|
ANKLE BRACE AIR GEL 9.0''
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
2893172
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Medicare |
$44.10
|
| Rate for Payer: BCBS MT CHIP |
$44.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$46.55
|
| Rate for Payer: BCBS MT HealthLink |
$44.10
|
| Rate for Payer: BCBS MT Medicare |
$44.10
|
| Rate for Payer: BCBS MT POS |
$46.55
|
| Rate for Payer: BCBS MT Traditional |
$49.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cigna Medicare |
$44.10
|
| Rate for Payer: Medicaid All Medicaid |
$45.08
|
| Rate for Payer: Medicare All Medicare |
$34.30
|
| Rate for Payer: Monida Allegiance |
$46.55
|
| Rate for Payer: Monida First Choice Health |
$47.53
|
| Rate for Payer: Monida Montana Health Co-op |
$46.55
|
| Rate for Payer: Monida PacificSource |
$46.55
|
|
|
ANKLE BRACE AIR GEL SM. 8.5
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2893151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: BCBS MT CHIP |
$51.30
|
| Rate for Payer: BCBS MT Closed Plan Network |
$54.15
|
| Rate for Payer: BCBS MT HealthLink |
$51.30
|
| Rate for Payer: BCBS MT Medicare |
$51.30
|
| Rate for Payer: BCBS MT POS |
$54.15
|
| Rate for Payer: BCBS MT Traditional |
$57.00
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cigna Medicare |
$51.30
|
| Rate for Payer: Medicaid All Medicaid |
$52.44
|
| Rate for Payer: Medicare All Medicare |
$39.90
|
| Rate for Payer: Monida Allegiance |
$54.15
|
| Rate for Payer: Monida First Choice Health |
$55.29
|
| Rate for Payer: Monida Montana Health Co-op |
$54.15
|
| Rate for Payer: Monida PacificSource |
$54.15
|
|
|
ANKLE BRACE AIR GEL SM. 8.5
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2893151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: BCBS MT CHIP |
$51.30
|
| Rate for Payer: BCBS MT Closed Plan Network |
$54.15
|
| Rate for Payer: BCBS MT HealthLink |
$51.30
|
| Rate for Payer: BCBS MT Medicare |
$51.30
|
| Rate for Payer: BCBS MT POS |
$54.15
|
| Rate for Payer: BCBS MT Traditional |
$57.00
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cigna Medicare |
$51.30
|
| Rate for Payer: Medicaid All Medicaid |
$52.44
|
| Rate for Payer: Medicare All Medicare |
$39.90
|
| Rate for Payer: Monida Allegiance |
$54.15
|
| Rate for Payer: Monida First Choice Health |
$55.29
|
| Rate for Payer: Monida Montana Health Co-op |
$54.15
|
| Rate for Payer: Monida PacificSource |
$54.15
|
|
|
ANKLE SPINT LACE-UP SM
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2820002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: BCBS MT CHIP |
$39.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$41.80
|
| Rate for Payer: BCBS MT HealthLink |
$39.60
|
| Rate for Payer: BCBS MT Medicare |
$39.60
|
| Rate for Payer: BCBS MT POS |
$41.80
|
| Rate for Payer: BCBS MT Traditional |
$44.00
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$41.80
|
| Rate for Payer: Cigna Medicare |
$39.60
|
| Rate for Payer: Medicaid All Medicaid |
$40.48
|
| Rate for Payer: Medicare All Medicare |
$30.80
|
| Rate for Payer: Monida Allegiance |
$41.80
|
| Rate for Payer: Monida First Choice Health |
$42.68
|
| Rate for Payer: Monida Montana Health Co-op |
$41.80
|
| Rate for Payer: Monida PacificSource |
$41.80
|
|
|
ANKLE SPINT LACE-UP SM
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2820002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: BCBS MT CHIP |
$39.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$41.80
|
| Rate for Payer: BCBS MT HealthLink |
$39.60
|
| Rate for Payer: BCBS MT Medicare |
$39.60
|
| Rate for Payer: BCBS MT POS |
$41.80
|
| Rate for Payer: BCBS MT Traditional |
$44.00
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$41.80
|
| Rate for Payer: Cigna Medicare |
$39.60
|
| Rate for Payer: Medicaid All Medicaid |
$40.48
|
| Rate for Payer: Medicare All Medicare |
$30.80
|
| Rate for Payer: Monida Allegiance |
$41.80
|
| Rate for Payer: Monida First Choice Health |
$42.68
|
| Rate for Payer: Monida Montana Health Co-op |
$41.80
|
| Rate for Payer: Monida PacificSource |
$41.80
|
|
|
ANKLE SPLINT LACE-UP LG
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS E1815
|
| Hospital Charge Code |
2893174
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
ANKLE SPLINT LACE-UP LG
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS E1815
|
| Hospital Charge Code |
2893174
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
ANKLE SPLINT LACE-UP MED
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS E1815
|
| Hospital Charge Code |
2893173
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
ANKLE SPLINT LACE-UP MED
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS E1815
|
| Hospital Charge Code |
2893173
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: BCBS MT CHIP |
$34.20
|
| Rate for Payer: BCBS MT Closed Plan Network |
$36.10
|
| Rate for Payer: BCBS MT HealthLink |
$34.20
|
| Rate for Payer: BCBS MT Medicare |
$34.20
|
| Rate for Payer: BCBS MT POS |
$36.10
|
| Rate for Payer: BCBS MT Traditional |
$38.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cigna Medicare |
$34.20
|
| Rate for Payer: Medicaid All Medicaid |
$34.96
|
| Rate for Payer: Medicare All Medicare |
$26.60
|
| Rate for Payer: Monida Allegiance |
$36.10
|
| Rate for Payer: Monida First Choice Health |
$36.86
|
| Rate for Payer: Monida Montana Health Co-op |
$36.10
|
| Rate for Payer: Monida PacificSource |
$36.10
|
|
|
ANKLE SUPPORT
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS L1902
|
| Hospital Charge Code |
8001902
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna Commercial |
$160.55
|
| Rate for Payer: Aetna Medicare |
$152.10
|
| Rate for Payer: BCBS MT CHIP |
$152.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$160.55
|
| Rate for Payer: BCBS MT HealthLink |
$152.10
|
| Rate for Payer: BCBS MT Medicare |
$152.10
|
| Rate for Payer: BCBS MT POS |
$160.55
|
| Rate for Payer: BCBS MT Traditional |
$169.00
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna Commercial |
$160.55
|
| Rate for Payer: Cigna Medicare |
$152.10
|
| Rate for Payer: Medicaid All Medicaid |
$155.48
|
| Rate for Payer: Medicare All Medicare |
$118.30
|
| Rate for Payer: Monida Allegiance |
$160.55
|
| Rate for Payer: Monida First Choice Health |
$163.93
|
| Rate for Payer: Monida Montana Health Co-op |
$160.55
|
| Rate for Payer: Monida PacificSource |
$160.55
|
|
|
ANKLE SUPPORT
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS L1902
|
| Hospital Charge Code |
8001902
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna Commercial |
$160.55
|
| Rate for Payer: Aetna Medicare |
$152.10
|
| Rate for Payer: BCBS MT CHIP |
$152.10
|
| Rate for Payer: BCBS MT Closed Plan Network |
$160.55
|
| Rate for Payer: BCBS MT HealthLink |
$152.10
|
| Rate for Payer: BCBS MT Medicare |
$152.10
|
| Rate for Payer: BCBS MT POS |
$160.55
|
| Rate for Payer: BCBS MT Traditional |
$169.00
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna Commercial |
$160.55
|
| Rate for Payer: Cigna Medicare |
$152.10
|
| Rate for Payer: Medicaid All Medicaid |
$155.48
|
| Rate for Payer: Medicare All Medicare |
$118.30
|
| Rate for Payer: Monida Allegiance |
$160.55
|
| Rate for Payer: Monida First Choice Health |
$163.93
|
| Rate for Payer: Monida Montana Health Co-op |
$160.55
|
| Rate for Payer: Monida PacificSource |
$160.55
|
|
|
ANKLE SUPPORT CRISCROS LG
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
2893177
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$48.60
|
| Rate for Payer: BCBS MT CHIP |
$48.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$51.30
|
| Rate for Payer: BCBS MT HealthLink |
$48.60
|
| Rate for Payer: BCBS MT Medicare |
$48.60
|
| Rate for Payer: BCBS MT POS |
$51.30
|
| Rate for Payer: BCBS MT Traditional |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cigna Medicare |
$48.60
|
| Rate for Payer: Medicaid All Medicaid |
$49.68
|
| Rate for Payer: Medicare All Medicare |
$37.80
|
| Rate for Payer: Monida Allegiance |
$51.30
|
| Rate for Payer: Monida First Choice Health |
$52.38
|
| Rate for Payer: Monida Montana Health Co-op |
$51.30
|
| Rate for Payer: Monida PacificSource |
$51.30
|
|
|
ANKLE SUPPORT CRISCROS LG
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
2893177
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$48.60
|
| Rate for Payer: BCBS MT CHIP |
$48.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$51.30
|
| Rate for Payer: BCBS MT HealthLink |
$48.60
|
| Rate for Payer: BCBS MT Medicare |
$48.60
|
| Rate for Payer: BCBS MT POS |
$51.30
|
| Rate for Payer: BCBS MT Traditional |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cigna Medicare |
$48.60
|
| Rate for Payer: Medicaid All Medicaid |
$49.68
|
| Rate for Payer: Medicare All Medicare |
$37.80
|
| Rate for Payer: Monida Allegiance |
$51.30
|
| Rate for Payer: Monida First Choice Health |
$52.38
|
| Rate for Payer: Monida Montana Health Co-op |
$51.30
|
| Rate for Payer: Monida PacificSource |
$51.30
|
|
|
ANKLE SUPPORT CRISCROS MED
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
2893176
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$48.60
|
| Rate for Payer: BCBS MT CHIP |
$48.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$51.30
|
| Rate for Payer: BCBS MT HealthLink |
$48.60
|
| Rate for Payer: BCBS MT Medicare |
$48.60
|
| Rate for Payer: BCBS MT POS |
$51.30
|
| Rate for Payer: BCBS MT Traditional |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cigna Medicare |
$48.60
|
| Rate for Payer: Medicaid All Medicaid |
$49.68
|
| Rate for Payer: Medicare All Medicare |
$37.80
|
| Rate for Payer: Monida Allegiance |
$51.30
|
| Rate for Payer: Monida First Choice Health |
$52.38
|
| Rate for Payer: Monida Montana Health Co-op |
$51.30
|
| Rate for Payer: Monida PacificSource |
$51.30
|
|
|
ANKLE SUPPORT CRISCROS MED
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
2893176
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$48.60
|
| Rate for Payer: BCBS MT CHIP |
$48.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$51.30
|
| Rate for Payer: BCBS MT HealthLink |
$48.60
|
| Rate for Payer: BCBS MT Medicare |
$48.60
|
| Rate for Payer: BCBS MT POS |
$51.30
|
| Rate for Payer: BCBS MT Traditional |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cigna Medicare |
$48.60
|
| Rate for Payer: Medicaid All Medicaid |
$49.68
|
| Rate for Payer: Medicare All Medicare |
$37.80
|
| Rate for Payer: Monida Allegiance |
$51.30
|
| Rate for Payer: Monida First Choice Health |
$52.38
|
| Rate for Payer: Monida Montana Health Co-op |
$51.30
|
| Rate for Payer: Monida PacificSource |
$51.30
|
|
|
ANKLE SUPPORT CRISCROS SM
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
2840087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Aetna Medicare |
$57.60
|
| Rate for Payer: BCBS MT CHIP |
$57.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$60.80
|
| Rate for Payer: BCBS MT HealthLink |
$57.60
|
| Rate for Payer: BCBS MT Medicare |
$57.60
|
| Rate for Payer: BCBS MT POS |
$60.80
|
| Rate for Payer: BCBS MT Traditional |
$64.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$60.80
|
| Rate for Payer: Cigna Medicare |
$57.60
|
| Rate for Payer: Medicaid All Medicaid |
$58.88
|
| Rate for Payer: Medicare All Medicare |
$44.80
|
| Rate for Payer: Monida Allegiance |
$60.80
|
| Rate for Payer: Monida First Choice Health |
$62.08
|
| Rate for Payer: Monida Montana Health Co-op |
$60.80
|
| Rate for Payer: Monida PacificSource |
$60.80
|
|
|
ANKLE SUPPORT CRISCROS SM
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
2840087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Aetna Medicare |
$57.60
|
| Rate for Payer: BCBS MT CHIP |
$57.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$60.80
|
| Rate for Payer: BCBS MT HealthLink |
$57.60
|
| Rate for Payer: BCBS MT Medicare |
$57.60
|
| Rate for Payer: BCBS MT POS |
$60.80
|
| Rate for Payer: BCBS MT Traditional |
$64.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$60.80
|
| Rate for Payer: Cigna Medicare |
$57.60
|
| Rate for Payer: Medicaid All Medicaid |
$58.88
|
| Rate for Payer: Medicare All Medicare |
$44.80
|
| Rate for Payer: Monida Allegiance |
$60.80
|
| Rate for Payer: Monida First Choice Health |
$62.08
|
| Rate for Payer: Monida Montana Health Co-op |
$60.80
|
| Rate for Payer: Monida PacificSource |
$60.80
|
|
|
ANKLE SUPPORT CRISCROS XLG
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
2893178
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$48.60
|
| Rate for Payer: BCBS MT CHIP |
$48.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$51.30
|
| Rate for Payer: BCBS MT HealthLink |
$48.60
|
| Rate for Payer: BCBS MT Medicare |
$48.60
|
| Rate for Payer: BCBS MT POS |
$51.30
|
| Rate for Payer: BCBS MT Traditional |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cigna Medicare |
$48.60
|
| Rate for Payer: Medicaid All Medicaid |
$49.68
|
| Rate for Payer: Medicare All Medicare |
$37.80
|
| Rate for Payer: Monida Allegiance |
$51.30
|
| Rate for Payer: Monida First Choice Health |
$52.38
|
| Rate for Payer: Monida Montana Health Co-op |
$51.30
|
| Rate for Payer: Monida PacificSource |
$51.30
|
|
|
ANKLE SUPPORT CRISCROS XLG
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
2893178
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$48.60
|
| Rate for Payer: BCBS MT CHIP |
$48.60
|
| Rate for Payer: BCBS MT Closed Plan Network |
$51.30
|
| Rate for Payer: BCBS MT HealthLink |
$48.60
|
| Rate for Payer: BCBS MT Medicare |
$48.60
|
| Rate for Payer: BCBS MT POS |
$51.30
|
| Rate for Payer: BCBS MT Traditional |
$54.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cigna Medicare |
$48.60
|
| Rate for Payer: Medicaid All Medicaid |
$49.68
|
| Rate for Payer: Medicare All Medicare |
$37.80
|
| Rate for Payer: Monida Allegiance |
$51.30
|
| Rate for Payer: Monida First Choice Health |
$52.38
|
| Rate for Payer: Monida Montana Health Co-op |
$51.30
|
| Rate for Payer: Monida PacificSource |
$51.30
|
|
|
ANKLE SUPPORT LG ELASTIC
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
2893181
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: BCBS MT CHIP |
$10.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$11.40
|
| Rate for Payer: BCBS MT HealthLink |
$10.80
|
| Rate for Payer: BCBS MT Medicare |
$10.80
|
| Rate for Payer: BCBS MT POS |
$11.40
|
| Rate for Payer: BCBS MT Traditional |
$12.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cigna Medicare |
$10.80
|
| Rate for Payer: Medicaid All Medicaid |
$11.04
|
| Rate for Payer: Medicare All Medicare |
$8.40
|
| Rate for Payer: Monida Allegiance |
$11.40
|
| Rate for Payer: Monida First Choice Health |
$11.64
|
| Rate for Payer: Monida Montana Health Co-op |
$11.40
|
| Rate for Payer: Monida PacificSource |
$11.40
|
|
|
ANKLE SUPPORT LG ELASTIC
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
2893181
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: BCBS MT CHIP |
$10.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$11.40
|
| Rate for Payer: BCBS MT HealthLink |
$10.80
|
| Rate for Payer: BCBS MT Medicare |
$10.80
|
| Rate for Payer: BCBS MT POS |
$11.40
|
| Rate for Payer: BCBS MT Traditional |
$12.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cigna Medicare |
$10.80
|
| Rate for Payer: Medicaid All Medicaid |
$11.04
|
| Rate for Payer: Medicare All Medicare |
$8.40
|
| Rate for Payer: Monida Allegiance |
$11.40
|
| Rate for Payer: Monida First Choice Health |
$11.64
|
| Rate for Payer: Monida Montana Health Co-op |
$11.40
|
| Rate for Payer: Monida PacificSource |
$11.40
|
|
|
ANKLE SUPPORT MD ELASTIC
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
2893180
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: BCBS MT CHIP |
$10.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$11.40
|
| Rate for Payer: BCBS MT HealthLink |
$10.80
|
| Rate for Payer: BCBS MT Medicare |
$10.80
|
| Rate for Payer: BCBS MT POS |
$11.40
|
| Rate for Payer: BCBS MT Traditional |
$12.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cigna Medicare |
$10.80
|
| Rate for Payer: Medicaid All Medicaid |
$11.04
|
| Rate for Payer: Medicare All Medicare |
$8.40
|
| Rate for Payer: Monida Allegiance |
$11.40
|
| Rate for Payer: Monida First Choice Health |
$11.64
|
| Rate for Payer: Monida Montana Health Co-op |
$11.40
|
| Rate for Payer: Monida PacificSource |
$11.40
|
|
|
ANKLE SUPPORT MD ELASTIC
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
2893180
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: BCBS MT CHIP |
$10.80
|
| Rate for Payer: BCBS MT Closed Plan Network |
$11.40
|
| Rate for Payer: BCBS MT HealthLink |
$10.80
|
| Rate for Payer: BCBS MT Medicare |
$10.80
|
| Rate for Payer: BCBS MT POS |
$11.40
|
| Rate for Payer: BCBS MT Traditional |
$12.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cigna Medicare |
$10.80
|
| Rate for Payer: Medicaid All Medicaid |
$11.04
|
| Rate for Payer: Medicare All Medicare |
$8.40
|
| Rate for Payer: Monida Allegiance |
$11.40
|
| Rate for Payer: Monida First Choice Health |
$11.64
|
| Rate for Payer: Monida Montana Health Co-op |
$11.40
|
| Rate for Payer: Monida PacificSource |
$11.40
|
|
|
ANKLE SUPPORT SM ELASTIC
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
2840174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$12.35
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: BCBS MT CHIP |
$11.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$12.35
|
| Rate for Payer: BCBS MT HealthLink |
$11.70
|
| Rate for Payer: BCBS MT Medicare |
$11.70
|
| Rate for Payer: BCBS MT POS |
$12.35
|
| Rate for Payer: BCBS MT Traditional |
$13.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna Commercial |
$12.35
|
| Rate for Payer: Cigna Medicare |
$11.70
|
| Rate for Payer: Medicaid All Medicaid |
$11.96
|
| Rate for Payer: Medicare All Medicare |
$9.10
|
| Rate for Payer: Monida Allegiance |
$12.35
|
| Rate for Payer: Monida First Choice Health |
$12.61
|
| Rate for Payer: Monida Montana Health Co-op |
$12.35
|
| Rate for Payer: Monida PacificSource |
$12.35
|
|
|
ANKLE SUPPORT SM ELASTIC
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
2840174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$12.35
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: BCBS MT CHIP |
$11.70
|
| Rate for Payer: BCBS MT Closed Plan Network |
$12.35
|
| Rate for Payer: BCBS MT HealthLink |
$11.70
|
| Rate for Payer: BCBS MT Medicare |
$11.70
|
| Rate for Payer: BCBS MT POS |
$12.35
|
| Rate for Payer: BCBS MT Traditional |
$13.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna Commercial |
$12.35
|
| Rate for Payer: Cigna Medicare |
$11.70
|
| Rate for Payer: Medicaid All Medicaid |
$11.96
|
| Rate for Payer: Medicare All Medicare |
$9.10
|
| Rate for Payer: Monida Allegiance |
$12.35
|
| Rate for Payer: Monida First Choice Health |
$12.61
|
| Rate for Payer: Monida Montana Health Co-op |
$12.35
|
| Rate for Payer: Monida PacificSource |
$12.35
|
|
