|
KNEE SPORT SLEEVE
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
KNEE STABILIZER LG LONG
|
Facility
OP
|
$76.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
KNEE STABILIZER LG LONG
|
Facility
IP
|
$76.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
KNEE STABILIZER MED LONG
|
Facility
IP
|
$95.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
KNEE STABILIZER MED LONG
|
Facility
OP
|
$95.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: AETNA Commercial |
$90.25
|
| Rate for Payer: AETNA Medicare |
$85.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$90.25
|
| Rate for Payer: BCBS Healthlink |
$85.50
|
| Rate for Payer: BCBS HMK CHIP |
$85.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$85.50
|
| Rate for Payer: BCBS POS |
$90.25
|
| Rate for Payer: BCBS Traditional |
$95.00
|
| Rate for Payer: CASH_PRICE |
$76.00
|
| Rate for Payer: CIGNA Commercial |
$90.25
|
| Rate for Payer: CIGNA Medicare |
$85.50
|
| Rate for Payer: HUMANA Commercial |
$85.50
|
| Rate for Payer: MEDICAID Medicaid |
$87.40
|
| Rate for Payer: MEDICARE Medicare |
$66.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$90.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$92.15
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$90.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$90.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$80.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$76.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$76.00
|
|
|
KNEE STABILIZER SM
|
Facility
OP
|
$76.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
KNEE STABILIZER SM
|
Facility
IP
|
$76.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
KNEE STABILIZER XL LONG
|
Facility
IP
|
$76.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
KNEE STABILIZER XL LONG
|
Facility
OP
|
$76.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: AETNA Commercial |
$72.20
|
| Rate for Payer: AETNA Medicare |
$68.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$72.20
|
| Rate for Payer: BCBS Healthlink |
$68.40
|
| Rate for Payer: BCBS HMK CHIP |
$68.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$68.40
|
| Rate for Payer: BCBS POS |
$72.20
|
| Rate for Payer: BCBS Traditional |
$76.00
|
| Rate for Payer: CASH_PRICE |
$60.80
|
| Rate for Payer: CIGNA Commercial |
$72.20
|
| Rate for Payer: CIGNA Medicare |
$68.40
|
| Rate for Payer: HUMANA Commercial |
$68.40
|
| Rate for Payer: MEDICAID Medicaid |
$69.92
|
| Rate for Payer: MEDICARE Medicare |
$53.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$72.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$73.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$72.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$72.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$64.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$60.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$60.80
|
|
|
KNEE SUPPORT W/PATELLA
|
Facility
IP
|
$273.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
KNEE SUPPORT W/PATELLA
|
Facility
OP
|
$273.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: AETNA Commercial |
$259.35
|
| Rate for Payer: AETNA Medicare |
$245.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$259.35
|
| Rate for Payer: BCBS Healthlink |
$245.70
|
| Rate for Payer: BCBS HMK CHIP |
$245.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$245.70
|
| Rate for Payer: BCBS POS |
$259.35
|
| Rate for Payer: BCBS Traditional |
$273.00
|
| Rate for Payer: CASH_PRICE |
$218.40
|
| Rate for Payer: CIGNA Commercial |
$259.35
|
| Rate for Payer: CIGNA Medicare |
$245.70
|
| Rate for Payer: HUMANA Commercial |
$245.70
|
| Rate for Payer: MEDICAID Medicaid |
$251.16
|
| Rate for Payer: MEDICARE Medicare |
$191.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$259.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$264.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$259.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$259.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$232.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$218.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$218.40
|
|
|
KNEE WRAP HINGED LG
|
Facility
OP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KNEE WRAP HINGED LG
|
Facility
IP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KNEE WRAP HINGED MD
|
Facility
OP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KNEE WRAP HINGED MD
|
Facility
IP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KNEE WRAP HINGED SM
|
Facility
OP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KNEE WRAP HINGED SM
|
Facility
IP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KNEE WRAP HINGED XL
|
Facility
OP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KNEE WRAP HINGED XL
|
Facility
IP
|
$185.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: AETNA Commercial |
$175.75
|
| Rate for Payer: AETNA Medicare |
$166.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$175.75
|
| Rate for Payer: BCBS Healthlink |
$166.50
|
| Rate for Payer: BCBS HMK CHIP |
$166.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$166.50
|
| Rate for Payer: BCBS POS |
$175.75
|
| Rate for Payer: BCBS Traditional |
$185.00
|
| Rate for Payer: CASH_PRICE |
$148.00
|
| Rate for Payer: CIGNA Commercial |
$175.75
|
| Rate for Payer: CIGNA Medicare |
$166.50
|
| Rate for Payer: HUMANA Commercial |
$166.50
|
| Rate for Payer: MEDICAID Medicaid |
$170.20
|
| Rate for Payer: MEDICARE Medicare |
$129.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$175.75
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$179.45
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$175.75
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$175.75
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$157.25
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$148.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$148.00
|
|
|
KOH PREP: SKIN, HAIR, OR NAILS
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
KOH PREP: SKIN, HAIR, OR NAILS
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: AETNA Commercial |
$55.10
|
| Rate for Payer: AETNA Medicare |
$52.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$55.10
|
| Rate for Payer: BCBS Healthlink |
$52.20
|
| Rate for Payer: BCBS HMK CHIP |
$52.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$52.20
|
| Rate for Payer: BCBS POS |
$55.10
|
| Rate for Payer: BCBS Traditional |
$58.00
|
| Rate for Payer: CASH_PRICE |
$46.40
|
| Rate for Payer: CIGNA Commercial |
$55.10
|
| Rate for Payer: CIGNA Medicare |
$52.20
|
| Rate for Payer: HUMANA Commercial |
$52.20
|
| Rate for Payer: MEDICAID Medicaid |
$53.36
|
| Rate for Payer: MEDICARE Medicare |
$40.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$55.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$56.26
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$55.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$55.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$49.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$46.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$46.40
|
|
|
LAB 24HR URINE CYSTINE
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 82131
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: AETNA Commercial |
$69.35
|
| Rate for Payer: AETNA Medicare |
$65.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$69.35
|
| Rate for Payer: BCBS Healthlink |
$65.70
|
| Rate for Payer: BCBS HMK CHIP |
$65.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$65.70
|
| Rate for Payer: BCBS POS |
$69.35
|
| Rate for Payer: BCBS Traditional |
$73.00
|
| Rate for Payer: CASH_PRICE |
$58.40
|
| Rate for Payer: CIGNA Commercial |
$69.35
|
| Rate for Payer: CIGNA Medicare |
$65.70
|
| Rate for Payer: HUMANA Commercial |
$65.70
|
| Rate for Payer: MEDICAID Medicaid |
$67.16
|
| Rate for Payer: MEDICARE Medicare |
$51.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$69.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$70.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$69.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$69.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$58.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$58.40
|
|
|
LAB 24HR URINE CYSTINE
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
CPT 82131
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: AETNA Commercial |
$69.35
|
| Rate for Payer: AETNA Medicare |
$65.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$69.35
|
| Rate for Payer: BCBS Healthlink |
$65.70
|
| Rate for Payer: BCBS HMK CHIP |
$65.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$65.70
|
| Rate for Payer: BCBS POS |
$69.35
|
| Rate for Payer: BCBS Traditional |
$73.00
|
| Rate for Payer: CASH_PRICE |
$58.40
|
| Rate for Payer: CIGNA Commercial |
$69.35
|
| Rate for Payer: CIGNA Medicare |
$65.70
|
| Rate for Payer: HUMANA Commercial |
$65.70
|
| Rate for Payer: MEDICAID Medicaid |
$67.16
|
| Rate for Payer: MEDICARE Medicare |
$51.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$69.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$70.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$69.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$69.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$58.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$58.40
|
|
|
LAB ACETYLCHOLINE RECEPTOR AB BINDING
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: AETNA Commercial |
$166.25
|
| Rate for Payer: AETNA Medicare |
$157.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$166.25
|
| Rate for Payer: BCBS Healthlink |
$157.50
|
| Rate for Payer: BCBS HMK CHIP |
$157.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$157.50
|
| Rate for Payer: BCBS POS |
$166.25
|
| Rate for Payer: BCBS Traditional |
$175.00
|
| Rate for Payer: CASH_PRICE |
$140.00
|
| Rate for Payer: CIGNA Commercial |
$166.25
|
| Rate for Payer: CIGNA Medicare |
$157.50
|
| Rate for Payer: HUMANA Commercial |
$157.50
|
| Rate for Payer: MEDICAID Medicaid |
$161.00
|
| Rate for Payer: MEDICARE Medicare |
$122.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$166.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$169.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$166.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$166.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$148.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$140.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$140.00
|
|
|
LAB ACETYLCHOLINE RECEPTOR AB BINDING
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
20211001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS HMK CHIP |
$157.50
|
| Rate for Payer: AETNA Commercial |
$166.25
|
| Rate for Payer: AETNA Medicare |
$157.50
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$166.25
|
| Rate for Payer: BCBS Healthlink |
$157.50
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$157.50
|
| Rate for Payer: BCBS POS |
$166.25
|
| Rate for Payer: BCBS Traditional |
$175.00
|
| Rate for Payer: CASH_PRICE |
$140.00
|
| Rate for Payer: CIGNA Commercial |
$166.25
|
| Rate for Payer: CIGNA Medicare |
$157.50
|
| Rate for Payer: HUMANA Commercial |
$157.50
|
| Rate for Payer: MEDICAID Medicaid |
$161.00
|
| Rate for Payer: MEDICARE Medicare |
$122.50
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$166.25
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$169.75
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$166.25
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$166.25
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$148.75
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$140.00
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$140.00
|
|
