Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PROTHROMBIN GENE ANALYSIS (511162)

Facility

$270.00

Service Code	HCPCS 81240
Hospital Charge Code	4081240
Hospital Revenue Code	301
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare	$243.00
Rate for Payer: BCBS MT CHIP	$243.00
Rate for Payer: BCBS MT Closed Plan Network	$256.50
Rate for Payer: BCBS MT HealthLink	$243.00
Rate for Payer: BCBS MT Medicare	$243.00
Rate for Payer: BCBS MT POS	$256.50
Rate for Payer: BCBS MT Traditional	$270.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cigna Commercial	$256.50
Rate for Payer: Cigna Medicare	$243.00
Rate for Payer: Medicaid All Medicaid	$248.40
Rate for Payer: Medicare All Medicare	$189.00
Rate for Payer: Monida Allegiance	$256.50
Rate for Payer: Monida First Choice Health	$261.90
Rate for Payer: Monida Montana Health Co-op	$256.50
Rate for Payer: Monida PacificSource	$256.50

PROTHROMBIN TIME (005199)

Facility

$7.00

Service Code	HCPCS 85610
Hospital Charge Code	4000068
Hospital Revenue Code	300
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare	$6.30
Rate for Payer: BCBS MT CHIP	$6.30
Rate for Payer: BCBS MT Closed Plan Network	$6.65
Rate for Payer: BCBS MT HealthLink	$6.30
Rate for Payer: BCBS MT Medicare	$6.30
Rate for Payer: BCBS MT POS	$6.65
Rate for Payer: BCBS MT Traditional	$7.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cigna Commercial	$6.65
Rate for Payer: Cigna Medicare	$6.30
Rate for Payer: Medicaid All Medicaid	$6.44
Rate for Payer: Medicare All Medicare	$4.90
Rate for Payer: Monida Allegiance	$6.65
Rate for Payer: Monida First Choice Health	$6.79
Rate for Payer: Monida Montana Health Co-op	$6.65
Rate for Payer: Monida PacificSource	$6.65

PROTHROMBIN TIME (005199)

Facility

$7.00

Service Code	HCPCS 85610
Hospital Charge Code	4000068
Hospital Revenue Code	300
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare	$6.30
Rate for Payer: BCBS MT CHIP	$6.30
Rate for Payer: BCBS MT Closed Plan Network	$6.65
Rate for Payer: BCBS MT HealthLink	$6.30
Rate for Payer: BCBS MT Medicare	$6.30
Rate for Payer: BCBS MT POS	$6.65
Rate for Payer: BCBS MT Traditional	$7.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cigna Commercial	$6.65
Rate for Payer: Cigna Medicare	$6.30
Rate for Payer: Medicaid All Medicaid	$6.44
Rate for Payer: Medicare All Medicare	$4.90
Rate for Payer: Monida Allegiance	$6.65
Rate for Payer: Monida First Choice Health	$6.79
Rate for Payer: Monida Montana Health Co-op	$6.65
Rate for Payer: Monida PacificSource	$6.65

PROTIME/INR

Facility

$67.00

Service Code	HCPCS 85610
Hospital Charge Code	4085610
Hospital Revenue Code	300
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare	$60.30
Rate for Payer: BCBS MT CHIP	$60.30
Rate for Payer: BCBS MT Closed Plan Network	$63.65
Rate for Payer: BCBS MT HealthLink	$60.30
Rate for Payer: BCBS MT Medicare	$60.30
Rate for Payer: BCBS MT POS	$63.65
Rate for Payer: BCBS MT Traditional	$67.00
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial	$63.65
Rate for Payer: Cigna Medicare	$60.30
Rate for Payer: Medicaid All Medicaid	$61.64
Rate for Payer: Medicare All Medicare	$46.90
Rate for Payer: Monida Allegiance	$63.65
Rate for Payer: Monida First Choice Health	$64.99
Rate for Payer: Monida Montana Health Co-op	$63.65
Rate for Payer: Monida PacificSource	$63.65

PROTIME/INR

Facility

$67.00

Service Code	HCPCS 85610
Hospital Charge Code	4085610
Hospital Revenue Code	300
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare	$60.30
Rate for Payer: BCBS MT CHIP	$60.30
Rate for Payer: BCBS MT Closed Plan Network	$63.65
Rate for Payer: BCBS MT HealthLink	$60.30
Rate for Payer: BCBS MT Medicare	$60.30
Rate for Payer: BCBS MT POS	$63.65
Rate for Payer: BCBS MT Traditional	$67.00
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial	$63.65
Rate for Payer: Cigna Medicare	$60.30
Rate for Payer: Medicaid All Medicaid	$61.64
Rate for Payer: Medicare All Medicare	$46.90
Rate for Payer: Monida Allegiance	$63.65
Rate for Payer: Monida First Choice Health	$64.99
Rate for Payer: Monida Montana Health Co-op	$63.65
Rate for Payer: Monida PacificSource	$63.65

.PSA FREE (480772)

Facility

$32.00

Service Code	HCPCS 84154
Hospital Charge Code	4084154
Hospital Revenue Code	301
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare	$28.80
Rate for Payer: BCBS MT CHIP	$28.80
Rate for Payer: BCBS MT Closed Plan Network	$30.40
Rate for Payer: BCBS MT HealthLink	$28.80
Rate for Payer: BCBS MT Medicare	$28.80
Rate for Payer: BCBS MT POS	$30.40
Rate for Payer: BCBS MT Traditional	$32.00
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial	$30.40
Rate for Payer: Cigna Medicare	$28.80
Rate for Payer: Medicaid All Medicaid	$29.44
Rate for Payer: Medicare All Medicare	$22.40
Rate for Payer: Monida Allegiance	$30.40
Rate for Payer: Monida First Choice Health	$31.04
Rate for Payer: Monida Montana Health Co-op	$30.40
Rate for Payer: Monida PacificSource	$30.40

.PSA FREE (480772)

Facility

$32.00

Service Code	HCPCS 84154
Hospital Charge Code	4084154
Hospital Revenue Code	301
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare	$28.80
Rate for Payer: BCBS MT CHIP	$28.80
Rate for Payer: BCBS MT Closed Plan Network	$30.40
Rate for Payer: BCBS MT HealthLink	$28.80
Rate for Payer: BCBS MT Medicare	$28.80
Rate for Payer: BCBS MT POS	$30.40
Rate for Payer: BCBS MT Traditional	$32.00
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial	$30.40
Rate for Payer: Cigna Medicare	$28.80
Rate for Payer: Medicaid All Medicaid	$29.44
Rate for Payer: Medicare All Medicare	$22.40
Rate for Payer: Monida Allegiance	$30.40
Rate for Payer: Monida First Choice Health	$31.04
Rate for Payer: Monida Montana Health Co-op	$30.40
Rate for Payer: Monida PacificSource	$30.40

PSA TOTAL W/ REFLEX TO PSA FREE (480772)

Facility

$23.00

Service Code	HCPCS 84153
Hospital Charge Code	4041531
Hospital Revenue Code	301
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$21.85
Rate for Payer: Aetna Medicare	$20.70
Rate for Payer: BCBS MT CHIP	$20.70
Rate for Payer: BCBS MT Closed Plan Network	$21.85
Rate for Payer: BCBS MT HealthLink	$20.70
Rate for Payer: BCBS MT Medicare	$20.70
Rate for Payer: BCBS MT POS	$21.85
Rate for Payer: BCBS MT Traditional	$23.00
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cigna Commercial	$21.85
Rate for Payer: Cigna Medicare	$20.70
Rate for Payer: Medicaid All Medicaid	$21.16
Rate for Payer: Medicare All Medicare	$16.10
Rate for Payer: Monida Allegiance	$21.85
Rate for Payer: Monida First Choice Health	$22.31
Rate for Payer: Monida Montana Health Co-op	$21.85
Rate for Payer: Monida PacificSource	$21.85

PSA TOTAL W/ REFLEX TO PSA FREE (480772)

Facility

$23.00

Service Code	HCPCS 84153
Hospital Charge Code	4041531
Hospital Revenue Code	301
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$21.85
Rate for Payer: Aetna Medicare	$20.70
Rate for Payer: BCBS MT CHIP	$20.70
Rate for Payer: BCBS MT Closed Plan Network	$21.85
Rate for Payer: BCBS MT HealthLink	$20.70
Rate for Payer: BCBS MT Medicare	$20.70
Rate for Payer: BCBS MT POS	$21.85
Rate for Payer: BCBS MT Traditional	$23.00
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cigna Commercial	$21.85
Rate for Payer: Cigna Medicare	$20.70
Rate for Payer: Medicaid All Medicaid	$21.16
Rate for Payer: Medicare All Medicare	$16.10
Rate for Payer: Monida Allegiance	$21.85
Rate for Payer: Monida First Choice Health	$22.31
Rate for Payer: Monida Montana Health Co-op	$21.85
Rate for Payer: Monida PacificSource	$21.85

PSYCHOTHERAPY W/ PT 45 W/ E/M

Facility

$190.00

Service Code	HCPCS 90836
Hospital Charge Code	8190836
Hospital Revenue Code	900
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare	$171.00
Rate for Payer: BCBS MT CHIP	$171.00
Rate for Payer: BCBS MT Closed Plan Network	$180.50
Rate for Payer: BCBS MT HealthLink	$171.00
Rate for Payer: BCBS MT Medicare	$171.00
Rate for Payer: BCBS MT POS	$180.50
Rate for Payer: BCBS MT Traditional	$190.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial	$180.50
Rate for Payer: Cigna Medicare	$171.00
Rate for Payer: Medicaid All Medicaid	$174.80
Rate for Payer: Medicare All Medicare	$133.00
Rate for Payer: Monida Allegiance	$180.50
Rate for Payer: Monida First Choice Health	$184.30
Rate for Payer: Monida Montana Health Co-op	$180.50
Rate for Payer: Monida PacificSource	$180.50

PSYCHOTHERAPY W/ PT 45 W/ E/M

Facility

$190.00

Service Code	HCPCS 90836
Hospital Charge Code	8190836
Hospital Revenue Code	900
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare	$171.00
Rate for Payer: BCBS MT CHIP	$171.00
Rate for Payer: BCBS MT Closed Plan Network	$180.50
Rate for Payer: BCBS MT HealthLink	$171.00
Rate for Payer: BCBS MT Medicare	$171.00
Rate for Payer: BCBS MT POS	$180.50
Rate for Payer: BCBS MT Traditional	$190.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial	$180.50
Rate for Payer: Cigna Medicare	$171.00
Rate for Payer: Medicaid All Medicaid	$174.80
Rate for Payer: Medicare All Medicare	$133.00
Rate for Payer: Monida Allegiance	$180.50
Rate for Payer: Monida First Choice Health	$184.30
Rate for Payer: Monida Montana Health Co-op	$180.50
Rate for Payer: Monida PacificSource	$180.50

PSYCHOTHERAPY W/ PT 60 W/ E/M

Facility

$251.00

Service Code	HCPCS 90838
Hospital Charge Code	8190838
Hospital Revenue Code	900
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$251.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare	$225.90
Rate for Payer: BCBS MT CHIP	$225.90
Rate for Payer: BCBS MT Closed Plan Network	$238.45
Rate for Payer: BCBS MT HealthLink	$225.90
Rate for Payer: BCBS MT Medicare	$225.90
Rate for Payer: BCBS MT POS	$238.45
Rate for Payer: BCBS MT Traditional	$251.00
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cigna Commercial	$238.45
Rate for Payer: Cigna Medicare	$225.90
Rate for Payer: Medicaid All Medicaid	$230.92
Rate for Payer: Medicare All Medicare	$175.70
Rate for Payer: Monida Allegiance	$238.45
Rate for Payer: Monida First Choice Health	$243.47
Rate for Payer: Monida Montana Health Co-op	$238.45
Rate for Payer: Monida PacificSource	$238.45

PSYCHOTHERAPY W/ PT 60 W/ E/M

Facility

$251.00

Service Code	HCPCS 90838
Hospital Charge Code	8190838
Hospital Revenue Code	900
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$251.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare	$225.90
Rate for Payer: BCBS MT CHIP	$225.90
Rate for Payer: BCBS MT Closed Plan Network	$238.45
Rate for Payer: BCBS MT HealthLink	$225.90
Rate for Payer: BCBS MT Medicare	$225.90
Rate for Payer: BCBS MT POS	$238.45
Rate for Payer: BCBS MT Traditional	$251.00
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cigna Commercial	$238.45
Rate for Payer: Cigna Medicare	$225.90
Rate for Payer: Medicaid All Medicaid	$230.92
Rate for Payer: Medicare All Medicare	$175.70
Rate for Payer: Monida Allegiance	$238.45
Rate for Payer: Monida First Choice Health	$243.47
Rate for Payer: Monida Montana Health Co-op	$238.45
Rate for Payer: Monida PacificSource	$238.45

PSYCOTHERAPY CRISIS +30 MIN

Facility

$147.00

Service Code	HCPCS 90840
Hospital Charge Code	8190840
Hospital Revenue Code	900
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$139.65
Rate for Payer: Aetna Medicare	$132.30
Rate for Payer: BCBS MT CHIP	$132.30
Rate for Payer: BCBS MT Closed Plan Network	$139.65
Rate for Payer: BCBS MT HealthLink	$132.30
Rate for Payer: BCBS MT Medicare	$132.30
Rate for Payer: BCBS MT POS	$139.65
Rate for Payer: BCBS MT Traditional	$147.00
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial	$139.65
Rate for Payer: Cigna Medicare	$132.30
Rate for Payer: Medicaid All Medicaid	$135.24
Rate for Payer: Medicare All Medicare	$102.90
Rate for Payer: Monida Allegiance	$139.65
Rate for Payer: Monida First Choice Health	$142.59
Rate for Payer: Monida Montana Health Co-op	$139.65
Rate for Payer: Monida PacificSource	$139.65

PSYCOTHERAPY CRISIS +30 MIN

Facility

$147.00

Service Code	HCPCS 90840
Hospital Charge Code	8190840
Hospital Revenue Code	900
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$139.65
Rate for Payer: Aetna Medicare	$132.30
Rate for Payer: BCBS MT CHIP	$132.30
Rate for Payer: BCBS MT Closed Plan Network	$139.65
Rate for Payer: BCBS MT HealthLink	$132.30
Rate for Payer: BCBS MT Medicare	$132.30
Rate for Payer: BCBS MT POS	$139.65
Rate for Payer: BCBS MT Traditional	$147.00
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial	$139.65
Rate for Payer: Cigna Medicare	$132.30
Rate for Payer: Medicaid All Medicaid	$135.24
Rate for Payer: Medicare All Medicare	$102.90
Rate for Payer: Monida Allegiance	$139.65
Rate for Payer: Monida First Choice Health	$142.59
Rate for Payer: Monida Montana Health Co-op	$139.65
Rate for Payer: Monida PacificSource	$139.65

PSYCOTHERAPY W/ PT 30 MIN

Facility

$147.00

Service Code	HCPCS 90832
Hospital Charge Code	8190832
Hospital Revenue Code	900
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$139.65
Rate for Payer: Aetna Medicare	$132.30
Rate for Payer: BCBS MT CHIP	$132.30
Rate for Payer: BCBS MT Closed Plan Network	$139.65
Rate for Payer: BCBS MT HealthLink	$132.30
Rate for Payer: BCBS MT Medicare	$132.30
Rate for Payer: BCBS MT POS	$139.65
Rate for Payer: BCBS MT Traditional	$147.00
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial	$139.65
Rate for Payer: Cigna Medicare	$132.30
Rate for Payer: Medicaid All Medicaid	$135.24
Rate for Payer: Medicare All Medicare	$102.90
Rate for Payer: Monida Allegiance	$139.65
Rate for Payer: Monida First Choice Health	$142.59
Rate for Payer: Monida Montana Health Co-op	$139.65
Rate for Payer: Monida PacificSource	$139.65

PSYCOTHERAPY W/ PT 30 MIN

Facility

$147.00

Service Code	HCPCS 90832
Hospital Charge Code	8190832
Hospital Revenue Code	900
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$139.65
Rate for Payer: Aetna Medicare	$132.30
Rate for Payer: BCBS MT CHIP	$132.30
Rate for Payer: BCBS MT Closed Plan Network	$139.65
Rate for Payer: BCBS MT HealthLink	$132.30
Rate for Payer: BCBS MT Medicare	$132.30
Rate for Payer: BCBS MT POS	$139.65
Rate for Payer: BCBS MT Traditional	$147.00
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial	$139.65
Rate for Payer: Cigna Medicare	$132.30
Rate for Payer: Medicaid All Medicaid	$135.24
Rate for Payer: Medicare All Medicare	$102.90
Rate for Payer: Monida Allegiance	$139.65
Rate for Payer: Monida First Choice Health	$142.59
Rate for Payer: Monida Montana Health Co-op	$139.65
Rate for Payer: Monida PacificSource	$139.65

PSYCOTHERAPY W/ PT 30 MIN W E/M

Facility

$153.00

Service Code	HCPCS 90833
Hospital Charge Code	8190833
Hospital Revenue Code	900
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$145.35
Rate for Payer: Aetna Medicare	$137.70
Rate for Payer: BCBS MT CHIP	$137.70
Rate for Payer: BCBS MT Closed Plan Network	$145.35
Rate for Payer: BCBS MT HealthLink	$137.70
Rate for Payer: BCBS MT Medicare	$137.70
Rate for Payer: BCBS MT POS	$145.35
Rate for Payer: BCBS MT Traditional	$153.00
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial	$145.35
Rate for Payer: Cigna Medicare	$137.70
Rate for Payer: Medicaid All Medicaid	$140.76
Rate for Payer: Medicare All Medicare	$107.10
Rate for Payer: Monida Allegiance	$145.35
Rate for Payer: Monida First Choice Health	$148.41
Rate for Payer: Monida Montana Health Co-op	$145.35
Rate for Payer: Monida PacificSource	$145.35

PSYCOTHERAPY W/ PT 30 MIN W E/M

Facility

$153.00

Service Code	HCPCS 90833
Hospital Charge Code	8190833
Hospital Revenue Code	900
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$145.35
Rate for Payer: Aetna Medicare	$137.70
Rate for Payer: BCBS MT CHIP	$137.70
Rate for Payer: BCBS MT Closed Plan Network	$145.35
Rate for Payer: BCBS MT HealthLink	$137.70
Rate for Payer: BCBS MT Medicare	$137.70
Rate for Payer: BCBS MT POS	$145.35
Rate for Payer: BCBS MT Traditional	$153.00
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial	$145.35
Rate for Payer: Cigna Medicare	$137.70
Rate for Payer: Medicaid All Medicaid	$140.76
Rate for Payer: Medicare All Medicare	$107.10
Rate for Payer: Monida Allegiance	$145.35
Rate for Payer: Monida First Choice Health	$148.41
Rate for Payer: Monida Montana Health Co-op	$145.35
Rate for Payer: Monida PacificSource	$145.35

PSYCOTHERAPY W/ PT 45 MIN

Facility

$196.00

Service Code	HCPCS 90834
Hospital Charge Code	8190834
Hospital Revenue Code	900
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$196.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare	$176.40
Rate for Payer: BCBS MT CHIP	$176.40
Rate for Payer: BCBS MT Closed Plan Network	$186.20
Rate for Payer: BCBS MT HealthLink	$176.40
Rate for Payer: BCBS MT Medicare	$176.40
Rate for Payer: BCBS MT POS	$186.20
Rate for Payer: BCBS MT Traditional	$196.00
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cigna Commercial	$186.20
Rate for Payer: Cigna Medicare	$176.40
Rate for Payer: Medicaid All Medicaid	$180.32
Rate for Payer: Medicare All Medicare	$137.20
Rate for Payer: Monida Allegiance	$186.20
Rate for Payer: Monida First Choice Health	$190.12
Rate for Payer: Monida Montana Health Co-op	$186.20
Rate for Payer: Monida PacificSource	$186.20

PSYCOTHERAPY W/ PT 45 MIN

Facility

$196.00

Service Code	HCPCS 90834
Hospital Charge Code	8190834
Hospital Revenue Code	900
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$196.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare	$176.40
Rate for Payer: BCBS MT CHIP	$176.40
Rate for Payer: BCBS MT Closed Plan Network	$186.20
Rate for Payer: BCBS MT HealthLink	$176.40
Rate for Payer: BCBS MT Medicare	$176.40
Rate for Payer: BCBS MT POS	$186.20
Rate for Payer: BCBS MT Traditional	$196.00
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cigna Commercial	$186.20
Rate for Payer: Cigna Medicare	$176.40
Rate for Payer: Medicaid All Medicaid	$180.32
Rate for Payer: Medicare All Medicare	$137.20
Rate for Payer: Monida Allegiance	$186.20
Rate for Payer: Monida First Choice Health	$190.12
Rate for Payer: Monida Montana Health Co-op	$186.20
Rate for Payer: Monida PacificSource	$186.20

PSYCOTHERAPY W/ PT 60 MIN

Facility

$290.00

Service Code	HCPCS 90837
Hospital Charge Code	8190837
Hospital Revenue Code	900
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare	$261.00
Rate for Payer: BCBS MT CHIP	$261.00
Rate for Payer: BCBS MT Closed Plan Network	$275.50
Rate for Payer: BCBS MT HealthLink	$261.00
Rate for Payer: BCBS MT Medicare	$261.00
Rate for Payer: BCBS MT POS	$275.50
Rate for Payer: BCBS MT Traditional	$290.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: Cigna Medicare	$261.00
Rate for Payer: Medicaid All Medicaid	$266.80
Rate for Payer: Medicare All Medicare	$203.00
Rate for Payer: Monida Allegiance	$275.50
Rate for Payer: Monida First Choice Health	$281.30
Rate for Payer: Monida Montana Health Co-op	$275.50
Rate for Payer: Monida PacificSource	$275.50

PSYCOTHERAPY W/ PT 60 MIN

Facility

$290.00

Service Code	HCPCS 90837
Hospital Charge Code	8190837
Hospital Revenue Code	900
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare	$261.00
Rate for Payer: BCBS MT CHIP	$261.00
Rate for Payer: BCBS MT Closed Plan Network	$275.50
Rate for Payer: BCBS MT HealthLink	$261.00
Rate for Payer: BCBS MT Medicare	$261.00
Rate for Payer: BCBS MT POS	$275.50
Rate for Payer: BCBS MT Traditional	$290.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: Cigna Medicare	$261.00
Rate for Payer: Medicaid All Medicaid	$266.80
Rate for Payer: Medicare All Medicare	$203.00
Rate for Payer: Monida Allegiance	$275.50
Rate for Payer: Monida First Choice Health	$281.30
Rate for Payer: Monida Montana Health Co-op	$275.50
Rate for Payer: Monida PacificSource	$275.50

PSYCOTHERAPY W/ PT 60 MIN W E/M

Facility

$251.00

Service Code	HCPCS 90838
Hospital Charge Code	8090838
Hospital Revenue Code	900
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$251.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare	$225.90
Rate for Payer: BCBS MT CHIP	$225.90
Rate for Payer: BCBS MT Closed Plan Network	$238.45
Rate for Payer: BCBS MT HealthLink	$225.90
Rate for Payer: BCBS MT Medicare	$225.90
Rate for Payer: BCBS MT POS	$238.45
Rate for Payer: BCBS MT Traditional	$251.00
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cigna Commercial	$238.45
Rate for Payer: Cigna Medicare	$225.90
Rate for Payer: Medicaid All Medicaid	$230.92
Rate for Payer: Medicare All Medicare	$175.70
Rate for Payer: Monida Allegiance	$238.45
Rate for Payer: Monida First Choice Health	$243.47
Rate for Payer: Monida Montana Health Co-op	$238.45
Rate for Payer: Monida PacificSource	$238.45

PSYCOTHERAPY W/ PT 60 MIN W E/M

Facility

$251.00

Service Code	HCPCS 90838
Hospital Charge Code	8090838
Hospital Revenue Code	900
Min. Negotiated Rate	$175.70
Max. Negotiated Rate	$251.00
Rate for Payer: Aetna Commercial	$238.45
Rate for Payer: Aetna Medicare	$225.90
Rate for Payer: BCBS MT CHIP	$225.90
Rate for Payer: BCBS MT Closed Plan Network	$238.45
Rate for Payer: BCBS MT HealthLink	$225.90
Rate for Payer: BCBS MT Medicare	$225.90
Rate for Payer: BCBS MT POS	$238.45
Rate for Payer: BCBS MT Traditional	$251.00
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cigna Commercial	$238.45
Rate for Payer: Cigna Medicare	$225.90
Rate for Payer: Medicaid All Medicaid	$230.92
Rate for Payer: Medicare All Medicare	$175.70
Rate for Payer: Monida Allegiance	$238.45
Rate for Payer: Monida First Choice Health	$243.47
Rate for Payer: Monida Montana Health Co-op	$238.45
Rate for Payer: Monida PacificSource	$238.45

Know your out-of-pocket cost for care.

All Charges