|
MR TMJ
|
Facility
OP
|
$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
|
|
|
MR UPPR XT W CON LT
|
Facility
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR UPPR XT W CON LT
|
Facility
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR UPPR XT W CON RT
|
Facility
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR UPPR XT W CON RT
|
Facility
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 73219 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: AETNA Commercial |
$2,614.40
|
| Rate for Payer: AETNA Medicare |
$2,476.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,614.40
|
| Rate for Payer: BCBS Healthlink |
$2,476.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,476.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,476.80
|
| Rate for Payer: BCBS POS |
$2,614.40
|
| Rate for Payer: BCBS Traditional |
$2,752.00
|
| Rate for Payer: CASH_PRICE |
$2,201.60
|
| Rate for Payer: CIGNA Commercial |
$2,614.40
|
| Rate for Payer: CIGNA Medicare |
$2,476.80
|
| Rate for Payer: HUMANA Commercial |
$2,476.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,531.84
|
| Rate for Payer: MEDICARE Medicare |
$1,926.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,669.44
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,614.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,614.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,339.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,201.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,201.60
|
|
|
MR UPPR XT WO CON LT
|
Facility
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR UPPR XT WO CON LT
|
Facility
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR UPPR XT WO CON RT
|
Facility
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR UPPR XT WO CON RT
|
Facility
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 73218 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,555.40 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: AETNA Commercial |
$2,110.90
|
| Rate for Payer: AETNA Medicare |
$1,999.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,110.90
|
| Rate for Payer: BCBS Healthlink |
$1,999.80
|
| Rate for Payer: BCBS HMK CHIP |
$1,999.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$1,999.80
|
| Rate for Payer: BCBS POS |
$2,110.90
|
| Rate for Payer: BCBS Traditional |
$2,222.00
|
| Rate for Payer: CASH_PRICE |
$1,777.60
|
| Rate for Payer: CIGNA Commercial |
$2,110.90
|
| Rate for Payer: CIGNA Medicare |
$1,999.80
|
| Rate for Payer: HUMANA Commercial |
$1,999.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,044.24
|
| Rate for Payer: MEDICARE Medicare |
$1,555.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,155.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,110.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,110.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$1,888.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$1,777.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$1,777.60
|
|
|
MR UPPR XT WO&W CON LT
|
Facility
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR UPPR XT WO&W CON LT
|
Facility
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 LT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR UPPR XT WO&W CON RT
|
Facility
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR UPPR XT WO&W CON RT
|
Facility
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 73220 RT
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,220.40 |
| Max. Negotiated Rate |
$3,172.00 |
| Rate for Payer: AETNA Commercial |
$3,013.40
|
| Rate for Payer: AETNA Medicare |
$2,854.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$3,013.40
|
| Rate for Payer: BCBS Healthlink |
$2,854.80
|
| Rate for Payer: BCBS HMK CHIP |
$2,854.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,854.80
|
| Rate for Payer: BCBS POS |
$3,013.40
|
| Rate for Payer: BCBS Traditional |
$3,172.00
|
| Rate for Payer: CASH_PRICE |
$2,537.60
|
| Rate for Payer: CIGNA Commercial |
$3,013.40
|
| Rate for Payer: CIGNA Medicare |
$2,854.80
|
| Rate for Payer: HUMANA Commercial |
$2,854.80
|
| Rate for Payer: MEDICAID Medicaid |
$2,918.24
|
| Rate for Payer: MEDICARE Medicare |
$2,220.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$3,076.84
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$3,013.40
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$3,013.40
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,696.20
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,537.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,537.60
|
|
|
MR WRIST 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 WRIST 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: MONIDA - ALLEGIANCE Commercial |
$2,428.20
|
| Rate for Payer: AETNA Commercial |
$2,428.20
|
| Rate for Payer: AETNA Medicare |
$2,300.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$2,428.20
|
| Rate for Payer: BCBS Healthlink |
$2,300.40
|
| Rate for Payer: BCBS HMK CHIP |
$2,300.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$2,300.40
|
| Rate for Payer: BCBS POS |
$2,428.20
|
| Rate for Payer: BCBS Traditional |
$2,556.00
|
| Rate for Payer: CASH_PRICE |
$2,044.80
|
| Rate for Payer: CIGNA Commercial |
$2,428.20
|
| Rate for Payer: CIGNA Medicare |
$2,300.40
|
| Rate for Payer: HUMANA Commercial |
$2,300.40
|
| Rate for Payer: MEDICAID Medicaid |
$2,351.52
|
| Rate for Payer: MEDICARE Medicare |
$1,789.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$2,479.32
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$2,428.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$2,428.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$2,172.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$2,044.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$2,044.80
|
|
|
MR WRIST 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: MONIDA - ALLEGIANCE Commercial |
$2,136.55
|
| 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 - 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 WRIST 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 WRIST 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
|
|
|
MR WRIST 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 WRIST 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 WRIST 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 WRIST 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 WRIST 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 WRIST 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: MONIDA - ALLEGIANCE Commercial |
$3,044.75
|
| 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 - 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 WRIST 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
|
|
