|
APPLICATION CAST SHOULDER-FINGER
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
APPLICATION FINGER SPLINT
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
APPLICATION FINGER SPLINT
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: AETNA Commercial |
$223.25
|
| Rate for Payer: AETNA Medicare |
$211.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$223.25
|
| Rate for Payer: BCBS Healthlink |
$211.50
|
| Rate for Payer: BCBS HMK CHIP |
$211.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$211.50
|
| Rate for Payer: BCBS POS |
$223.25
|
| Rate for Payer: BCBS Traditional |
$235.00
|
| Rate for Payer: CASH_PRICE |
$188.00
|
| Rate for Payer: CIGNA Commercial |
$223.25
|
| Rate for Payer: CIGNA Medicare |
$211.50
|
| Rate for Payer: HUMANA Commercial |
$211.50
|
| Rate for Payer: MEDICAID Medicaid |
$216.20
|
| Rate for Payer: MEDICARE Medicare |
$164.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$223.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$227.95
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$223.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$223.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$199.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$188.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$188.00
|
|
|
APPLICATION HAND/WRIST CAST
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
APPLICATION HAND/WRIST CAST
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: AETNA Commercial |
$254.60
|
| Rate for Payer: AETNA Medicare |
$241.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$254.60
|
| Rate for Payer: BCBS Healthlink |
$241.20
|
| Rate for Payer: BCBS HMK CHIP |
$241.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$241.20
|
| Rate for Payer: BCBS POS |
$254.60
|
| Rate for Payer: BCBS Traditional |
$268.00
|
| Rate for Payer: CASH_PRICE |
$214.40
|
| Rate for Payer: CIGNA Commercial |
$254.60
|
| Rate for Payer: CIGNA Medicare |
$241.20
|
| Rate for Payer: HUMANA Commercial |
$241.20
|
| Rate for Payer: MEDICAID Medicaid |
$246.56
|
| Rate for Payer: MEDICARE Medicare |
$187.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$254.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$259.96
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$254.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$254.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$227.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$214.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$214.40
|
|
|
APPLICATION LONG ARM SPLINT
|
Facility
OP
|
$345.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: AETNA Commercial |
$327.75
|
| Rate for Payer: AETNA Medicare |
$310.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$327.75
|
| Rate for Payer: BCBS Healthlink |
$310.50
|
| Rate for Payer: BCBS HMK CHIP |
$310.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$310.50
|
| Rate for Payer: BCBS POS |
$327.75
|
| Rate for Payer: BCBS Traditional |
$345.00
|
| Rate for Payer: CASH_PRICE |
$276.00
|
| Rate for Payer: CIGNA Commercial |
$327.75
|
| Rate for Payer: CIGNA Medicare |
$310.50
|
| Rate for Payer: HUMANA Commercial |
$310.50
|
| Rate for Payer: MEDICAID Medicaid |
$317.40
|
| Rate for Payer: MEDICARE Medicare |
$241.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$327.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$334.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$327.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$327.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$293.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$276.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$276.00
|
|
|
APPLICATION LONG ARM SPLINT
|
Facility
IP
|
$345.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: BCBS HMK CHIP |
$310.50
|
| Rate for Payer: AETNA Commercial |
$327.75
|
| Rate for Payer: AETNA Medicare |
$310.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$327.75
|
| Rate for Payer: BCBS Healthlink |
$310.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$310.50
|
| Rate for Payer: BCBS POS |
$327.75
|
| Rate for Payer: BCBS Traditional |
$345.00
|
| Rate for Payer: CASH_PRICE |
$276.00
|
| Rate for Payer: CIGNA Commercial |
$327.75
|
| Rate for Payer: CIGNA Medicare |
$310.50
|
| Rate for Payer: HUMANA Commercial |
$310.50
|
| Rate for Payer: MEDICAID Medicaid |
$317.40
|
| Rate for Payer: MEDICARE Medicare |
$241.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$327.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$334.65
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$327.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$327.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$293.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$276.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$276.00
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
IP
|
$328.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
APPLICATION LONG LEG SPLINT
|
Facility
OP
|
$328.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: AETNA Commercial |
$311.60
|
| Rate for Payer: AETNA Medicare |
$295.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$311.60
|
| Rate for Payer: BCBS Healthlink |
$295.20
|
| Rate for Payer: BCBS HMK CHIP |
$295.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$295.20
|
| Rate for Payer: BCBS POS |
$311.60
|
| Rate for Payer: BCBS Traditional |
$328.00
|
| Rate for Payer: CASH_PRICE |
$262.40
|
| Rate for Payer: CIGNA Commercial |
$311.60
|
| Rate for Payer: CIGNA Medicare |
$295.20
|
| Rate for Payer: HUMANA Commercial |
$295.20
|
| Rate for Payer: MEDICAID Medicaid |
$301.76
|
| Rate for Payer: MEDICARE Medicare |
$229.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$311.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$318.16
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$311.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$311.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$278.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$262.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$262.40
|
|
|
APPLICATION SHORT LEG CAST(KNEE TO TOES)
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
APPLICATION SHORT LEG CAST(KNEE TO TOES)
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
|
APPLICATION SPLINT HAND-LOWER F-ARM
|
Facility
OP
|
$311.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
APPLICATION SPLINT HAND-LOWER F-ARM
|
Facility
IP
|
$311.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$217.70 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: AETNA Commercial |
$295.45
|
| Rate for Payer: AETNA Medicare |
$279.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$295.45
|
| Rate for Payer: BCBS Healthlink |
$279.90
|
| Rate for Payer: BCBS HMK CHIP |
$279.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$279.90
|
| Rate for Payer: BCBS POS |
$295.45
|
| Rate for Payer: BCBS Traditional |
$311.00
|
| Rate for Payer: CASH_PRICE |
$248.80
|
| Rate for Payer: CIGNA Commercial |
$295.45
|
| Rate for Payer: CIGNA Medicare |
$279.90
|
| Rate for Payer: HUMANA Commercial |
$279.90
|
| Rate for Payer: MEDICAID Medicaid |
$286.12
|
| Rate for Payer: MEDICARE Medicare |
$217.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$295.45
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$301.67
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$295.45
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$295.45
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$264.35
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$248.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$248.80
|
|
|
APPLICATION SPLINT SHORT LEG
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
APPLICATION SPLINT SHORT LEG
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
APPLY SHORT LEG SPLINT
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
APPLY SHORT LEG SPLINT
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: AETNA Commercial |
$305.90
|
| Rate for Payer: AETNA Medicare |
$289.80
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$305.90
|
| Rate for Payer: BCBS Healthlink |
$289.80
|
| Rate for Payer: BCBS HMK CHIP |
$289.80
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$289.80
|
| Rate for Payer: BCBS POS |
$305.90
|
| Rate for Payer: BCBS Traditional |
$322.00
|
| Rate for Payer: CASH_PRICE |
$257.60
|
| Rate for Payer: CIGNA Commercial |
$305.90
|
| Rate for Payer: CIGNA Medicare |
$289.80
|
| Rate for Payer: HUMANA Commercial |
$289.80
|
| Rate for Payer: MEDICAID Medicaid |
$296.24
|
| Rate for Payer: MEDICARE Medicare |
$225.40
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$305.90
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$312.34
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$305.90
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$305.90
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$273.70
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$257.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$257.60
|
|
|
APTT (005207)
|
Facility
IP
|
$16.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
APTT (005207)
|
Facility
OP
|
$16.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: AETNA Commercial |
$15.20
|
| Rate for Payer: AETNA Medicare |
$14.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$15.20
|
| Rate for Payer: BCBS Healthlink |
$14.40
|
| Rate for Payer: BCBS HMK CHIP |
$14.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$14.40
|
| Rate for Payer: BCBS POS |
$15.20
|
| Rate for Payer: BCBS Traditional |
$16.00
|
| Rate for Payer: CASH_PRICE |
$12.80
|
| Rate for Payer: CIGNA Commercial |
$15.20
|
| Rate for Payer: CIGNA Medicare |
$14.40
|
| Rate for Payer: HUMANA Commercial |
$14.40
|
| Rate for Payer: MEDICAID Medicaid |
$14.72
|
| Rate for Payer: MEDICARE Medicare |
$11.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$15.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$15.52
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$15.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$15.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$13.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$12.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$12.80
|
|
|
ARIPIPRAZOLE (ABILIFY) 5MG TAB NON FORM
|
Facility
OP
|
$108.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: AETNA Commercial |
$102.60
|
| Rate for Payer: AETNA Medicare |
$97.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$102.60
|
| Rate for Payer: BCBS Healthlink |
$97.20
|
| Rate for Payer: BCBS HMK CHIP |
$97.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$97.20
|
| Rate for Payer: BCBS POS |
$102.60
|
| Rate for Payer: BCBS Traditional |
$108.00
|
| Rate for Payer: CASH_PRICE |
$86.40
|
| Rate for Payer: CIGNA Commercial |
$102.60
|
| Rate for Payer: CIGNA Medicare |
$97.20
|
| Rate for Payer: HUMANA Commercial |
$97.20
|
| Rate for Payer: MEDICAID Medicaid |
$99.36
|
| Rate for Payer: MEDICARE Medicare |
$75.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$102.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$104.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$102.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$102.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$91.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$86.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$86.40
|
|
|
ARIPIPRAZOLE (ABILIFY) 5MG TAB NON FORM
|
Facility
IP
|
$108.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: AETNA Commercial |
$102.60
|
| Rate for Payer: AETNA Medicare |
$97.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$102.60
|
| Rate for Payer: BCBS Healthlink |
$97.20
|
| Rate for Payer: BCBS HMK CHIP |
$97.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$97.20
|
| Rate for Payer: BCBS POS |
$102.60
|
| Rate for Payer: BCBS Traditional |
$108.00
|
| Rate for Payer: CASH_PRICE |
$86.40
|
| Rate for Payer: CIGNA Commercial |
$102.60
|
| Rate for Payer: CIGNA Medicare |
$97.20
|
| Rate for Payer: HUMANA Commercial |
$97.20
|
| Rate for Payer: MEDICAID Medicaid |
$99.36
|
| Rate for Payer: MEDICARE Medicare |
$75.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$102.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$104.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$102.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$102.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$91.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$86.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$86.40
|
|
|
ARM SLING LG
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
ARM SLING LG
|
Facility
IP
|
$14.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
ARM SLING MED
|
Facility
IP
|
$14.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
|
ARM SLING MED
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: AETNA Commercial |
$13.30
|
| Rate for Payer: AETNA Medicare |
$12.60
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$13.30
|
| Rate for Payer: BCBS Healthlink |
$12.60
|
| Rate for Payer: BCBS HMK CHIP |
$12.60
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$12.60
|
| Rate for Payer: BCBS POS |
$13.30
|
| Rate for Payer: BCBS Traditional |
$14.00
|
| Rate for Payer: CASH_PRICE |
$11.20
|
| Rate for Payer: CIGNA Commercial |
$13.30
|
| Rate for Payer: CIGNA Medicare |
$12.60
|
| Rate for Payer: HUMANA Commercial |
$12.60
|
| Rate for Payer: MEDICAID Medicaid |
$12.88
|
| Rate for Payer: MEDICARE Medicare |
$9.80
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$13.30
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$13.58
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$13.30
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$13.30
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$11.90
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$11.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$11.20
|
|
