|
MR FOOT 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: BCBS HMK CHIP |
$2,850.30
|
| 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 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 FOREARM LT W CONTRAST
|
Facility
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR FOREARM LT W CONTRAST
|
Facility
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR FOREARM LT WO CONTRAST
|
Facility
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR FOREARM LT WO CONTRAST
|
Facility
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR FOREARM LT W WO CONTRAST
|
Facility
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR FOREARM LT W WO CONTRAST
|
Facility
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR FOREARM RT W CONTRAST
|
Facility
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR FOREARM RT W CONTRAST
|
Facility
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR FOREARM RT WO CONTRAST
|
Facility
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR FOREARM RT WO CONTRAST
|
Facility
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR FOREARM RT W WO CONTRAST
|
Facility
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR FOREARM RT W WO CONTRAST
|
Facility
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR HAND LT W CONTRAST
|
Facility
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR HAND LT W CONTRAST
|
Facility
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR HAND LT WO CONTRAST
|
Facility
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR HAND LT WO CONTRAST
|
Facility
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR HAND LT W WO CONTRAST
|
Facility
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR HAND LT W WO CONTRAST
|
Facility
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR HAND RT W CONTRAST
|
Facility
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR HAND RT W CONTRAST
|
Facility
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR HAND RT WO CONTRAST
|
Facility
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR HAND RT WO CONTRAST
|
Facility
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR HAND RT W WO CONTRAST
|
Facility
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR HAND RT W WO CONTRAST
|
Facility
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
