|
MR SHOULDER RT W CONTRAST
|
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 SHOULDER RT W CONTRAST
|
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 SHOULDER RT WO CONTRAST
|
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 SHOULDER RT WO CONTRAST
|
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 SHOULDER RT W WO CONTRAST
|
Facility
IP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,243.50 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: AETNA Commercial |
$3,044.75
|
| Rate for Payer: AETNA Medicare |
$2,884.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,044.75
|
| Rate for Payer: BCBS Healthlink |
$2,884.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,884.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,884.50
|
| Rate for Payer: BCBS POS |
$3,044.75
|
| Rate for Payer: BCBS Traditional |
$3,205.00
|
| Rate for Payer: CASH_PRICE |
$2,564.00
|
| Rate for Payer: CIGNA Commercial |
$3,044.75
|
| Rate for Payer: CIGNA Medicare |
$2,884.50
|
| Rate for Payer: HUMANA Commercial |
$2,884.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,948.60
|
| Rate for Payer: MEDICARE Medicare |
$2,243.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,108.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,044.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,724.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,564.00
|
|
|
MR SHOULDER RT W WO CONTRAST
|
Facility
OP
|
$3,205.00
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,243.50 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: AETNA Commercial |
$3,044.75
|
| Rate for Payer: AETNA Medicare |
$2,884.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,044.75
|
| Rate for Payer: BCBS Healthlink |
$2,884.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,884.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,884.50
|
| Rate for Payer: BCBS POS |
$3,044.75
|
| Rate for Payer: BCBS Traditional |
$3,205.00
|
| Rate for Payer: CASH_PRICE |
$2,564.00
|
| Rate for Payer: CIGNA Commercial |
$3,044.75
|
| Rate for Payer: CIGNA Medicare |
$2,884.50
|
| Rate for Payer: HUMANA Commercial |
$2,884.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,948.60
|
| Rate for Payer: MEDICARE Medicare |
$2,243.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,108.85
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,044.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,044.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,724.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,564.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,564.00
|
|
|
MR THORACIC SPINE W CONTRAST
|
Facility
IP
|
$2,757.00
|
|
|
Service Code
|
CPT 72147 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 THORACIC SPINE W CONTRAST
|
Facility
OP
|
$2,757.00
|
|
|
Service Code
|
CPT 72147 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 THORACIC SPINE WO CONTRAST
|
Facility
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 72146 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 THORACIC SPINE WO CONTRAST
|
Facility
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 72146 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 THORACIC SPINE W WO CONTRAST
|
Facility
IP
|
$3,472.00
|
|
|
Service Code
|
CPT 72157 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 THORACIC SPINE W WO CONTRAST
|
Facility
OP
|
$3,472.00
|
|
|
Service Code
|
CPT 72157 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 TIBIA FIBULA LT W CONTRAST
|
Facility
IP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR TIBIA FIBULA LT W CONTRAST
|
Facility
OP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR TIBIA FIBULA LT WO CONTRAST
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR TIBIA FIBULA LT WO CONTRAST
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR TIBIA FIBULA LT W WO CONTRAST
|
Facility
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| 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 MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR TIBIA FIBULA LT W WO CONTRAST
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR TIBIA FIBULA RT W CONTRAST
|
Facility
IP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: AETNA Commercial |
$2,370.25
|
| Rate for Payer: AETNA Medicare |
$2,245.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,370.25
|
| Rate for Payer: BCBS Healthlink |
$2,245.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,245.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,245.50
|
| Rate for Payer: BCBS POS |
$2,370.25
|
| Rate for Payer: BCBS Traditional |
$2,495.00
|
| Rate for Payer: CASH_PRICE |
$1,996.00
|
| Rate for Payer: CIGNA Commercial |
$2,370.25
|
| Rate for Payer: CIGNA Medicare |
$2,245.50
|
| Rate for Payer: HUMANA Commercial |
$2,245.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,295.40
|
| Rate for Payer: MEDICARE Medicare |
$1,746.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,420.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,370.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,370.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR TIBIA FIBULA RT W CONTRAST
|
Facility
OP
|
$2,495.00
|
|
|
Service Code
|
CPT 73719 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,746.50 |
| Max. Negotiated Rate |
$2,495.00 |
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,120.75
|
| 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 MCD ADVANTAGE Medicaid |
$1,996.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,996.00
|
|
|
MR TIBIA FIBULA RT WO CONTRAST
|
Facility
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR TIBIA FIBULA RT WO CONTRAST
|
Facility
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,578.50 |
| Max. Negotiated Rate |
$2,255.00 |
| Rate for Payer: AETNA Commercial |
$2,142.25
|
| Rate for Payer: AETNA Medicare |
$2,029.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,142.25
|
| Rate for Payer: BCBS Healthlink |
$2,029.50
|
| Rate for Payer: BCBS HMK CHIP |
$2,029.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,029.50
|
| Rate for Payer: BCBS POS |
$2,142.25
|
| Rate for Payer: BCBS Traditional |
$2,255.00
|
| Rate for Payer: CASH_PRICE |
$1,804.00
|
| Rate for Payer: CIGNA Commercial |
$2,142.25
|
| Rate for Payer: CIGNA Medicare |
$2,029.50
|
| Rate for Payer: HUMANA Commercial |
$2,029.50
|
| Rate for Payer: MEDICAID Medicaid |
$2,074.60
|
| Rate for Payer: MEDICARE Medicare |
$1,578.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,187.35
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,142.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,142.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,916.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,804.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,804.00
|
|
|
MR TIBIA FIBULA RT W WO CONTRAST
|
Facility
IP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR TIBIA FIBULA RT W WO CONTRAST
|
Facility
OP
|
$3,167.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,216.90 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: AETNA Commercial |
$3,008.65
|
| Rate for Payer: AETNA Medicare |
$2,850.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,008.65
|
| Rate for Payer: BCBS Healthlink |
$2,850.30
|
| Rate for Payer: BCBS HMK CHIP |
$2,850.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,850.30
|
| Rate for Payer: BCBS POS |
$3,008.65
|
| Rate for Payer: BCBS Traditional |
$3,167.00
|
| Rate for Payer: CASH_PRICE |
$2,533.60
|
| Rate for Payer: CIGNA Commercial |
$3,008.65
|
| Rate for Payer: CIGNA Medicare |
$2,850.30
|
| Rate for Payer: HUMANA Commercial |
$2,850.30
|
| Rate for Payer: MEDICAID Medicaid |
$2,913.64
|
| Rate for Payer: MEDICARE Medicare |
$2,216.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,071.99
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,008.65
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,008.65
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,691.95
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,533.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,533.60
|
|
|
MR TMJ
|
Facility
IP
|
$2,113.00
|
|
|
Service Code
|
CPT 70336 TC
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,479.10 |
| Max. Negotiated Rate |
$2,113.00 |
| Rate for Payer: AETNA Commercial |
$2,007.35
|
| Rate for Payer: AETNA Medicare |
$1,901.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,007.35
|
| Rate for Payer: BCBS Healthlink |
$1,901.70
|
| Rate for Payer: BCBS HMK CHIP |
$1,901.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,901.70
|
| Rate for Payer: BCBS POS |
$2,007.35
|
| Rate for Payer: BCBS Traditional |
$2,113.00
|
| Rate for Payer: CASH_PRICE |
$1,690.40
|
| Rate for Payer: CIGNA Commercial |
$2,007.35
|
| Rate for Payer: CIGNA Medicare |
$1,901.70
|
| Rate for Payer: HUMANA Commercial |
$1,901.70
|
| Rate for Payer: MEDICAID Medicaid |
$1,943.96
|
| Rate for Payer: MEDICARE Medicare |
$1,479.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,007.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,049.61
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,007.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,007.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,796.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,690.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,690.40
|
|
