Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PT PARAFFIN BATH

Facility

$71.00

Service Code	HCPCS 97018 GP
Hospital Charge Code	6197018
Hospital Revenue Code	420
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

PT PARAFFIN BATH

Facility

$71.00

Service Code	HCPCS 97018 GP
Hospital Charge Code	6197018
Hospital Revenue Code	420
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

PT PROSTHETIC SOCKS

Facility

$102.00

Service Code	HCPCS L8440
Hospital Charge Code	6199071
Hospital Revenue Code	274
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: BCBS MT CHIP	$91.80
Rate for Payer: BCBS MT Closed Plan Network	$96.90
Rate for Payer: BCBS MT HealthLink	$91.80
Rate for Payer: BCBS MT Medicare	$91.80
Rate for Payer: BCBS MT POS	$96.90
Rate for Payer: BCBS MT Traditional	$102.00
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial	$96.90
Rate for Payer: Cigna Medicare	$91.80
Rate for Payer: Medicaid All Medicaid	$93.84
Rate for Payer: Medicare All Medicare	$71.40
Rate for Payer: Monida Allegiance	$96.90
Rate for Payer: Monida First Choice Health	$98.94
Rate for Payer: Monida Montana Health Co-op	$96.90
Rate for Payer: Monida PacificSource	$96.90

PT PROSTHETIC SOCKS

Facility

$102.00

Service Code	HCPCS L8440
Hospital Charge Code	6199071
Hospital Revenue Code	274
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: BCBS MT CHIP	$91.80
Rate for Payer: BCBS MT Closed Plan Network	$96.90
Rate for Payer: BCBS MT HealthLink	$91.80
Rate for Payer: BCBS MT Medicare	$91.80
Rate for Payer: BCBS MT POS	$96.90
Rate for Payer: BCBS MT Traditional	$102.00
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial	$96.90
Rate for Payer: Cigna Medicare	$91.80
Rate for Payer: Medicaid All Medicaid	$93.84
Rate for Payer: Medicare All Medicare	$71.40
Rate for Payer: Monida Allegiance	$96.90
Rate for Payer: Monida First Choice Health	$98.94
Rate for Payer: Monida Montana Health Co-op	$96.90
Rate for Payer: Monida PacificSource	$96.90

PT RE-EVAL EST PLAN CARE

Facility

$134.00

Service Code	HCPCS 97164 GP,59
Hospital Charge Code	6197164
Hospital Revenue Code	420
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$134.00
Rate for Payer: Aetna Commercial	$127.30
Rate for Payer: Aetna Medicare	$120.60
Rate for Payer: BCBS MT CHIP	$120.60
Rate for Payer: BCBS MT Closed Plan Network	$127.30
Rate for Payer: BCBS MT HealthLink	$120.60
Rate for Payer: BCBS MT Medicare	$120.60
Rate for Payer: BCBS MT POS	$127.30
Rate for Payer: BCBS MT Traditional	$134.00
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cigna Commercial	$127.30
Rate for Payer: Cigna Medicare	$120.60
Rate for Payer: Medicaid All Medicaid	$123.28
Rate for Payer: Medicare All Medicare	$93.80
Rate for Payer: Monida Allegiance	$127.30
Rate for Payer: Monida First Choice Health	$129.98
Rate for Payer: Monida Montana Health Co-op	$127.30
Rate for Payer: Monida PacificSource	$127.30

PT RE-EVAL EST PLAN CARE

Facility

$134.00

Service Code	HCPCS 97164 GP,59
Hospital Charge Code	6197164
Hospital Revenue Code	420
Min. Negotiated Rate	$93.80
Max. Negotiated Rate	$134.00
Rate for Payer: Aetna Commercial	$127.30
Rate for Payer: Aetna Medicare	$120.60
Rate for Payer: BCBS MT CHIP	$120.60
Rate for Payer: BCBS MT Closed Plan Network	$127.30
Rate for Payer: BCBS MT HealthLink	$120.60
Rate for Payer: BCBS MT Medicare	$120.60
Rate for Payer: BCBS MT POS	$127.30
Rate for Payer: BCBS MT Traditional	$134.00
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cigna Commercial	$127.30
Rate for Payer: Cigna Medicare	$120.60
Rate for Payer: Medicaid All Medicaid	$123.28
Rate for Payer: Medicare All Medicare	$93.80
Rate for Payer: Monida Allegiance	$127.30
Rate for Payer: Monida First Choice Health	$129.98
Rate for Payer: Monida Montana Health Co-op	$127.30
Rate for Payer: Monida PacificSource	$127.30

PT SELF CARE HOME MGMT ADL

Facility

$113.00

Service Code	HCPCS 97535 GP
Hospital Charge Code	6197535
Hospital Revenue Code	420
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$107.35
Rate for Payer: Aetna Medicare	$101.70
Rate for Payer: BCBS MT CHIP	$101.70
Rate for Payer: BCBS MT Closed Plan Network	$107.35
Rate for Payer: BCBS MT HealthLink	$101.70
Rate for Payer: BCBS MT Medicare	$101.70
Rate for Payer: BCBS MT POS	$107.35
Rate for Payer: BCBS MT Traditional	$113.00
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial	$107.35
Rate for Payer: Cigna Medicare	$101.70
Rate for Payer: Medicaid All Medicaid	$103.96
Rate for Payer: Medicare All Medicare	$79.10
Rate for Payer: Monida Allegiance	$107.35
Rate for Payer: Monida First Choice Health	$109.61
Rate for Payer: Monida Montana Health Co-op	$107.35
Rate for Payer: Monida PacificSource	$107.35

PT SELF CARE HOME MGMT ADL

Facility

$113.00

Service Code	HCPCS 97535 GP
Hospital Charge Code	6197535
Hospital Revenue Code	420
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$107.35
Rate for Payer: Aetna Medicare	$101.70
Rate for Payer: BCBS MT CHIP	$101.70
Rate for Payer: BCBS MT Closed Plan Network	$107.35
Rate for Payer: BCBS MT HealthLink	$101.70
Rate for Payer: BCBS MT Medicare	$101.70
Rate for Payer: BCBS MT POS	$107.35
Rate for Payer: BCBS MT Traditional	$113.00
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial	$107.35
Rate for Payer: Cigna Medicare	$101.70
Rate for Payer: Medicaid All Medicaid	$103.96
Rate for Payer: Medicare All Medicare	$79.10
Rate for Payer: Monida Allegiance	$107.35
Rate for Payer: Monida First Choice Health	$109.61
Rate for Payer: Monida Montana Health Co-op	$107.35
Rate for Payer: Monida PacificSource	$107.35

PT SHARP DEBRIDEMENT

Facility

$213.00

Service Code	HCPCS 97602 GP
Hospital Charge Code	6107601
Hospital Revenue Code	420
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$202.35
Rate for Payer: Aetna Medicare	$191.70
Rate for Payer: BCBS MT CHIP	$191.70
Rate for Payer: BCBS MT Closed Plan Network	$202.35
Rate for Payer: BCBS MT HealthLink	$191.70
Rate for Payer: BCBS MT Medicare	$191.70
Rate for Payer: BCBS MT POS	$202.35
Rate for Payer: BCBS MT Traditional	$213.00
Rate for Payer: Cash Price	$191.70
Rate for Payer: Cigna Commercial	$202.35
Rate for Payer: Cigna Medicare	$191.70
Rate for Payer: Medicaid All Medicaid	$195.96
Rate for Payer: Medicare All Medicare	$149.10
Rate for Payer: Monida Allegiance	$202.35
Rate for Payer: Monida First Choice Health	$206.61
Rate for Payer: Monida Montana Health Co-op	$202.35
Rate for Payer: Monida PacificSource	$202.35

PT SHARP DEBRIDEMENT

Facility

$350.00

Service Code	HCPCS 97597 GP
Hospital Charge Code	6107597
Hospital Revenue Code	420
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare	$315.00
Rate for Payer: BCBS MT CHIP	$315.00
Rate for Payer: BCBS MT Closed Plan Network	$332.50
Rate for Payer: BCBS MT HealthLink	$315.00
Rate for Payer: BCBS MT Medicare	$315.00
Rate for Payer: BCBS MT POS	$332.50
Rate for Payer: BCBS MT Traditional	$350.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: Cigna Medicare	$315.00
Rate for Payer: Medicaid All Medicaid	$322.00
Rate for Payer: Medicare All Medicare	$245.00
Rate for Payer: Monida Allegiance	$332.50
Rate for Payer: Monida First Choice Health	$339.50
Rate for Payer: Monida Montana Health Co-op	$332.50
Rate for Payer: Monida PacificSource	$332.50

PT SHARP DEBRIDEMENT

Facility

$213.00

Service Code	HCPCS 97602 GP
Hospital Charge Code	6107601
Hospital Revenue Code	420
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$213.00
Rate for Payer: Aetna Commercial	$202.35
Rate for Payer: Aetna Medicare	$191.70
Rate for Payer: BCBS MT CHIP	$191.70
Rate for Payer: BCBS MT Closed Plan Network	$202.35
Rate for Payer: BCBS MT HealthLink	$191.70
Rate for Payer: BCBS MT Medicare	$191.70
Rate for Payer: BCBS MT POS	$202.35
Rate for Payer: BCBS MT Traditional	$213.00
Rate for Payer: Cash Price	$191.70
Rate for Payer: Cigna Commercial	$202.35
Rate for Payer: Cigna Medicare	$191.70
Rate for Payer: Medicaid All Medicaid	$195.96
Rate for Payer: Medicare All Medicare	$149.10
Rate for Payer: Monida Allegiance	$202.35
Rate for Payer: Monida First Choice Health	$206.61
Rate for Payer: Monida Montana Health Co-op	$202.35
Rate for Payer: Monida PacificSource	$202.35

PT SHARP DEBRIDEMENT

Facility

$350.00

Service Code	HCPCS 97597 GP
Hospital Charge Code	6107597
Hospital Revenue Code	420
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare	$315.00
Rate for Payer: BCBS MT CHIP	$315.00
Rate for Payer: BCBS MT Closed Plan Network	$332.50
Rate for Payer: BCBS MT HealthLink	$315.00
Rate for Payer: BCBS MT Medicare	$315.00
Rate for Payer: BCBS MT POS	$332.50
Rate for Payer: BCBS MT Traditional	$350.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: Cigna Medicare	$315.00
Rate for Payer: Medicaid All Medicaid	$322.00
Rate for Payer: Medicare All Medicare	$245.00
Rate for Payer: Monida Allegiance	$332.50
Rate for Payer: Monida First Choice Health	$339.50
Rate for Payer: Monida Montana Health Co-op	$332.50
Rate for Payer: Monida PacificSource	$332.50

PT SPECIAL REPORTS

Facility

$127.00

Service Code	HCPCS 99080
Hospital Charge Code	6199080
Hospital Revenue Code	420
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$127.00
Rate for Payer: Aetna Commercial	$120.65
Rate for Payer: Aetna Medicare	$114.30
Rate for Payer: BCBS MT CHIP	$114.30
Rate for Payer: BCBS MT Closed Plan Network	$120.65
Rate for Payer: BCBS MT HealthLink	$114.30
Rate for Payer: BCBS MT Medicare	$114.30
Rate for Payer: BCBS MT POS	$120.65
Rate for Payer: BCBS MT Traditional	$127.00
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial	$120.65
Rate for Payer: Cigna Medicare	$114.30
Rate for Payer: Medicaid All Medicaid	$116.84
Rate for Payer: Medicare All Medicare	$88.90
Rate for Payer: Monida Allegiance	$120.65
Rate for Payer: Monida First Choice Health	$123.19
Rate for Payer: Monida Montana Health Co-op	$120.65
Rate for Payer: Monida PacificSource	$120.65

PT SPECIAL REPORTS

Facility

$127.00

Service Code	HCPCS 99080
Hospital Charge Code	6199080
Hospital Revenue Code	420
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$127.00
Rate for Payer: Aetna Commercial	$120.65
Rate for Payer: Aetna Medicare	$114.30
Rate for Payer: BCBS MT CHIP	$114.30
Rate for Payer: BCBS MT Closed Plan Network	$120.65
Rate for Payer: BCBS MT HealthLink	$114.30
Rate for Payer: BCBS MT Medicare	$114.30
Rate for Payer: BCBS MT POS	$120.65
Rate for Payer: BCBS MT Traditional	$127.00
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial	$120.65
Rate for Payer: Cigna Medicare	$114.30
Rate for Payer: Medicaid All Medicaid	$116.84
Rate for Payer: Medicare All Medicare	$88.90
Rate for Payer: Monida Allegiance	$120.65
Rate for Payer: Monida First Choice Health	$123.19
Rate for Payer: Monida Montana Health Co-op	$120.65
Rate for Payer: Monida PacificSource	$120.65

PT STANDARDIZED DEVELOP TESTING

Facility

$54.00

Hospital Charge Code	6111111
Hospital Revenue Code	420
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

PT STANDARDIZED DEVELOP TESTING

Facility

$54.00

Hospital Charge Code	6111111
Hospital Revenue Code	420
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

PT THERA CANE

Facility

$102.00

Hospital Charge Code	6199998
Hospital Revenue Code	420
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: BCBS MT CHIP	$91.80
Rate for Payer: BCBS MT Closed Plan Network	$96.90
Rate for Payer: BCBS MT HealthLink	$91.80
Rate for Payer: BCBS MT Medicare	$91.80
Rate for Payer: BCBS MT POS	$96.90
Rate for Payer: BCBS MT Traditional	$102.00
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial	$96.90
Rate for Payer: Cigna Medicare	$91.80
Rate for Payer: Medicaid All Medicaid	$93.84
Rate for Payer: Medicare All Medicare	$71.40
Rate for Payer: Monida Allegiance	$96.90
Rate for Payer: Monida First Choice Health	$98.94
Rate for Payer: Monida Montana Health Co-op	$96.90
Rate for Payer: Monida PacificSource	$96.90

PT THERA CANE

Facility

$102.00

Hospital Charge Code	6199998
Hospital Revenue Code	420
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: BCBS MT CHIP	$91.80
Rate for Payer: BCBS MT Closed Plan Network	$96.90
Rate for Payer: BCBS MT HealthLink	$91.80
Rate for Payer: BCBS MT Medicare	$91.80
Rate for Payer: BCBS MT POS	$96.90
Rate for Payer: BCBS MT Traditional	$102.00
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial	$96.90
Rate for Payer: Cigna Medicare	$91.80
Rate for Payer: Medicaid All Medicaid	$93.84
Rate for Payer: Medicare All Medicare	$71.40
Rate for Payer: Monida Allegiance	$96.90
Rate for Payer: Monida First Choice Health	$98.94
Rate for Payer: Monida Montana Health Co-op	$96.90
Rate for Payer: Monida PacificSource	$96.90

PT THERAPEUTIC ACTIVITIES

Facility

$118.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	6197530
Hospital Revenue Code	420
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare	$106.20
Rate for Payer: BCBS MT CHIP	$106.20
Rate for Payer: BCBS MT Closed Plan Network	$112.10
Rate for Payer: BCBS MT HealthLink	$106.20
Rate for Payer: BCBS MT Medicare	$106.20
Rate for Payer: BCBS MT POS	$112.10
Rate for Payer: BCBS MT Traditional	$118.00
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna Commercial	$112.10
Rate for Payer: Cigna Medicare	$106.20
Rate for Payer: Medicaid All Medicaid	$108.56
Rate for Payer: Medicare All Medicare	$82.60
Rate for Payer: Monida Allegiance	$112.10
Rate for Payer: Monida First Choice Health	$114.46
Rate for Payer: Monida Montana Health Co-op	$112.10
Rate for Payer: Monida PacificSource	$112.10

PT THERAPEUTIC ACTIVITIES

Facility

$118.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	6197530
Hospital Revenue Code	420
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare	$106.20
Rate for Payer: BCBS MT CHIP	$106.20
Rate for Payer: BCBS MT Closed Plan Network	$112.10
Rate for Payer: BCBS MT HealthLink	$106.20
Rate for Payer: BCBS MT Medicare	$106.20
Rate for Payer: BCBS MT POS	$112.10
Rate for Payer: BCBS MT Traditional	$118.00
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna Commercial	$112.10
Rate for Payer: Cigna Medicare	$106.20
Rate for Payer: Medicaid All Medicaid	$108.56
Rate for Payer: Medicare All Medicare	$82.60
Rate for Payer: Monida Allegiance	$112.10
Rate for Payer: Monida First Choice Health	$114.46
Rate for Payer: Monida Montana Health Co-op	$112.10
Rate for Payer: Monida PacificSource	$112.10

PT THERAPEUTIC EXERCISES

Facility

$114.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	6197110
Hospital Revenue Code	420
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$108.30
Rate for Payer: Aetna Medicare	$102.60
Rate for Payer: BCBS MT CHIP	$102.60
Rate for Payer: BCBS MT Closed Plan Network	$108.30
Rate for Payer: BCBS MT HealthLink	$102.60
Rate for Payer: BCBS MT Medicare	$102.60
Rate for Payer: BCBS MT POS	$108.30
Rate for Payer: BCBS MT Traditional	$114.00
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cigna Commercial	$108.30
Rate for Payer: Cigna Medicare	$102.60
Rate for Payer: Medicaid All Medicaid	$104.88
Rate for Payer: Medicare All Medicare	$79.80
Rate for Payer: Monida Allegiance	$108.30
Rate for Payer: Monida First Choice Health	$110.58
Rate for Payer: Monida Montana Health Co-op	$108.30
Rate for Payer: Monida PacificSource	$108.30

PT THERAPEUTIC EXERCISES

Facility

$114.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	6197110
Hospital Revenue Code	420
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$108.30
Rate for Payer: Aetna Medicare	$102.60
Rate for Payer: BCBS MT CHIP	$102.60
Rate for Payer: BCBS MT Closed Plan Network	$108.30
Rate for Payer: BCBS MT HealthLink	$102.60
Rate for Payer: BCBS MT Medicare	$102.60
Rate for Payer: BCBS MT POS	$108.30
Rate for Payer: BCBS MT Traditional	$114.00
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cigna Commercial	$108.30
Rate for Payer: Cigna Medicare	$102.60
Rate for Payer: Medicaid All Medicaid	$104.88
Rate for Payer: Medicare All Medicare	$79.80
Rate for Payer: Monida Allegiance	$108.30
Rate for Payer: Monida First Choice Health	$110.58
Rate for Payer: Monida Montana Health Co-op	$108.30
Rate for Payer: Monida PacificSource	$108.30

PT THERAPEUTIC MASSAGE

Facility

$93.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	6197124
Hospital Revenue Code	420
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$88.35
Rate for Payer: Aetna Medicare	$83.70
Rate for Payer: BCBS MT CHIP	$83.70
Rate for Payer: BCBS MT Closed Plan Network	$88.35
Rate for Payer: BCBS MT HealthLink	$83.70
Rate for Payer: BCBS MT Medicare	$83.70
Rate for Payer: BCBS MT POS	$88.35
Rate for Payer: BCBS MT Traditional	$93.00
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna Commercial	$88.35
Rate for Payer: Cigna Medicare	$83.70
Rate for Payer: Medicaid All Medicaid	$85.56
Rate for Payer: Medicare All Medicare	$65.10
Rate for Payer: Monida Allegiance	$88.35
Rate for Payer: Monida First Choice Health	$90.21
Rate for Payer: Monida Montana Health Co-op	$88.35
Rate for Payer: Monida PacificSource	$88.35

PT THERAPEUTIC MASSAGE

Facility

$93.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	6197124
Hospital Revenue Code	420
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$88.35
Rate for Payer: Aetna Medicare	$83.70
Rate for Payer: BCBS MT CHIP	$83.70
Rate for Payer: BCBS MT Closed Plan Network	$88.35
Rate for Payer: BCBS MT HealthLink	$83.70
Rate for Payer: BCBS MT Medicare	$83.70
Rate for Payer: BCBS MT POS	$88.35
Rate for Payer: BCBS MT Traditional	$93.00
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna Commercial	$88.35
Rate for Payer: Cigna Medicare	$83.70
Rate for Payer: Medicaid All Medicaid	$85.56
Rate for Payer: Medicare All Medicare	$65.10
Rate for Payer: Monida Allegiance	$88.35
Rate for Payer: Monida First Choice Health	$90.21
Rate for Payer: Monida Montana Health Co-op	$88.35
Rate for Payer: Monida PacificSource	$88.35

PT THERAPEUTIC PROC GROUP

Facility

$99.00

Service Code	HCPCS 97150 GP
Hospital Charge Code	6197150
Hospital Revenue Code	420
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare	$89.10
Rate for Payer: BCBS MT CHIP	$89.10
Rate for Payer: BCBS MT Closed Plan Network	$94.05
Rate for Payer: BCBS MT HealthLink	$89.10
Rate for Payer: BCBS MT Medicare	$89.10
Rate for Payer: BCBS MT POS	$94.05
Rate for Payer: BCBS MT Traditional	$99.00
Rate for Payer: Cash Price	$89.10
Rate for Payer: Cigna Commercial	$94.05
Rate for Payer: Cigna Medicare	$89.10
Rate for Payer: Medicaid All Medicaid	$91.08
Rate for Payer: Medicare All Medicare	$69.30
Rate for Payer: Monida Allegiance	$94.05
Rate for Payer: Monida First Choice Health	$96.03
Rate for Payer: Monida Montana Health Co-op	$94.05
Rate for Payer: Monida PacificSource	$94.05

Know your out-of-pocket cost for care.

All Charges