|
MR KNEE LT W CONTRAST
|
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 KNEE LT W CONTRAST
|
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 KNEE LT WO CONTRAST
|
Facility
IP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR KNEE LT WO CONTRAST
|
Facility
OP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR KNEE LT W WO CONTRAST
|
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 KNEE LT W WO CONTRAST
|
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: 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 KNEE RT W CONTRAST
|
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 KNEE RT W CONTRAST
|
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 KNEE RT WO CONTRAST
|
Facility
IP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR KNEE RT WO CONTRAST
|
Facility
OP
|
$2,276.00
|
|
|
Service Code
|
CPT 73721 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,593.20 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: AETNA Commercial |
$2,162.20
|
| Rate for Payer: AETNA Medicare |
$2,048.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,162.20
|
| Rate for Payer: BCBS Healthlink |
$2,048.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,048.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,048.40
|
| Rate for Payer: BCBS POS |
$2,162.20
|
| Rate for Payer: BCBS Traditional |
$2,276.00
|
| Rate for Payer: CASH_PRICE |
$1,820.80
|
| Rate for Payer: CIGNA Commercial |
$2,162.20
|
| Rate for Payer: CIGNA Medicare |
$2,048.40
|
| Rate for Payer: HUMANA Commercial |
$2,048.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,093.92
|
| Rate for Payer: MEDICARE Medicare |
$1,593.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,207.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,162.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,162.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,934.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,820.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,820.80
|
|
|
MR KNEE RT W WO CONTRAST
|
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 KNEE RT W WO CONTRAST
|
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 LUMBAR SPINE W CONTRAST
|
Facility
OP
|
$2,757.00
|
|
|
Service Code
|
CPT 72149 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,929.90 |
| Max. Negotiated Rate |
$2,757.00 |
| Rate for Payer: AETNA Commercial |
$2,619.15
|
| Rate for Payer: AETNA Medicare |
$2,481.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,619.15
|
| Rate for Payer: BCBS Healthlink |
$2,481.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,481.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,481.30
|
| Rate for Payer: BCBS POS |
$2,619.15
|
| Rate for Payer: BCBS Traditional |
$2,757.00
|
| Rate for Payer: CASH_PRICE |
$2,205.60
|
| Rate for Payer: CIGNA Commercial |
$2,619.15
|
| Rate for Payer: CIGNA Medicare |
$2,481.30
|
| Rate for Payer: HUMANA Commercial |
$2,481.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,536.44
|
| Rate for Payer: MEDICARE Medicare |
$1,929.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,619.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,674.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,619.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,619.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,343.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,205.60
|
|
|
MR LUMBAR SPINE W CONTRAST
|
Facility
IP
|
$2,757.00
|
|
|
Service Code
|
CPT 72149 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,929.90 |
| Max. Negotiated Rate |
$2,757.00 |
| Rate for Payer: AETNA Commercial |
$2,619.15
|
| Rate for Payer: AETNA Medicare |
$2,481.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,619.15
|
| Rate for Payer: BCBS Healthlink |
$2,481.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,481.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,481.30
|
| Rate for Payer: BCBS POS |
$2,619.15
|
| Rate for Payer: BCBS Traditional |
$2,757.00
|
| Rate for Payer: CASH_PRICE |
$2,205.60
|
| Rate for Payer: CIGNA Commercial |
$2,619.15
|
| Rate for Payer: CIGNA Medicare |
$2,481.30
|
| Rate for Payer: HUMANA Commercial |
$2,481.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,536.44
|
| Rate for Payer: MEDICARE Medicare |
$1,929.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,619.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,674.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,619.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,619.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,343.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,205.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,205.60
|
|
|
MR LUMBAR SPINE WO CONTRAST
|
Facility
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,662.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: AETNA Commercial |
$2,256.25
|
| Rate for Payer: AETNA Medicare |
$2,137.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,256.25
|
| Rate for Payer: BCBS Healthlink |
$2,137.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,137.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,137.50
|
| Rate for Payer: BCBS POS |
$2,256.25
|
| Rate for Payer: BCBS Traditional |
$2,375.00
|
| Rate for Payer: CASH_PRICE |
$1,900.00
|
| Rate for Payer: CIGNA Commercial |
$2,256.25
|
| Rate for Payer: CIGNA Medicare |
$2,137.50
|
| Rate for Payer: HUMANA Commercial |
$2,137.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,185.00
|
| Rate for Payer: MEDICARE Medicare |
$1,662.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,303.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,256.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,018.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,900.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,900.00
|
|
|
MR LUMBAR SPINE WO CONTRAST
|
Facility
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,662.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: AETNA Commercial |
$2,256.25
|
| Rate for Payer: AETNA Medicare |
$2,137.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,256.25
|
| Rate for Payer: BCBS Healthlink |
$2,137.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,137.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,137.50
|
| Rate for Payer: BCBS POS |
$2,256.25
|
| Rate for Payer: BCBS Traditional |
$2,375.00
|
| Rate for Payer: CASH_PRICE |
$1,900.00
|
| Rate for Payer: CIGNA Commercial |
$2,256.25
|
| Rate for Payer: CIGNA Medicare |
$2,137.50
|
| Rate for Payer: HUMANA Commercial |
$2,137.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,185.00
|
| Rate for Payer: MEDICARE Medicare |
$1,662.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,303.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,256.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,256.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,018.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,900.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,900.00
|
|
|
MR LUMBAR SPINE W WO CONTRAST
|
Facility
OP
|
$3,472.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,430.40 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: AETNA Commercial |
$3,298.40
|
| Rate for Payer: AETNA Medicare |
$3,124.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,298.40
|
| Rate for Payer: BCBS Healthlink |
$3,124.80
|
| Rate for Payer: BCBS HMK CHIP |
$3,124.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,124.80
|
| Rate for Payer: BCBS POS |
$3,298.40
|
| Rate for Payer: BCBS Traditional |
$3,472.00
|
| Rate for Payer: CASH_PRICE |
$2,777.60
|
| Rate for Payer: CIGNA Commercial |
$3,298.40
|
| Rate for Payer: CIGNA Medicare |
$3,124.80
|
| Rate for Payer: HUMANA Commercial |
$3,124.80
|
| Rate for Payer: MEDICAID Medicaid |
$3,194.24
|
| Rate for Payer: MEDICARE Medicare |
$2,430.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,367.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,298.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,951.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,777.60
|
|
|
MR LUMBAR SPINE W WO CONTRAST
|
Facility
IP
|
$3,472.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,430.40 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: AETNA Commercial |
$3,298.40
|
| Rate for Payer: AETNA Medicare |
$3,124.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,298.40
|
| Rate for Payer: BCBS Healthlink |
$3,124.80
|
| Rate for Payer: BCBS HMK CHIP |
$3,124.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$3,124.80
|
| Rate for Payer: BCBS POS |
$3,298.40
|
| Rate for Payer: BCBS Traditional |
$3,472.00
|
| Rate for Payer: CASH_PRICE |
$2,777.60
|
| Rate for Payer: CIGNA Commercial |
$3,298.40
|
| Rate for Payer: CIGNA Medicare |
$3,124.80
|
| Rate for Payer: HUMANA Commercial |
$3,124.80
|
| Rate for Payer: MEDICAID Medicaid |
$3,194.24
|
| Rate for Payer: MEDICARE Medicare |
$2,430.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,367.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,298.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,298.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,951.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,777.60
|
|
|
MR LWR EXT W CON LT
|
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 LWR EXT W CON LT
|
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 LWR EXT W CON RT
|
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 LWR EXT W CON RT
|
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 LWR XT WO CON LT
|
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 LWR XT WO CON LT
|
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 LWR XT WO CON RT
|
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
|
|
