|
MRI DOTAREM 20ML CONTRAST BOTTLE
|
Facility
IP
|
$218.00
|
|
|
Service Code
|
CPT A9575
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.60 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: AETNA Commercial |
$207.10
|
| Rate for Payer: AETNA Medicare |
$196.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$207.10
|
| Rate for Payer: BCBS Healthlink |
$196.20
|
| Rate for Payer: BCBS HMK CHIP |
$196.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$196.20
|
| Rate for Payer: BCBS POS |
$207.10
|
| Rate for Payer: BCBS Traditional |
$218.00
|
| Rate for Payer: CASH_PRICE |
$174.40
|
| Rate for Payer: CIGNA Commercial |
$207.10
|
| Rate for Payer: CIGNA Medicare |
$196.20
|
| Rate for Payer: HUMANA Commercial |
$196.20
|
| Rate for Payer: MEDICAID Medicaid |
$200.56
|
| Rate for Payer: MEDICARE Medicare |
$152.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$207.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$211.46
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$207.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$207.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$185.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$174.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$174.40
|
|
|
MR JNT LWR EXT W CON LT
|
Facility
IP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR JNT LWR EXT W CON LT
|
Facility
OP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR JNT LWR EXT W CON RT
|
Facility
IP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR JNT LWR EXT W CON RT
|
Facility
OP
|
$2,571.00
|
|
|
Service Code
|
CPT 73722 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,799.70 |
| Max. Negotiated Rate |
$2,571.00 |
| Rate for Payer: AETNA Commercial |
$2,442.45
|
| Rate for Payer: AETNA Medicare |
$2,313.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,442.45
|
| Rate for Payer: BCBS Healthlink |
$2,313.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,313.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,313.90
|
| Rate for Payer: BCBS POS |
$2,442.45
|
| Rate for Payer: BCBS Traditional |
$2,571.00
|
| Rate for Payer: CASH_PRICE |
$2,056.80
|
| Rate for Payer: CIGNA Commercial |
$2,442.45
|
| Rate for Payer: CIGNA Medicare |
$2,313.90
|
| Rate for Payer: HUMANA Commercial |
$2,313.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,365.32
|
| Rate for Payer: MEDICARE Medicare |
$1,799.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,493.87
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,442.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,442.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,185.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,056.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,056.80
|
|
|
MR JNT LWR EXT W/O CON LT
|
Facility
IP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| 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 - 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 JNT LWR EXT W/O CON LT
|
Facility
OP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
610
|
| 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 JNT LWR XT WO CON RT
|
Facility
OP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
610
|
| 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 JNT LWR XT WO CON RT
|
Facility
IP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
610
|
| 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 JNT LWR XT WO&W CON L
|
Facility
IP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR JNT LWR XT WO&W CON L
|
Facility
OP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR JNT LWR XT WO&W CON R
|
Facility
IP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR JNT LWR XT WO&W CON R
|
Facility
OP
|
$3,281.00
|
|
|
Service Code
|
CPT 73723 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: AETNA Commercial |
$3,116.95
|
| Rate for Payer: AETNA Medicare |
$2,952.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,116.95
|
| Rate for Payer: BCBS Healthlink |
$2,952.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,952.90
|
| Rate for Payer: BCBS POS |
$3,116.95
|
| Rate for Payer: BCBS Traditional |
$3,281.00
|
| Rate for Payer: CASH_PRICE |
$2,624.80
|
| Rate for Payer: CIGNA Commercial |
$3,116.95
|
| Rate for Payer: CIGNA Medicare |
$2,952.90
|
| Rate for Payer: HUMANA Commercial |
$2,952.90
|
| Rate for Payer: MEDICAID Medicaid |
$3,018.52
|
| Rate for Payer: MEDICARE Medicare |
$2,296.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,182.57
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,116.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,116.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,788.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,624.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,624.80
|
|
|
MR JNT UPPR EXT W CON LT
|
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: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| 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 - 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 JNT UPPR EXT W CON LT
|
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 JNT UPPR EXT W CON RT
|
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 JNT UPPR EXT W CON RT
|
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 JNT UPPR EXT WO CO LT
|
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 JNT UPPR EXT WO CO LT
|
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 JNT UPPR EXT WO CON R
|
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 JNT UPPR EXT WO CON R
|
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
|
|
|
MR JNT UPPR EXT WO&W CN LT
|
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 JNT UPPR EXT WO&W CN LT
|
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 JNT UPPR EXT WO&W CN RT
|
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 JNT UPPR EXT WO&W CN RT
|
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
|
|
