|
MR LWR XT WO CON RT
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR LWR XT WO&W CON LT
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR LWR XT WO&W CON LT
|
Facility
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR LWR XT WO&W CON RT
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR LWR XT WO&W CON RT
|
Facility
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR ORBIT FACE NECK W CONTRAST
|
Facility
IP
|
$2,501.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,750.70 |
| Max. Negotiated Rate |
$2,501.00 |
| Rate for Payer: AETNA Commercial |
$2,375.95
|
| Rate for Payer: AETNA Medicare |
$2,250.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,375.95
|
| Rate for Payer: BCBS Healthlink |
$2,250.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,250.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,250.90
|
| Rate for Payer: BCBS POS |
$2,375.95
|
| Rate for Payer: BCBS Traditional |
$2,501.00
|
| Rate for Payer: CASH_PRICE |
$2,000.80
|
| Rate for Payer: CIGNA Commercial |
$2,375.95
|
| Rate for Payer: CIGNA Medicare |
$2,250.90
|
| Rate for Payer: HUMANA Commercial |
$2,250.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,300.92
|
| Rate for Payer: MEDICARE Medicare |
$1,750.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,375.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,425.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,375.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,375.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,125.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,000.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,000.80
|
|
|
MR ORBIT FACE NECK W CONTRAST
|
Facility
OP
|
$2,501.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,750.70 |
| Max. Negotiated Rate |
$2,501.00 |
| Rate for Payer: AETNA Commercial |
$2,375.95
|
| Rate for Payer: AETNA Medicare |
$2,250.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,375.95
|
| Rate for Payer: BCBS Healthlink |
$2,250.90
|
| Rate for Payer: BCBS HMK CHIP |
$2,250.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,250.90
|
| Rate for Payer: BCBS POS |
$2,375.95
|
| Rate for Payer: BCBS Traditional |
$2,501.00
|
| Rate for Payer: CASH_PRICE |
$2,000.80
|
| Rate for Payer: CIGNA Commercial |
$2,375.95
|
| Rate for Payer: CIGNA Medicare |
$2,250.90
|
| Rate for Payer: HUMANA Commercial |
$2,250.90
|
| Rate for Payer: MEDICAID Medicaid |
$2,300.92
|
| Rate for Payer: MEDICARE Medicare |
$1,750.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,375.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,425.97
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,375.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,375.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,125.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,000.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,000.80
|
|
|
MR ORBIT FACE NECK WO CONTRAST
|
Facility
OP
|
$2,298.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,608.60 |
| Max. Negotiated Rate |
$2,298.00 |
| Rate for Payer: AETNA Commercial |
$2,183.10
|
| Rate for Payer: AETNA Medicare |
$2,068.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,183.10
|
| Rate for Payer: BCBS Healthlink |
$2,068.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,068.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,068.20
|
| Rate for Payer: BCBS POS |
$2,183.10
|
| Rate for Payer: BCBS Traditional |
$2,298.00
|
| Rate for Payer: CASH_PRICE |
$1,838.40
|
| Rate for Payer: CIGNA Commercial |
$2,183.10
|
| Rate for Payer: CIGNA Medicare |
$2,068.20
|
| Rate for Payer: HUMANA Commercial |
$2,068.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,114.16
|
| Rate for Payer: MEDICARE Medicare |
$1,608.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,183.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,229.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,183.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,183.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,953.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,838.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,838.40
|
|
|
MR ORBIT FACE NECK WO CONTRAST
|
Facility
IP
|
$2,298.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,608.60 |
| Max. Negotiated Rate |
$2,298.00 |
| Rate for Payer: AETNA Commercial |
$2,183.10
|
| Rate for Payer: AETNA Medicare |
$2,068.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,183.10
|
| Rate for Payer: BCBS Healthlink |
$2,068.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,068.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,068.20
|
| Rate for Payer: BCBS POS |
$2,183.10
|
| Rate for Payer: BCBS Traditional |
$2,298.00
|
| Rate for Payer: CASH_PRICE |
$1,838.40
|
| Rate for Payer: CIGNA Commercial |
$2,183.10
|
| Rate for Payer: CIGNA Medicare |
$2,068.20
|
| Rate for Payer: HUMANA Commercial |
$2,068.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,114.16
|
| Rate for Payer: MEDICARE Medicare |
$1,608.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,183.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,229.06
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,183.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,183.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,953.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,838.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,838.40
|
|
|
MR ORBIT FACE NECK W WO CONTRAST
|
Facility
OP
|
$3,281.00
|
|
|
Service Code
|
CPT 70543 TC
|
| 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 ORBIT FACE NECK W WO CONTRAST
|
Facility
IP
|
$3,281.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,296.70 |
| Max. Negotiated Rate |
$3,281.00 |
| Rate for Payer: BCBS HMK CHIP |
$2,952.90
|
| 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 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 PELVIS W CONTRAST
|
Facility
IP
|
$2,544.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,780.80 |
| Max. Negotiated Rate |
$2,544.00 |
| Rate for Payer: AETNA Commercial |
$2,416.80
|
| Rate for Payer: AETNA Medicare |
$2,289.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,416.80
|
| Rate for Payer: BCBS Healthlink |
$2,289.60
|
| Rate for Payer: BCBS HMK CHIP |
$2,289.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,289.60
|
| Rate for Payer: BCBS POS |
$2,416.80
|
| Rate for Payer: BCBS Traditional |
$2,544.00
|
| Rate for Payer: CASH_PRICE |
$2,035.20
|
| Rate for Payer: CIGNA Commercial |
$2,416.80
|
| Rate for Payer: CIGNA Medicare |
$2,289.60
|
| Rate for Payer: HUMANA Commercial |
$2,289.60
|
| Rate for Payer: MEDICAID Medicaid |
$2,340.48
|
| Rate for Payer: MEDICARE Medicare |
$1,780.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,416.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,467.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,416.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,416.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,162.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,035.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,035.20
|
|
|
MR PELVIS W CONTRAST
|
Facility
OP
|
$2,544.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,780.80 |
| Max. Negotiated Rate |
$2,544.00 |
| Rate for Payer: AETNA Commercial |
$2,416.80
|
| Rate for Payer: AETNA Medicare |
$2,289.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,416.80
|
| Rate for Payer: BCBS Healthlink |
$2,289.60
|
| Rate for Payer: BCBS HMK CHIP |
$2,289.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,289.60
|
| Rate for Payer: BCBS POS |
$2,416.80
|
| Rate for Payer: BCBS Traditional |
$2,544.00
|
| Rate for Payer: CASH_PRICE |
$2,035.20
|
| Rate for Payer: CIGNA Commercial |
$2,416.80
|
| Rate for Payer: CIGNA Medicare |
$2,289.60
|
| Rate for Payer: HUMANA Commercial |
$2,289.60
|
| Rate for Payer: MEDICAID Medicaid |
$2,340.48
|
| Rate for Payer: MEDICARE Medicare |
$1,780.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,416.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,467.68
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,416.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,416.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,162.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,035.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,035.20
|
|
|
MR PELVIS WO CONTRAST
|
Facility
IP
|
$2,288.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,601.60 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: AETNA Commercial |
$2,173.60
|
| Rate for Payer: AETNA Medicare |
$2,059.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,173.60
|
| Rate for Payer: BCBS Healthlink |
$2,059.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,059.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,059.20
|
| Rate for Payer: BCBS POS |
$2,173.60
|
| Rate for Payer: BCBS Traditional |
$2,288.00
|
| Rate for Payer: CASH_PRICE |
$1,830.40
|
| Rate for Payer: CIGNA Commercial |
$2,173.60
|
| Rate for Payer: CIGNA Medicare |
$2,059.20
|
| Rate for Payer: HUMANA Commercial |
$2,059.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,104.96
|
| Rate for Payer: MEDICARE Medicare |
$1,601.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,219.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,173.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,944.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,830.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,830.40
|
|
|
MR PELVIS WO CONTRAST
|
Facility
OP
|
$2,288.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,601.60 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: AETNA Commercial |
$2,173.60
|
| Rate for Payer: AETNA Medicare |
$2,059.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,173.60
|
| Rate for Payer: BCBS Healthlink |
$2,059.20
|
| Rate for Payer: BCBS HMK CHIP |
$2,059.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,059.20
|
| Rate for Payer: BCBS POS |
$2,173.60
|
| Rate for Payer: BCBS Traditional |
$2,288.00
|
| Rate for Payer: CASH_PRICE |
$1,830.40
|
| Rate for Payer: CIGNA Commercial |
$2,173.60
|
| Rate for Payer: CIGNA Medicare |
$2,059.20
|
| Rate for Payer: HUMANA Commercial |
$2,059.20
|
| Rate for Payer: MEDICAID Medicaid |
$2,104.96
|
| Rate for Payer: MEDICARE Medicare |
$1,601.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,219.36
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,173.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,173.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,944.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,830.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,830.40
|
|
|
MR PELVIS W WO CONTRAST
|
Facility
IP
|
$3,232.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$3,232.00 |
| Rate for Payer: AETNA Commercial |
$3,070.40
|
| Rate for Payer: AETNA Medicare |
$2,908.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,070.40
|
| Rate for Payer: BCBS Healthlink |
$2,908.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,908.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,908.80
|
| Rate for Payer: BCBS POS |
$3,070.40
|
| Rate for Payer: BCBS Traditional |
$3,232.00
|
| Rate for Payer: CASH_PRICE |
$2,585.60
|
| Rate for Payer: CIGNA Commercial |
$3,070.40
|
| Rate for Payer: CIGNA Medicare |
$2,908.80
|
| Rate for Payer: HUMANA Commercial |
$2,908.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,973.44
|
| Rate for Payer: MEDICARE Medicare |
$2,262.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,070.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,135.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,070.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,070.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,747.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,585.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,585.60
|
|
|
MR PELVIS W WO CONTRAST
|
Facility
OP
|
$3,232.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$3,232.00 |
| Rate for Payer: AETNA Commercial |
$3,070.40
|
| Rate for Payer: AETNA Medicare |
$2,908.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,070.40
|
| Rate for Payer: BCBS Healthlink |
$2,908.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,908.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,908.80
|
| Rate for Payer: BCBS POS |
$3,070.40
|
| Rate for Payer: BCBS Traditional |
$3,232.00
|
| Rate for Payer: CASH_PRICE |
$2,585.60
|
| Rate for Payer: CIGNA Commercial |
$3,070.40
|
| Rate for Payer: CIGNA Medicare |
$2,908.80
|
| Rate for Payer: HUMANA Commercial |
$2,908.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,973.44
|
| Rate for Payer: MEDICARE Medicare |
$2,262.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,070.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,135.04
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,070.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,070.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,747.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,585.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,585.60
|
|
|
MRSA, NAA (182956)
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: AETNA Commercial |
$174.80
|
| Rate for Payer: AETNA Medicare |
$165.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$174.80
|
| Rate for Payer: BCBS Healthlink |
$165.60
|
| Rate for Payer: BCBS HMK CHIP |
$165.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$165.60
|
| Rate for Payer: BCBS POS |
$174.80
|
| Rate for Payer: BCBS Traditional |
$184.00
|
| Rate for Payer: CASH_PRICE |
$147.20
|
| Rate for Payer: CIGNA Commercial |
$174.80
|
| Rate for Payer: CIGNA Medicare |
$165.60
|
| Rate for Payer: HUMANA Commercial |
$165.60
|
| Rate for Payer: MEDICAID Medicaid |
$169.28
|
| Rate for Payer: MEDICARE Medicare |
$128.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$174.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$178.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$174.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$174.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$156.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$147.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$147.20
|
|
|
MRSA, NAA (182956)
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: AETNA Commercial |
$174.80
|
| Rate for Payer: AETNA Medicare |
$165.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$174.80
|
| Rate for Payer: BCBS Healthlink |
$165.60
|
| Rate for Payer: BCBS HMK CHIP |
$165.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$165.60
|
| Rate for Payer: BCBS POS |
$174.80
|
| Rate for Payer: BCBS Traditional |
$184.00
|
| Rate for Payer: CASH_PRICE |
$147.20
|
| Rate for Payer: CIGNA Commercial |
$174.80
|
| Rate for Payer: CIGNA Medicare |
$165.60
|
| Rate for Payer: HUMANA Commercial |
$165.60
|
| Rate for Payer: MEDICAID Medicaid |
$169.28
|
| Rate for Payer: MEDICARE Medicare |
$128.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$174.80
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$178.48
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$174.80
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$174.80
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$156.40
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$147.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$147.20
|
|
|
MR SHOULDER LT W CONTRAST
|
Facility
IP
|
$2,556.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,789.20 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: AETNA Commercial |
$2,428.20
|
| Rate for Payer: AETNA Medicare |
$2,300.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,428.20
|
| Rate for Payer: BCBS Healthlink |
$2,300.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,300.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,300.40
|
| Rate for Payer: BCBS POS |
$2,428.20
|
| Rate for Payer: BCBS Traditional |
$2,556.00
|
| Rate for Payer: CASH_PRICE |
$2,044.80
|
| Rate for Payer: CIGNA Commercial |
$2,428.20
|
| Rate for Payer: CIGNA Medicare |
$2,300.40
|
| Rate for Payer: HUMANA Commercial |
$2,300.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,351.52
|
| Rate for Payer: MEDICARE Medicare |
$1,789.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,479.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,428.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,172.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,044.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,044.80
|
|
|
MR SHOULDER LT W CONTRAST
|
Facility
OP
|
$2,556.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,789.20 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: AETNA Commercial |
$2,428.20
|
| Rate for Payer: AETNA Medicare |
$2,300.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,428.20
|
| Rate for Payer: BCBS Healthlink |
$2,300.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,300.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,300.40
|
| Rate for Payer: BCBS POS |
$2,428.20
|
| Rate for Payer: BCBS Traditional |
$2,556.00
|
| Rate for Payer: CASH_PRICE |
$2,044.80
|
| Rate for Payer: CIGNA Commercial |
$2,428.20
|
| Rate for Payer: CIGNA Medicare |
$2,300.40
|
| Rate for Payer: HUMANA Commercial |
$2,300.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,351.52
|
| Rate for Payer: MEDICARE Medicare |
$1,789.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,479.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,428.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,172.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,044.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,044.80
|
|
|
MR SHOULDER LT WO CONTRAST
|
Facility
IP
|
$2,249.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,574.30 |
| Max. Negotiated Rate |
$2,249.00 |
| Rate for Payer: AETNA Commercial |
$2,136.55
|
| Rate for Payer: AETNA Medicare |
$2,024.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,136.55
|
| Rate for Payer: BCBS Healthlink |
$2,024.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,024.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,024.10
|
| Rate for Payer: BCBS POS |
$2,136.55
|
| Rate for Payer: BCBS Traditional |
$2,249.00
|
| Rate for Payer: CASH_PRICE |
$1,799.20
|
| Rate for Payer: CIGNA Commercial |
$2,136.55
|
| Rate for Payer: CIGNA Medicare |
$2,024.10
|
| Rate for Payer: HUMANA Commercial |
$2,024.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,069.08
|
| Rate for Payer: MEDICARE Medicare |
$1,574.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,181.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,136.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,911.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,799.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,799.20
|
|
|
MR SHOULDER LT WO CONTRAST
|
Facility
OP
|
$2,249.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,574.30 |
| Max. Negotiated Rate |
$2,249.00 |
| Rate for Payer: AETNA Commercial |
$2,136.55
|
| Rate for Payer: AETNA Medicare |
$2,024.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,136.55
|
| Rate for Payer: BCBS Healthlink |
$2,024.10
|
| Rate for Payer: BCBS HMK CHIP |
$2,024.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,024.10
|
| Rate for Payer: BCBS POS |
$2,136.55
|
| Rate for Payer: BCBS Traditional |
$2,249.00
|
| Rate for Payer: CASH_PRICE |
$1,799.20
|
| Rate for Payer: CIGNA Commercial |
$2,136.55
|
| Rate for Payer: CIGNA Medicare |
$2,024.10
|
| Rate for Payer: HUMANA Commercial |
$2,024.10
|
| Rate for Payer: MEDICAID Medicaid |
$2,069.08
|
| Rate for Payer: MEDICARE Medicare |
$1,574.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,181.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,136.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,136.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,911.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,799.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,799.20
|
|
|
MR SHOULDER LT W WO CONTRAST
|
Facility
IP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,243.50 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: AETNA Commercial |
$3,044.75
|
| Rate for Payer: AETNA Medicare |
$2,884.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,044.75
|
| Rate for Payer: BCBS Healthlink |
$2,884.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,884.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,884.50
|
| Rate for Payer: BCBS POS |
$3,044.75
|
| Rate for Payer: BCBS Traditional |
$3,205.00
|
| Rate for Payer: CASH_PRICE |
$2,564.00
|
| Rate for Payer: CIGNA Commercial |
$3,044.75
|
| Rate for Payer: CIGNA Medicare |
$2,884.50
|
| Rate for Payer: HUMANA Commercial |
$2,884.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,948.60
|
| Rate for Payer: MEDICARE Medicare |
$2,243.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,108.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,044.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,724.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,564.00
|
|
|
MR SHOULDER LT W WO CONTRAST
|
Facility
OP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,243.50 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: AETNA Commercial |
$3,044.75
|
| Rate for Payer: AETNA Medicare |
$2,884.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,044.75
|
| Rate for Payer: BCBS Healthlink |
$2,884.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,884.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,884.50
|
| Rate for Payer: BCBS POS |
$3,044.75
|
| Rate for Payer: BCBS Traditional |
$3,205.00
|
| Rate for Payer: CASH_PRICE |
$2,564.00
|
| Rate for Payer: CIGNA Commercial |
$3,044.75
|
| Rate for Payer: CIGNA Medicare |
$2,884.50
|
| Rate for Payer: HUMANA Commercial |
$2,884.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,948.60
|
| Rate for Payer: MEDICARE Medicare |
$2,243.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,108.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,044.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,724.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,564.00
|
|
