicare |
$1,563.30
|
| Rate for Payer: HUMANA Commercial |
$1,563.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,598.04
|
| Rate for Payer: MEDICARE Medicare |
$1,215.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,684.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,650.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,476.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,389.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,389.60
|
|
|
CT UPPER EXTREMITY LT WO CONTRAST
|
Facility
IP
|
$1,447.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,012.90 |
| Max. Negotiated Rate |
$1,447.00 |
| Rate for Payer: AETNA Commercial |
$1,374.65
|
| Rate for Payer: AETNA Medicare |
$1,302.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,374.65
|
| Rate for Payer: BCBS Healthlink |
$1,302.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,302.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,302.30
|
| Rate for Payer: BCBS POS |
$1,374.65
|
| Rate for Payer: BCBS Traditional |
$1,447.00
|
| Rate for Payer: CASH_PRICE |
$1,157.60
|
| Rate for Payer: CIGNA Commercial |
$1,374.65
|
| Rate for Payer: CIGNA Medicare |
$1,302.30
|
| Rate for Payer: HUMANA Commercial |
$1,302.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,331.24
|
| Rate for Payer: MEDICARE Medicare |
$1,012.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,403.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,374.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,229.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,157.60
|
|
|
CT UPPER EXTREMITY LT WO CONTRAST
|
Facility
OP
|
$1,447.00
|
|
|
Service Code
|
CPT 73200 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,012.90 |
| Max. Negotiated Rate |
$1,447.00 |
| Rate for Payer: AETNA Commercial |
$1,374.65
|
| Rate for Payer: AETNA Medicare |
$1,302.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,374.65
|
| Rate for Payer: BCBS Healthlink |
$1,302.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,302.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,302.30
|
| Rate for Payer: BCBS POS |
$1,374.65
|
| Rate for Payer: BCBS Traditional |
$1,447.00
|
| Rate for Payer: CASH_PRICE |
$1,157.60
|
| Rate for Payer: CIGNA Commercial |
$1,374.65
|
| Rate for Payer: CIGNA Medicare |
$1,302.30
|
| Rate for Payer: HUMANA Commercial |
$1,302.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,331.24
|
| Rate for Payer: MEDICARE Medicare |
$1,012.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,403.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,374.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,229.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,157.60
|
|
|
CT UPPER EXTREMITY LT W WO CONTRAST
|
Facility
IP
|
$1,878.00
|
|
|
Service Code
|
CPT 73202 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,314.60 |
| Max. Negotiated Rate |
$1,878.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,690.20
|
| 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 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
|
|
|
CT UPPER EXTREMITY LT W WO CONTRAST
|
Facility
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 73202 LT
|
| 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
|
|
|
CT UPPER EXTREMITY RT W CONTRAST
|
Facility
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,215.90 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: AETNA Commercial |
$1,650.15
|
| Rate for Payer: AETNA Medicare |
$1,563.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,650.15
|
| Rate for Payer: BCBS Healthlink |
$1,563.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,563.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,563.30
|
| Rate for Payer: BCBS POS |
$1,650.15
|
| Rate for Payer: BCBS Traditional |
$1,737.00
|
| Rate for Payer: CASH_PRICE |
$1,389.60
|
| Rate for Payer: CIGNA Commercial |
$1,650.15
|
| Rate for Payer: CIGNA Medicare |
$1,563.30
|
| Rate for Payer: HUMANA Commercial |
$1,563.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,598.04
|
| Rate for Payer: MEDICARE Medicare |
$1,215.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,684.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,650.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,476.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,389.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,389.60
|
|
|
CT UPPER EXTREMITY RT W CONTRAST
|
Facility
IP
|
$1,737.00
|
|
|
Service Code
|
CPT 73201 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,215.90 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,563.30
|
| Rate for Payer: AETNA Commercial |
$1,650.15
|
| Rate for Payer: AETNA Medicare |
$1,563.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,650.15
|
| Rate for Payer: BCBS Healthlink |
$1,563.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,563.30
|
| Rate for Payer: BCBS POS |
$1,650.15
|
| Rate for Payer: BCBS Traditional |
$1,737.00
|
| Rate for Payer: CASH_PRICE |
$1,389.60
|
| Rate for Payer: CIGNA Commercial |
$1,650.15
|
| Rate for Payer: CIGNA Medicare |
$1,563.30
|
| Rate for Payer: HUMANA Commercial |
$1,563.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,598.04
|
| Rate for Payer: MEDICARE Medicare |
$1,215.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,684.89
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,650.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,650.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,476.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,389.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,389.60
|
|
|
CT UPPER EXTREMITY RT WO CONTRAST
|
Facility
OP
|
$1,447.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,012.90 |
| Max. Negotiated Rate |
$1,447.00 |
| Rate for Payer: AETNA Commercial |
$1,374.65
|
| Rate for Payer: AETNA Medicare |
$1,302.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,374.65
|
| Rate for Payer: BCBS Healthlink |
$1,302.30
|
| Rate for Payer: BCBS HMK CHIP |
$1,302.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,302.30
|
| Rate for Payer: BCBS POS |
$1,374.65
|
| Rate for Payer: BCBS Traditional |
$1,447.00
|
| Rate for Payer: CASH_PRICE |
$1,157.60
|
| Rate for Payer: CIGNA Commercial |
$1,374.65
|
| Rate for Payer: CIGNA Medicare |
$1,302.30
|
| Rate for Payer: HUMANA Commercial |
$1,302.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,331.24
|
| Rate for Payer: MEDICARE Medicare |
$1,012.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,403.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,374.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,229.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,157.60
|
|
|
CT UPPER EXTREMITY RT WO CONTRAST
|
Facility
IP
|
$1,447.00
|
|
|
Service Code
|
CPT 73200 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,012.90 |
| Max. Negotiated Rate |
$1,447.00 |
| Rate for Payer: BCBS HMK CHIP |
$1,302.30
|
| Rate for Payer: AETNA Commercial |
$1,374.65
|
| Rate for Payer: AETNA Medicare |
$1,302.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$1,374.65
|
| Rate for Payer: BCBS Healthlink |
$1,302.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,302.30
|
| Rate for Payer: BCBS POS |
$1,374.65
|
| Rate for Payer: BCBS Traditional |
$1,447.00
|
| Rate for Payer: CASH_PRICE |
$1,157.60
|
| Rate for Payer: CIGNA Commercial |
$1,374.65
|
| Rate for Payer: CIGNA Medicare |
$1,302.30
|
| Rate for Payer: HUMANA Commercial |
$1,302.30
|
| Rate for Payer: MEDICAID Medicaid |
$1,331.24
|
| Rate for Payer: MEDICARE Medicare |
$1,012.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$1,403.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$1,374.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$1,374.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,229.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,157.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,157.60
|
|
|
CT UPPER EXTREMITY RT W WO CONTRAST
|
Facility
IP
|
$1,878.00
|
|
|
Service Code
|
CPT 73202 RT
|
| 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
|
|
|
CT UPPER EXTREMITY RT W WO CONTRAST
|
Facility
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 73202 RT
|
| 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
|
|
|
CYANOCOBALAMIN INJ [1000 MCG/ML]
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
CYANOCOBALAMIN INJ [1000 MCG/ML]
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: AETNA Commercial |
$27.55
|
| Rate for Payer: AETNA Medicare |
$26.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$27.55
|
| Rate for Payer: BCBS Healthlink |
$26.10
|
| Rate for Payer: BCBS HMK CHIP |
$26.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$26.10
|
| Rate for Payer: BCBS POS |
$27.55
|
| Rate for Payer: BCBS Traditional |
$29.00
|
| Rate for Payer: CASH_PRICE |
$23.20
|
| Rate for Payer: CIGNA Commercial |
$27.55
|
| Rate for Payer: CIGNA Medicare |
$26.10
|
| Rate for Payer: HUMANA Commercial |
$26.10
|
| Rate for Payer: MEDICAID Medicaid |
$26.68
|
| Rate for Payer: MEDICARE Medicare |
$20.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$27.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$28.13
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$27.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$27.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$24.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$23.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$23.20
|
|
|
CYCLOBENZAPRINE TAB [10 MG]
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CYCLOBENZAPRINE TAB [10 MG]
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
CYGNUS MATRIX-PER SQ CENTIMETER
|
Facility
OP
|
$592.00
|
|
|
Service Code
|
CPT Q4199
|
| Hospital Charge Code |
20230101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$414.40 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: AETNA Commercial |
$562.40
|
| Rate for Payer: AETNA Medicare |
$532.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$562.40
|
| Rate for Payer: BCBS Healthlink |
$532.80
|
| Rate for Payer: BCBS HMK CHIP |
$532.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$532.80
|
| Rate for Payer: BCBS POS |
$562.40
|
| Rate for Payer: BCBS Traditional |
$592.00
|
| Rate for Payer: CASH_PRICE |
$473.60
|
| Rate for Payer: CIGNA Commercial |
$562.40
|
| Rate for Payer: CIGNA Medicare |
$532.80
|
| Rate for Payer: HUMANA Commercial |
$532.80
|
| Rate for Payer: MEDICAID Medicaid |
$544.64
|
| Rate for Payer: MEDICARE Medicare |
$414.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$562.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$574.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$562.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$562.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$503.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$473.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$473.60
|
|
|
CYGNUS MATRIX-PER SQ CENTIMETER
|
Facility
IP
|
$592.00
|
|
|
Service Code
|
CPT Q4199
|
| Hospital Charge Code |
20230101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$414.40 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: AETNA Commercial |
$562.40
|
| Rate for Payer: AETNA Medicare |
$532.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$562.40
|
| Rate for Payer: BCBS Healthlink |
$532.80
|
| Rate for Payer: BCBS HMK CHIP |
$532.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$532.80
|
| Rate for Payer: BCBS POS |
$562.40
|
| Rate for Payer: BCBS Traditional |
$592.00
|
| Rate for Payer: CASH_PRICE |
$473.60
|
| Rate for Payer: CIGNA Commercial |
$562.40
|
| Rate for Payer: CIGNA Medicare |
$532.80
|
| Rate for Payer: HUMANA Commercial |
$532.80
|
| Rate for Payer: MEDICAID Medicaid |
$544.64
|
| Rate for Payer: MEDICARE Medicare |
$414.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$562.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$574.24
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$562.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$562.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$503.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$473.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$473.60
|
|
|
CYSTATIN C W/ EGFR (121265)
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
CYSTATIN C W/ EGFR (121265)
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$355.00 |
| Rate for Payer: BCBS HMK CHIP |
$319.50
|
| Rate for Payer: AETNA Commercial |
$337.25
|
| Rate for Payer: AETNA Medicare |
$319.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$337.25
|
| Rate for Payer: BCBS Healthlink |
$319.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$319.50
|
| Rate for Payer: BCBS POS |
$337.25
|
| Rate for Payer: BCBS Traditional |
$355.00
|
| Rate for Payer: CASH_PRICE |
$284.00
|
| Rate for Payer: CIGNA Commercial |
$337.25
|
| Rate for Payer: CIGNA Medicare |
$319.50
|
| Rate for Payer: HUMANA Commercial |
$319.50
|
| Rate for Payer: MEDICAID Medicaid |
$326.60
|
| Rate for Payer: MEDICARE Medicare |
$248.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$337.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$344.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$337.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$337.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$301.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$284.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$284.00
|
|
|
CYTOLOGY, URINE (009068)
|
Facility
OP
|
$155.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: AETNA Commercial |
$147.25
|
| Rate for Payer: AETNA Medicare |
$139.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$147.25
|
| Rate for Payer: BCBS Healthlink |
$139.50
|
| Rate for Payer: BCBS HMK CHIP |
$139.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$139.50
|
| Rate for Payer: BCBS POS |
$147.25
|
| Rate for Payer: BCBS Traditional |
$155.00
|
| Rate for Payer: CASH_PRICE |
$124.00
|
| Rate for Payer: CIGNA Commercial |
$147.25
|
| Rate for Payer: CIGNA Medicare |
$139.50
|
| Rate for Payer: HUMANA Commercial |
$139.50
|
| Rate for Payer: MEDICAID Medicaid |
$142.60
|
| Rate for Payer: MEDICARE Medicare |
$108.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$147.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$150.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$147.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$147.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$131.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.00
|
|
|
CYTOLOGY, URINE (009068)
|
Facility
IP
|
$155.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: AETNA Commercial |
$147.25
|
| Rate for Payer: AETNA Medicare |
$139.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$147.25
|
| Rate for Payer: BCBS Healthlink |
$139.50
|
| Rate for Payer: BCBS HMK CHIP |
$139.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$139.50
|
| Rate for Payer: BCBS POS |
$147.25
|
| Rate for Payer: BCBS Traditional |
$155.00
|
| Rate for Payer: CASH_PRICE |
$124.00
|
| Rate for Payer: CIGNA Commercial |
$147.25
|
| Rate for Payer: CIGNA Medicare |
$139.50
|
| Rate for Payer: HUMANA Commercial |
$139.50
|
| Rate for Payer: MEDICAID Medicaid |
$142.60
|
| Rate for Payer: MEDICARE Medicare |
$108.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$147.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$150.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$147.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$147.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$131.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$124.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$124.00
|
|
|
CYTP CERV/VAG AUTO THIN LAYER PREP MNL S
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: AETNA Commercial |
$164.35
|
| Rate for Payer: AETNA Medicare |
$155.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$164.35
|
| Rate for Payer: BCBS Healthlink |
$155.70
|
| Rate for Payer: BCBS HMK CHIP |
$155.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$155.70
|
| Rate for Payer: BCBS POS |
$164.35
|
| Rate for Payer: BCBS Traditional |
$173.00
|
| Rate for Payer: CASH_PRICE |
$138.40
|
| Rate for Payer: CIGNA Commercial |
$164.35
|
| Rate for Payer: CIGNA Medicare |
$155.70
|
| Rate for Payer: HUMANA Commercial |
$155.70
|
| Rate for Payer: MEDICAID Medicaid |
$159.16
|
| Rate for Payer: MEDICARE Medicare |
$121.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$164.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$167.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$164.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$164.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$147.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$138.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$138.40
|
|
