|
MR ELBOW RT W WO CONTRAST
|
Facility
IP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 RT
|
| 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 WO CONTRAST
|
Facility
OP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 RT
|
| 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 FEMUR LT W CONTRAST
|
Facility
OP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FEMUR LT W CONTRAST
|
Facility
IP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FEMUR LT WO CONTRAST
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FEMUR LT WO CONTRAST
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FEMUR LT W WO CONTRAST
|
Facility
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR FEMUR LT W WO CONTRAST
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR FEMUR RT W CONTRAST
|
Facility
OP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FEMUR RT W CONTRAST
|
Facility
IP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FEMUR RT WO CONTRAST
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FEMUR RT WO CONTRAST
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FEMUR RT W WO CONTRAST
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR FEMUR RT W WO CONTRAST
|
Facility
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR FOOT LT W CONTRAST
|
Facility
OP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FOOT LT W CONTRAST
|
Facility
IP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FOOT LT WO CONTRAST
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FOOT LT WO CONTRAST
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FOOT LT W WO CONTRAST
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR FOOT LT W WO CONTRAST
|
Facility
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR FOOT RT W CONTRAST
|
Facility
OP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FOOT RT W CONTRAST
|
Facility
IP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR FOOT RT WO CONTRAST
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FOOT RT WO CONTRAST
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR FOOT RT W WO CONTRAST
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
