|
MR BRAIN WO CONTRAST
|
Facility
IP
|
$2,321.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,624.70 |
| Max. Negotiated Rate |
$2,321.00 |
| Rate for Payer: AETNA Commercial |
$2,204.95
|
| Rate for Payer: AETNA Medicare |
$2,088.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,204.95
|
| Rate for Payer: BCBS Healthlink |
$2,088.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,088.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,088.90
|
| Rate for Payer: BCBS POS |
$2,204.95
|
| Rate for Payer: BCBS Traditional |
$2,321.00
|
| Rate for Payer: CASH_PRICE |
$1,856.80
|
| Rate for Payer: CIGNA Commercial |
$2,204.95
|
| Rate for Payer: CIGNA Medicare |
$2,088.90
|
| Rate for Payer: HUMANA Commercial |
$2,088.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,135.32
|
| Rate for Payer: MEDICARE Medicare |
$1,624.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,204.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,251.37
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,204.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,204.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,972.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,856.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,856.80
|
|
|
MR BRAIN W WO CONTRAST
|
Facility
IP
|
$3,450.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,415.00 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: AETNA Commercial |
$3,277.50
|
| Rate for Payer: AETNA Medicare |
$3,105.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,277.50
|
| Rate for Payer: BCBS Healthlink |
$3,105.00
|
| Rate for Payer: BCBS HMK CHIP |
$3,105.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,105.00
|
| Rate for Payer: BCBS POS |
$3,277.50
|
| Rate for Payer: BCBS Traditional |
$3,450.00
|
| Rate for Payer: CASH_PRICE |
$2,760.00
|
| Rate for Payer: CIGNA Commercial |
$3,277.50
|
| Rate for Payer: CIGNA Medicare |
$3,105.00
|
| Rate for Payer: HUMANA Commercial |
$3,105.00
|
| Rate for Payer: MEDICAID Medicaid |
$3,174.00
|
| Rate for Payer: MEDICARE Medicare |
$2,415.00
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,277.50
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,346.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,277.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,277.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,932.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,760.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,760.00
|
|
|
MR BRAIN W WO CONTRAST
|
Facility
OP
|
$3,450.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,415.00 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,277.50
|
| Rate for Payer: AETNA Commercial |
$3,277.50
|
| Rate for Payer: AETNA Medicare |
$3,105.00
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,277.50
|
| Rate for Payer: BCBS Healthlink |
$3,105.00
|
| Rate for Payer: BCBS HMK CHIP |
$3,105.00
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,105.00
|
| Rate for Payer: BCBS POS |
$3,277.50
|
| Rate for Payer: BCBS Traditional |
$3,450.00
|
| Rate for Payer: CASH_PRICE |
$2,760.00
|
| Rate for Payer: CIGNA Commercial |
$3,277.50
|
| Rate for Payer: CIGNA Medicare |
$3,105.00
|
| Rate for Payer: HUMANA Commercial |
$3,105.00
|
| Rate for Payer: MEDICAID Medicaid |
$3,174.00
|
| Rate for Payer: MEDICARE Medicare |
$2,415.00
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,346.50
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,277.50
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,277.50
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,932.50
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,760.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,760.00
|
|
|
MR CERVICAL SPINE W CONTRAST
|
Facility
IP
|
$2,757.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,929.90 |
| Max. Negotiated Rate |
$2,757.00 |
| Rate for Payer: AETNA Commercial |
$2,619.15
|
| Rate for Payer: AETNA Medicare |
$2,481.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,619.15
|
| Rate for Payer: BCBS Healthlink |
$2,481.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,481.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,481.30
|
| Rate for Payer: BCBS POS |
$2,619.15
|
| Rate for Payer: BCBS Traditional |
$2,757.00
|
| Rate for Payer: CASH_PRICE |
$2,205.60
|
| Rate for Payer: CIGNA Commercial |
$2,619.15
|
| Rate for Payer: CIGNA Medicare |
$2,481.30
|
| Rate for Payer: HUMANA Commercial |
$2,481.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,536.44
|
| Rate for Payer: MEDICARE Medicare |
$1,929.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,619.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,674.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,619.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,619.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,343.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,205.60
|
|
|
MR CERVICAL SPINE W CONTRAST
|
Facility
OP
|
$2,757.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,929.90 |
| Max. Negotiated Rate |
$2,757.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,619.15
|
| Rate for Payer: AETNA Commercial |
$2,619.15
|
| Rate for Payer: AETNA Medicare |
$2,481.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,619.15
|
| Rate for Payer: BCBS Healthlink |
$2,481.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,481.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,481.30
|
| Rate for Payer: BCBS POS |
$2,619.15
|
| Rate for Payer: BCBS Traditional |
$2,757.00
|
| Rate for Payer: CASH_PRICE |
$2,205.60
|
| Rate for Payer: CIGNA Commercial |
$2,619.15
|
| Rate for Payer: CIGNA Medicare |
$2,481.30
|
| Rate for Payer: HUMANA Commercial |
$2,481.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,536.44
|
| Rate for Payer: MEDICARE Medicare |
$1,929.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,674.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,619.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,619.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,343.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,205.60
|
|
|
MR CERVICAL SPINE WO CONTRAST
|
Facility
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,662.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: AETNA Commercial |
$2,256.25
|
| Rate for Payer: AETNA Medicare |
$2,137.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,256.25
|
| Rate for Payer: BCBS Healthlink |
$2,137.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,137.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,137.50
|
| Rate for Payer: BCBS POS |
$2,256.25
|
| Rate for Payer: BCBS Traditional |
$2,375.00
|
| Rate for Payer: CASH_PRICE |
$1,900.00
|
| Rate for Payer: CIGNA Commercial |
$2,256.25
|
| Rate for Payer: CIGNA Medicare |
$2,137.50
|
| Rate for Payer: HUMANA Commercial |
$2,137.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,185.00
|
| Rate for Payer: MEDICARE Medicare |
$1,662.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,303.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,256.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,018.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,900.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,900.00
|
|
|
MR CERVICAL SPINE WO CONTRAST
|
Facility
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,662.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: AETNA Commercial |
$2,256.25
|
| Rate for Payer: AETNA Medicare |
$2,137.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,256.25
|
| Rate for Payer: BCBS Healthlink |
$2,137.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,137.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,137.50
|
| Rate for Payer: BCBS POS |
$2,256.25
|
| Rate for Payer: BCBS Traditional |
$2,375.00
|
| Rate for Payer: CASH_PRICE |
$1,900.00
|
| Rate for Payer: CIGNA Commercial |
$2,256.25
|
| Rate for Payer: CIGNA Medicare |
$2,137.50
|
| Rate for Payer: HUMANA Commercial |
$2,137.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,185.00
|
| Rate for Payer: MEDICARE Medicare |
$1,662.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,303.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,256.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,018.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,900.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,900.00
|
|
|
MR CERVICAL SPINE W WO CONTRAST
|
Facility
OP
|
$3,472.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,430.40 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: AETNA Commercial |
$3,298.40
|
| Rate for Payer: AETNA Medicare |
$3,124.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,298.40
|
| Rate for Payer: BCBS Healthlink |
$3,124.80
|
| Rate for Payer: BCBS HMK CHIP |
$3,124.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,124.80
|
| Rate for Payer: BCBS POS |
$3,298.40
|
| Rate for Payer: BCBS Traditional |
$3,472.00
|
| Rate for Payer: CASH_PRICE |
$2,777.60
|
| Rate for Payer: CIGNA Commercial |
$3,298.40
|
| Rate for Payer: CIGNA Medicare |
$3,124.80
|
| Rate for Payer: HUMANA Commercial |
$3,124.80
|
| Rate for Payer: MEDICAID Medicaid |
$3,194.24
|
| Rate for Payer: MEDICARE Medicare |
$2,430.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,367.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,298.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,951.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,777.60
|
|
|
MR CERVICAL SPINE W WO CONTRAST
|
Facility
IP
|
$3,472.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,430.40 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: AETNA Commercial |
$3,298.40
|
| Rate for Payer: AETNA Medicare |
$3,124.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,298.40
|
| Rate for Payer: BCBS Healthlink |
$3,124.80
|
| Rate for Payer: BCBS HMK CHIP |
$3,124.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,124.80
|
| Rate for Payer: BCBS POS |
$3,298.40
|
| Rate for Payer: BCBS Traditional |
$3,472.00
|
| Rate for Payer: CASH_PRICE |
$2,777.60
|
| Rate for Payer: CIGNA Commercial |
$3,298.40
|
| Rate for Payer: CIGNA Medicare |
$3,124.80
|
| Rate for Payer: HUMANA Commercial |
$3,124.80
|
| Rate for Payer: MEDICAID Medicaid |
$3,194.24
|
| Rate for Payer: MEDICARE Medicare |
$2,430.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,367.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,298.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,951.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,777.60
|
|
|
MR CHEST W CONTRAST
|
Facility
IP
|
$2,577.00
|
|
|
Service Code
|
CPT 71551 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,803.90 |
| Max. Negotiated Rate |
$2,577.00 |
| Rate for Payer: AETNA Commercial |
$2,448.15
|
| Rate for Payer: AETNA Medicare |
$2,319.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,448.15
|
| Rate for Payer: BCBS Healthlink |
$2,319.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,319.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,319.30
|
| Rate for Payer: BCBS POS |
$2,448.15
|
| Rate for Payer: BCBS Traditional |
$2,577.00
|
| Rate for Payer: CASH_PRICE |
$2,061.60
|
| Rate for Payer: CIGNA Commercial |
$2,448.15
|
| Rate for Payer: CIGNA Medicare |
$2,319.30
|
| Rate for Payer: HUMANA Commercial |
$2,319.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,370.84
|
| Rate for Payer: MEDICARE Medicare |
$1,803.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,448.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,499.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,448.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,448.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,190.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,061.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,061.60
|
|
|
MR CHEST W CONTRAST
|
Facility
OP
|
$2,577.00
|
|
|
Service Code
|
CPT 71551 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,803.90 |
| Max. Negotiated Rate |
$2,577.00 |
| Rate for Payer: AETNA Commercial |
$2,448.15
|
| Rate for Payer: AETNA Medicare |
$2,319.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,448.15
|
| Rate for Payer: BCBS Healthlink |
$2,319.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,319.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,319.30
|
| Rate for Payer: BCBS POS |
$2,448.15
|
| Rate for Payer: BCBS Traditional |
$2,577.00
|
| Rate for Payer: CASH_PRICE |
$2,061.60
|
| Rate for Payer: CIGNA Commercial |
$2,448.15
|
| Rate for Payer: CIGNA Medicare |
$2,319.30
|
| Rate for Payer: HUMANA Commercial |
$2,319.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,370.84
|
| Rate for Payer: MEDICARE Medicare |
$1,803.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,448.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,499.69
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,448.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,448.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,190.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,061.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,061.60
|
|
|
MR CHEST WO CONTRAST
|
Facility
IP
|
$2,276.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR CHEST WO CONTRAST
|
Facility
OP
|
$2,276.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR CHEST W WO CONTRAST
|
Facility
OP
|
$3,347.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,342.90 |
| Max. Negotiated Rate |
$3,347.00 |
| Rate for Payer: AETNA Commercial |
$3,179.65
|
| Rate for Payer: AETNA Medicare |
$3,012.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,179.65
|
| Rate for Payer: BCBS Healthlink |
$3,012.30
|
| Rate for Payer: BCBS HMK CHIP |
$3,012.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,012.30
|
| Rate for Payer: BCBS POS |
$3,179.65
|
| Rate for Payer: BCBS Traditional |
$3,347.00
|
| Rate for Payer: CASH_PRICE |
$2,677.60
|
| Rate for Payer: CIGNA Commercial |
$3,179.65
|
| Rate for Payer: CIGNA Medicare |
$3,012.30
|
| Rate for Payer: HUMANA Commercial |
$3,012.30
|
| Rate for Payer: MEDICAID Medicaid |
$3,079.24
|
| Rate for Payer: MEDICARE Medicare |
$2,342.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,179.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,246.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,179.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,179.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,844.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,677.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,677.60
|
|
|
MR CHEST W WO CONTRAST
|
Facility
IP
|
$3,347.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,342.90 |
| Max. Negotiated Rate |
$3,347.00 |
| Rate for Payer: AETNA Commercial |
$3,179.65
|
| Rate for Payer: AETNA Medicare |
$3,012.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,179.65
|
| Rate for Payer: BCBS Healthlink |
$3,012.30
|
| Rate for Payer: BCBS HMK CHIP |
$3,012.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,012.30
|
| Rate for Payer: BCBS POS |
$3,179.65
|
| Rate for Payer: BCBS Traditional |
$3,347.00
|
| Rate for Payer: CASH_PRICE |
$2,677.60
|
| Rate for Payer: CIGNA Commercial |
$3,179.65
|
| Rate for Payer: CIGNA Medicare |
$3,012.30
|
| Rate for Payer: HUMANA Commercial |
$3,012.30
|
| Rate for Payer: MEDICAID Medicaid |
$3,079.24
|
| Rate for Payer: MEDICARE Medicare |
$2,342.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,179.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,246.59
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,179.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,179.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,844.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,677.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,677.60
|
|
|
MR ELBOW LT W CONTRAST
|
Facility
OP
|
$2,556.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,789.20 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: AETNA Commercial |
$2,428.20
|
| Rate for Payer: AETNA Medicare |
$2,300.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,428.20
|
| Rate for Payer: BCBS Healthlink |
$2,300.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,300.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,300.40
|
| Rate for Payer: BCBS POS |
$2,428.20
|
| Rate for Payer: BCBS Traditional |
$2,556.00
|
| Rate for Payer: CASH_PRICE |
$2,044.80
|
| Rate for Payer: CIGNA Commercial |
$2,428.20
|
| Rate for Payer: CIGNA Medicare |
$2,300.40
|
| Rate for Payer: HUMANA Commercial |
$2,300.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,351.52
|
| Rate for Payer: MEDICARE Medicare |
$1,789.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,479.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,428.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,172.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,044.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,044.80
|
|
|
MR ELBOW LT W CONTRAST
|
Facility
IP
|
$2,556.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,789.20 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: AETNA Commercial |
$2,428.20
|
| Rate for Payer: AETNA Medicare |
$2,300.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,428.20
|
| Rate for Payer: BCBS Healthlink |
$2,300.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,300.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,300.40
|
| Rate for Payer: BCBS POS |
$2,428.20
|
| Rate for Payer: BCBS Traditional |
$2,556.00
|
| Rate for Payer: CASH_PRICE |
$2,044.80
|
| Rate for Payer: CIGNA Commercial |
$2,428.20
|
| Rate for Payer: CIGNA Medicare |
$2,300.40
|
| Rate for Payer: HUMANA Commercial |
$2,300.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,351.52
|
| Rate for Payer: MEDICARE Medicare |
$1,789.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,479.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,428.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,172.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,044.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,044.80
|
|
|
MR ELBOW LT WO CONTRAST
|
Facility
OP
|
$2,249.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,574.30 |
| Max. Negotiated Rate |
$2,249.00 |
| Rate for Payer: AETNA Commercial |
$2,136.55
|
| Rate for Payer: AETNA Medicare |
$2,024.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,136.55
|
| Rate for Payer: BCBS Healthlink |
$2,024.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,024.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,024.10
|
| Rate for Payer: BCBS POS |
$2,136.55
|
| Rate for Payer: BCBS Traditional |
$2,249.00
|
| Rate for Payer: CASH_PRICE |
$1,799.20
|
| Rate for Payer: CIGNA Commercial |
$2,136.55
|
| Rate for Payer: CIGNA Medicare |
$2,024.10
|
| Rate for Payer: HUMANA Commercial |
$2,024.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,069.08
|
| Rate for Payer: MEDICARE Medicare |
$1,574.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,181.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,136.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,911.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,799.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,799.20
|
|
|
MR ELBOW LT WO CONTRAST
|
Facility
IP
|
$2,249.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,574.30 |
| Max. Negotiated Rate |
$2,249.00 |
| Rate for Payer: AETNA Commercial |
$2,136.55
|
| Rate for Payer: AETNA Medicare |
$2,024.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,136.55
|
| Rate for Payer: BCBS Healthlink |
$2,024.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,024.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,024.10
|
| Rate for Payer: BCBS POS |
$2,136.55
|
| Rate for Payer: BCBS Traditional |
$2,249.00
|
| Rate for Payer: CASH_PRICE |
$1,799.20
|
| Rate for Payer: CIGNA Commercial |
$2,136.55
|
| Rate for Payer: CIGNA Medicare |
$2,024.10
|
| Rate for Payer: HUMANA Commercial |
$2,024.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,069.08
|
| Rate for Payer: MEDICARE Medicare |
$1,574.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,181.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,136.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,911.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,799.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,799.20
|
|
|
MR ELBOW LT W WO CONTRAST
|
Facility
OP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,243.50 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: AETNA Commercial |
$3,044.75
|
| Rate for Payer: AETNA Medicare |
$2,884.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,044.75
|
| Rate for Payer: BCBS Healthlink |
$2,884.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,884.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,884.50
|
| Rate for Payer: BCBS POS |
$3,044.75
|
| Rate for Payer: BCBS Traditional |
$3,205.00
|
| Rate for Payer: CASH_PRICE |
$2,564.00
|
| Rate for Payer: CIGNA Commercial |
$3,044.75
|
| Rate for Payer: CIGNA Medicare |
$2,884.50
|
| Rate for Payer: HUMANA Commercial |
$2,884.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,948.60
|
| Rate for Payer: MEDICARE Medicare |
$2,243.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,108.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,044.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,724.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,564.00
|
|
|
MR ELBOW LT W WO CONTRAST
|
Facility
IP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,243.50 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: AETNA Commercial |
$3,044.75
|
| Rate for Payer: AETNA Medicare |
$2,884.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,044.75
|
| Rate for Payer: BCBS Healthlink |
$2,884.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,884.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,884.50
|
| Rate for Payer: BCBS POS |
$3,044.75
|
| Rate for Payer: BCBS Traditional |
$3,205.00
|
| Rate for Payer: CASH_PRICE |
$2,564.00
|
| Rate for Payer: CIGNA Commercial |
$3,044.75
|
| Rate for Payer: CIGNA Medicare |
$2,884.50
|
| Rate for Payer: HUMANA Commercial |
$2,884.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,948.60
|
| Rate for Payer: MEDICARE Medicare |
$2,243.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,108.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,044.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,724.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,564.00
|
|
|
MR ELBOW RT W CONTRAST
|
Facility
OP
|
$2,556.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,789.20 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: AETNA Commercial |
$2,428.20
|
| Rate for Payer: AETNA Medicare |
$2,300.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,428.20
|
| Rate for Payer: BCBS Healthlink |
$2,300.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,300.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,300.40
|
| Rate for Payer: BCBS POS |
$2,428.20
|
| Rate for Payer: BCBS Traditional |
$2,556.00
|
| Rate for Payer: CASH_PRICE |
$2,044.80
|
| Rate for Payer: CIGNA Commercial |
$2,428.20
|
| Rate for Payer: CIGNA Medicare |
$2,300.40
|
| Rate for Payer: HUMANA Commercial |
$2,300.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,351.52
|
| Rate for Payer: MEDICARE Medicare |
$1,789.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,479.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,428.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,172.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,044.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,044.80
|
|
|
MR ELBOW RT W CONTRAST
|
Facility
IP
|
$2,556.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,789.20 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: AETNA Commercial |
$2,428.20
|
| Rate for Payer: AETNA Medicare |
$2,300.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,428.20
|
| Rate for Payer: BCBS Healthlink |
$2,300.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,300.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,300.40
|
| Rate for Payer: BCBS POS |
$2,428.20
|
| Rate for Payer: BCBS Traditional |
$2,556.00
|
| Rate for Payer: CASH_PRICE |
$2,044.80
|
| Rate for Payer: CIGNA Commercial |
$2,428.20
|
| Rate for Payer: CIGNA Medicare |
$2,300.40
|
| Rate for Payer: HUMANA Commercial |
$2,300.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,351.52
|
| Rate for Payer: MEDICARE Medicare |
$1,789.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,479.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,428.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,172.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,044.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,044.80
|
|
|
MR ELBOW RT WO CONTRAST
|
Facility
IP
|
$2,249.00
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,574.30 |
| Max. Negotiated Rate |
$2,249.00 |
| Rate for Payer: AETNA Commercial |
$2,136.55
|
| Rate for Payer: AETNA Medicare |
$2,024.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,136.55
|
| Rate for Payer: BCBS Healthlink |
$2,024.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,024.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,024.10
|
| Rate for Payer: BCBS POS |
$2,136.55
|
| Rate for Payer: BCBS Traditional |
$2,249.00
|
| Rate for Payer: CASH_PRICE |
$1,799.20
|
| Rate for Payer: CIGNA Commercial |
$2,136.55
|
| Rate for Payer: CIGNA Medicare |
$2,024.10
|
| Rate for Payer: HUMANA Commercial |
$2,024.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,069.08
|
| Rate for Payer: MEDICARE Medicare |
$1,574.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,181.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,136.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,911.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,799.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,799.20
|
|
|
MR ELBOW RT WO CONTRAST
|
Facility
OP
|
$2,249.00
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,574.30 |
| Max. Negotiated Rate |
$2,249.00 |
| Rate for Payer: AETNA Commercial |
$2,136.55
|
| Rate for Payer: AETNA Medicare |
$2,024.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,136.55
|
| Rate for Payer: BCBS Healthlink |
$2,024.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,024.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,024.10
|
| Rate for Payer: BCBS POS |
$2,136.55
|
| Rate for Payer: BCBS Traditional |
$2,249.00
|
| Rate for Payer: CASH_PRICE |
$1,799.20
|
| Rate for Payer: CIGNA Commercial |
$2,136.55
|
| Rate for Payer: CIGNA Medicare |
$2,024.10
|
| Rate for Payer: HUMANA Commercial |
$2,024.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,069.08
|
| Rate for Payer: MEDICARE Medicare |
$1,574.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,181.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,136.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,911.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,799.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,799.20
|
|
