Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

TRIGLYCERIDES

Facility

$76.00

Service Code	HCPCS 84478
Hospital Charge Code	4084478
Hospital Revenue Code	301
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 MT CHIP	$68.40
Rate for Payer: BCBS MT Closed Plan Network	$72.20
Rate for Payer: BCBS MT HealthLink	$68.40
Rate for Payer: BCBS MT Medicare	$68.40
Rate for Payer: BCBS MT POS	$72.20
Rate for Payer: BCBS MT Traditional	$76.00
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cigna Commercial	$72.20
Rate for Payer: Cigna Medicare	$68.40
Rate for Payer: Medicaid All Medicaid	$69.92
Rate for Payer: Medicare All Medicare	$53.20
Rate for Payer: Monida Allegiance	$72.20
Rate for Payer: Monida First Choice Health	$73.72
Rate for Payer: Monida Montana Health Co-op	$72.20
Rate for Payer: Monida PacificSource	$72.20

TRIGLYCERIDES

Facility

$76.00

Service Code	HCPCS 84478
Hospital Charge Code	4084478
Hospital Revenue Code	301
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 MT CHIP	$68.40
Rate for Payer: BCBS MT Closed Plan Network	$72.20
Rate for Payer: BCBS MT HealthLink	$68.40
Rate for Payer: BCBS MT Medicare	$68.40
Rate for Payer: BCBS MT POS	$72.20
Rate for Payer: BCBS MT Traditional	$76.00
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cigna Commercial	$72.20
Rate for Payer: Cigna Medicare	$68.40
Rate for Payer: Medicaid All Medicaid	$69.92
Rate for Payer: Medicare All Medicare	$53.20
Rate for Payer: Monida Allegiance	$72.20
Rate for Payer: Monida First Choice Health	$73.72
Rate for Payer: Monida Montana Health Co-op	$72.20
Rate for Payer: Monida PacificSource	$72.20

TR IMMUNIZATION ADMIN EA ADDTL VACCINE

Facility

$38.00

Service Code	HCPCS 90472
Hospital Charge Code	590472
Hospital Revenue Code	771
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare	$34.20
Rate for Payer: BCBS MT CHIP	$34.20
Rate for Payer: BCBS MT Closed Plan Network	$36.10
Rate for Payer: BCBS MT HealthLink	$34.20
Rate for Payer: BCBS MT Medicare	$34.20
Rate for Payer: BCBS MT POS	$36.10
Rate for Payer: BCBS MT Traditional	$38.00
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cigna Commercial	$36.10
Rate for Payer: Cigna Medicare	$34.20
Rate for Payer: Medicaid All Medicaid	$34.96
Rate for Payer: Medicare All Medicare	$26.60
Rate for Payer: Monida Allegiance	$36.10
Rate for Payer: Monida First Choice Health	$36.86
Rate for Payer: Monida Montana Health Co-op	$36.10
Rate for Payer: Monida PacificSource	$36.10

TR IMMUNIZATION ADMIN EA ADDTL VACCINE

Facility

$38.00

Service Code	HCPCS 90472
Hospital Charge Code	590472
Hospital Revenue Code	771
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare	$34.20
Rate for Payer: BCBS MT CHIP	$34.20
Rate for Payer: BCBS MT Closed Plan Network	$36.10
Rate for Payer: BCBS MT HealthLink	$34.20
Rate for Payer: BCBS MT Medicare	$34.20
Rate for Payer: BCBS MT POS	$36.10
Rate for Payer: BCBS MT Traditional	$38.00
Rate for Payer: Cash Price	$34.20
Rate for Payer: Cigna Commercial	$36.10
Rate for Payer: Cigna Medicare	$34.20
Rate for Payer: Medicaid All Medicaid	$34.96
Rate for Payer: Medicare All Medicare	$26.60
Rate for Payer: Monida Allegiance	$36.10
Rate for Payer: Monida First Choice Health	$36.86
Rate for Payer: Monida Montana Health Co-op	$36.10
Rate for Payer: Monida PacificSource	$36.10

TR IMMUNIZATION ADMIN - SINGLE VACCINE

Facility

$69.00

Service Code	HCPCS 90471
Hospital Charge Code	590471
Hospital Revenue Code	771
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna Medicare	$62.10
Rate for Payer: BCBS MT CHIP	$62.10
Rate for Payer: BCBS MT Closed Plan Network	$65.55
Rate for Payer: BCBS MT HealthLink	$62.10
Rate for Payer: BCBS MT Medicare	$62.10
Rate for Payer: BCBS MT POS	$65.55
Rate for Payer: BCBS MT Traditional	$69.00
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna Commercial	$65.55
Rate for Payer: Cigna Medicare	$62.10
Rate for Payer: Medicaid All Medicaid	$63.48
Rate for Payer: Medicare All Medicare	$48.30
Rate for Payer: Monida Allegiance	$65.55
Rate for Payer: Monida First Choice Health	$66.93
Rate for Payer: Monida Montana Health Co-op	$65.55
Rate for Payer: Monida PacificSource	$65.55

TR IMMUNIZATION ADMIN - SINGLE VACCINE

Facility

$69.00

Service Code	HCPCS 90471
Hospital Charge Code	590471
Hospital Revenue Code	771
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna Medicare	$62.10
Rate for Payer: BCBS MT CHIP	$62.10
Rate for Payer: BCBS MT Closed Plan Network	$65.55
Rate for Payer: BCBS MT HealthLink	$62.10
Rate for Payer: BCBS MT Medicare	$62.10
Rate for Payer: BCBS MT POS	$65.55
Rate for Payer: BCBS MT Traditional	$69.00
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna Commercial	$65.55
Rate for Payer: Cigna Medicare	$62.10
Rate for Payer: Medicaid All Medicaid	$63.48
Rate for Payer: Medicare All Medicare	$48.30
Rate for Payer: Monida Allegiance	$65.55
Rate for Payer: Monida First Choice Health	$66.93
Rate for Payer: Monida Montana Health Co-op	$65.55
Rate for Payer: Monida PacificSource	$65.55

TR INCISION AND DRAINAGE

Facility

$477.00

Service Code	HCPCS 27603
Hospital Charge Code	1027603
Hospital Revenue Code	761
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$477.00
Rate for Payer: Aetna Commercial	$453.15
Rate for Payer: Aetna Medicare	$429.30
Rate for Payer: BCBS MT CHIP	$429.30
Rate for Payer: BCBS MT Closed Plan Network	$453.15
Rate for Payer: BCBS MT HealthLink	$429.30
Rate for Payer: BCBS MT Medicare	$429.30
Rate for Payer: BCBS MT POS	$453.15
Rate for Payer: BCBS MT Traditional	$477.00
Rate for Payer: Cash Price	$429.30
Rate for Payer: Cigna Commercial	$453.15
Rate for Payer: Cigna Medicare	$429.30
Rate for Payer: Medicaid All Medicaid	$438.84
Rate for Payer: Medicare All Medicare	$333.90
Rate for Payer: Monida Allegiance	$453.15
Rate for Payer: Monida First Choice Health	$462.69
Rate for Payer: Monida Montana Health Co-op	$453.15
Rate for Payer: Monida PacificSource	$453.15

TR INCISION AND DRAINAGE

Facility

$477.00

Service Code	HCPCS 27603
Hospital Charge Code	1027603
Hospital Revenue Code	761
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$477.00
Rate for Payer: Aetna Commercial	$453.15
Rate for Payer: Aetna Medicare	$429.30
Rate for Payer: BCBS MT CHIP	$429.30
Rate for Payer: BCBS MT Closed Plan Network	$453.15
Rate for Payer: BCBS MT HealthLink	$429.30
Rate for Payer: BCBS MT Medicare	$429.30
Rate for Payer: BCBS MT POS	$453.15
Rate for Payer: BCBS MT Traditional	$477.00
Rate for Payer: Cash Price	$429.30
Rate for Payer: Cigna Commercial	$453.15
Rate for Payer: Cigna Medicare	$429.30
Rate for Payer: Medicaid All Medicaid	$438.84
Rate for Payer: Medicare All Medicare	$333.90
Rate for Payer: Monida Allegiance	$453.15
Rate for Payer: Monida First Choice Health	$462.69
Rate for Payer: Monida Montana Health Co-op	$453.15
Rate for Payer: Monida PacificSource	$453.15

TR INCISION AND DRAINAGE ABCESS SIMPLE

Facility

$416.00

Service Code	HCPCS 10060
Hospital Charge Code	1010060
Hospital Revenue Code	761
Min. Negotiated Rate	$291.20
Max. Negotiated Rate	$416.00
Rate for Payer: Aetna Commercial	$395.20
Rate for Payer: Aetna Medicare	$374.40
Rate for Payer: BCBS MT CHIP	$374.40
Rate for Payer: BCBS MT Closed Plan Network	$395.20
Rate for Payer: BCBS MT HealthLink	$374.40
Rate for Payer: BCBS MT Medicare	$374.40
Rate for Payer: BCBS MT POS	$395.20
Rate for Payer: BCBS MT Traditional	$416.00
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cigna Commercial	$395.20
Rate for Payer: Cigna Medicare	$374.40
Rate for Payer: Medicaid All Medicaid	$382.72
Rate for Payer: Medicare All Medicare	$291.20
Rate for Payer: Monida Allegiance	$395.20
Rate for Payer: Monida First Choice Health	$403.52
Rate for Payer: Monida Montana Health Co-op	$395.20
Rate for Payer: Monida PacificSource	$395.20

TR INCISION AND DRAINAGE ABCESS SIMPLE

Facility

$416.00

Service Code	HCPCS 10060
Hospital Charge Code	1010060
Hospital Revenue Code	761
Min. Negotiated Rate	$291.20
Max. Negotiated Rate	$416.00
Rate for Payer: Aetna Commercial	$395.20
Rate for Payer: Aetna Medicare	$374.40
Rate for Payer: BCBS MT CHIP	$374.40
Rate for Payer: BCBS MT Closed Plan Network	$395.20
Rate for Payer: BCBS MT HealthLink	$374.40
Rate for Payer: BCBS MT Medicare	$374.40
Rate for Payer: BCBS MT POS	$395.20
Rate for Payer: BCBS MT Traditional	$416.00
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cigna Commercial	$395.20
Rate for Payer: Cigna Medicare	$374.40
Rate for Payer: Medicaid All Medicaid	$382.72
Rate for Payer: Medicare All Medicare	$291.20
Rate for Payer: Monida Allegiance	$395.20
Rate for Payer: Monida First Choice Health	$403.52
Rate for Payer: Monida Montana Health Co-op	$395.20
Rate for Payer: Monida PacificSource	$395.20

TR INJ TENDON SHEATH/LIGAMENT

Facility

$312.00

Service Code	HCPCS 20550
Hospital Charge Code	1020550
Hospital Revenue Code	761
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare	$280.80
Rate for Payer: BCBS MT CHIP	$280.80
Rate for Payer: BCBS MT Closed Plan Network	$296.40
Rate for Payer: BCBS MT HealthLink	$280.80
Rate for Payer: BCBS MT Medicare	$280.80
Rate for Payer: BCBS MT POS	$296.40
Rate for Payer: BCBS MT Traditional	$312.00
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cigna Commercial	$296.40
Rate for Payer: Cigna Medicare	$280.80
Rate for Payer: Medicaid All Medicaid	$287.04
Rate for Payer: Medicare All Medicare	$218.40
Rate for Payer: Monida Allegiance	$296.40
Rate for Payer: Monida First Choice Health	$302.64
Rate for Payer: Monida Montana Health Co-op	$296.40
Rate for Payer: Monida PacificSource	$296.40

TR INJ TENDON SHEATH/LIGAMENT

Facility

$312.00

Service Code	HCPCS 20550
Hospital Charge Code	1020550
Hospital Revenue Code	761
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare	$280.80
Rate for Payer: BCBS MT CHIP	$280.80
Rate for Payer: BCBS MT Closed Plan Network	$296.40
Rate for Payer: BCBS MT HealthLink	$280.80
Rate for Payer: BCBS MT Medicare	$280.80
Rate for Payer: BCBS MT POS	$296.40
Rate for Payer: BCBS MT Traditional	$312.00
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cigna Commercial	$296.40
Rate for Payer: Cigna Medicare	$280.80
Rate for Payer: Medicaid All Medicaid	$287.04
Rate for Payer: Medicare All Medicare	$218.40
Rate for Payer: Monida Allegiance	$296.40
Rate for Payer: Monida First Choice Health	$302.64
Rate for Payer: Monida Montana Health Co-op	$296.40
Rate for Payer: Monida PacificSource	$296.40

TR: IRRIGATION OF BLADDER

Facility

$145.00

Service Code	HCPCS 51700
Hospital Charge Code	551700
Hospital Revenue Code	761
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$137.75
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS MT CHIP	$130.50
Rate for Payer: BCBS MT Closed Plan Network	$137.75
Rate for Payer: BCBS MT HealthLink	$130.50
Rate for Payer: BCBS MT Medicare	$130.50
Rate for Payer: BCBS MT POS	$137.75
Rate for Payer: BCBS MT Traditional	$145.00
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial	$137.75
Rate for Payer: Cigna Medicare	$130.50
Rate for Payer: Medicaid All Medicaid	$133.40
Rate for Payer: Medicare All Medicare	$101.50
Rate for Payer: Monida Allegiance	$137.75
Rate for Payer: Monida First Choice Health	$140.65
Rate for Payer: Monida Montana Health Co-op	$137.75
Rate for Payer: Monida PacificSource	$137.75

TR: IRRIGATION OF BLADDER

Facility

$145.00

Service Code	HCPCS 51700
Hospital Charge Code	551700
Hospital Revenue Code	761
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$137.75
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS MT CHIP	$130.50
Rate for Payer: BCBS MT Closed Plan Network	$137.75
Rate for Payer: BCBS MT HealthLink	$130.50
Rate for Payer: BCBS MT Medicare	$130.50
Rate for Payer: BCBS MT POS	$137.75
Rate for Payer: BCBS MT Traditional	$145.00
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial	$137.75
Rate for Payer: Cigna Medicare	$130.50
Rate for Payer: Medicaid All Medicaid	$133.40
Rate for Payer: Medicare All Medicare	$101.50
Rate for Payer: Monida Allegiance	$137.75
Rate for Payer: Monida First Choice Health	$140.65
Rate for Payer: Monida Montana Health Co-op	$137.75
Rate for Payer: Monida PacificSource	$137.75

TR LUMBAR PUNCTURE

Facility

$1,913.00

Service Code	HCPCS 62270
Hospital Charge Code	1062270
Hospital Revenue Code	761
Min. Negotiated Rate	$1,339.10
Max. Negotiated Rate	$1,913.00
Rate for Payer: Aetna Commercial	$1,817.35
Rate for Payer: Aetna Medicare	$1,721.70
Rate for Payer: BCBS MT CHIP	$1,721.70
Rate for Payer: BCBS MT Closed Plan Network	$1,817.35
Rate for Payer: BCBS MT HealthLink	$1,721.70
Rate for Payer: BCBS MT Medicare	$1,721.70
Rate for Payer: BCBS MT POS	$1,817.35
Rate for Payer: BCBS MT Traditional	$1,913.00
Rate for Payer: Cash Price	$1,721.70
Rate for Payer: Cigna Commercial	$1,817.35
Rate for Payer: Cigna Medicare	$1,721.70
Rate for Payer: Medicaid All Medicaid	$1,759.96
Rate for Payer: Medicare All Medicare	$1,339.10
Rate for Payer: Monida Allegiance	$1,817.35
Rate for Payer: Monida First Choice Health	$1,855.61
Rate for Payer: Monida Montana Health Co-op	$1,817.35
Rate for Payer: Monida PacificSource	$1,817.35

TR LUMBAR PUNCTURE

Facility

$1,913.00

Service Code	HCPCS 62270
Hospital Charge Code	1062270
Hospital Revenue Code	761
Min. Negotiated Rate	$1,339.10
Max. Negotiated Rate	$1,913.00
Rate for Payer: Aetna Commercial	$1,817.35
Rate for Payer: Aetna Medicare	$1,721.70
Rate for Payer: BCBS MT CHIP	$1,721.70
Rate for Payer: BCBS MT Closed Plan Network	$1,817.35
Rate for Payer: BCBS MT HealthLink	$1,721.70
Rate for Payer: BCBS MT Medicare	$1,721.70
Rate for Payer: BCBS MT POS	$1,817.35
Rate for Payer: BCBS MT Traditional	$1,913.00
Rate for Payer: Cash Price	$1,721.70
Rate for Payer: Cigna Commercial	$1,817.35
Rate for Payer: Cigna Medicare	$1,721.70
Rate for Payer: Medicaid All Medicaid	$1,759.96
Rate for Payer: Medicare All Medicare	$1,339.10
Rate for Payer: Monida Allegiance	$1,817.35
Rate for Payer: Monida First Choice Health	$1,855.61
Rate for Payer: Monida Montana Health Co-op	$1,817.35
Rate for Payer: Monida PacificSource	$1,817.35

TR NEG PRESS WOUND TX </=50CM

Facility

$417.00

Service Code	HCPCS 97605
Hospital Charge Code	1097605
Hospital Revenue Code	760
Min. Negotiated Rate	$291.90
Max. Negotiated Rate	$417.00
Rate for Payer: Aetna Commercial	$396.15
Rate for Payer: Aetna Medicare	$375.30
Rate for Payer: BCBS MT CHIP	$375.30
Rate for Payer: BCBS MT Closed Plan Network	$396.15
Rate for Payer: BCBS MT HealthLink	$375.30
Rate for Payer: BCBS MT Medicare	$375.30
Rate for Payer: BCBS MT POS	$396.15
Rate for Payer: BCBS MT Traditional	$417.00
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cigna Commercial	$396.15
Rate for Payer: Cigna Medicare	$375.30
Rate for Payer: Medicaid All Medicaid	$383.64
Rate for Payer: Medicare All Medicare	$291.90
Rate for Payer: Monida Allegiance	$396.15
Rate for Payer: Monida First Choice Health	$404.49
Rate for Payer: Monida Montana Health Co-op	$396.15
Rate for Payer: Monida PacificSource	$396.15

TR NEG PRESS WOUND TX </=50CM

Facility

$417.00

Service Code	HCPCS 97605
Hospital Charge Code	1097605
Hospital Revenue Code	760
Min. Negotiated Rate	$291.90
Max. Negotiated Rate	$417.00
Rate for Payer: Aetna Commercial	$396.15
Rate for Payer: Aetna Medicare	$375.30
Rate for Payer: BCBS MT CHIP	$375.30
Rate for Payer: BCBS MT Closed Plan Network	$396.15
Rate for Payer: BCBS MT HealthLink	$375.30
Rate for Payer: BCBS MT Medicare	$375.30
Rate for Payer: BCBS MT POS	$396.15
Rate for Payer: BCBS MT Traditional	$417.00
Rate for Payer: Cash Price	$375.30
Rate for Payer: Cigna Commercial	$396.15
Rate for Payer: Cigna Medicare	$375.30
Rate for Payer: Medicaid All Medicaid	$383.64
Rate for Payer: Medicare All Medicare	$291.90
Rate for Payer: Monida Allegiance	$396.15
Rate for Payer: Monida First Choice Health	$404.49
Rate for Payer: Monida Montana Health Co-op	$396.15
Rate for Payer: Monida PacificSource	$396.15

TR OF ANKLE FRACTURE

Facility

$475.00

Service Code	HCPCS 27788
Hospital Charge Code	1027788
Hospital Revenue Code	450
Min. Negotiated Rate	$332.50
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$451.25
Rate for Payer: Aetna Medicare	$427.50
Rate for Payer: BCBS MT CHIP	$427.50
Rate for Payer: BCBS MT Closed Plan Network	$451.25
Rate for Payer: BCBS MT HealthLink	$427.50
Rate for Payer: BCBS MT Medicare	$427.50
Rate for Payer: BCBS MT POS	$451.25
Rate for Payer: BCBS MT Traditional	$475.00
Rate for Payer: Cash Price	$427.50
Rate for Payer: Cigna Commercial	$451.25
Rate for Payer: Cigna Medicare	$427.50
Rate for Payer: Medicaid All Medicaid	$437.00
Rate for Payer: Medicare All Medicare	$332.50
Rate for Payer: Monida Allegiance	$451.25
Rate for Payer: Monida First Choice Health	$460.75
Rate for Payer: Monida Montana Health Co-op	$451.25
Rate for Payer: Monida PacificSource	$451.25

TR OF ANKLE FRACTURE

Facility

$475.00

Service Code	HCPCS 27788
Hospital Charge Code	1027788
Hospital Revenue Code	450
Min. Negotiated Rate	$332.50
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$451.25
Rate for Payer: Aetna Medicare	$427.50
Rate for Payer: BCBS MT CHIP	$427.50
Rate for Payer: BCBS MT Closed Plan Network	$451.25
Rate for Payer: BCBS MT HealthLink	$427.50
Rate for Payer: BCBS MT Medicare	$427.50
Rate for Payer: BCBS MT POS	$451.25
Rate for Payer: BCBS MT Traditional	$475.00
Rate for Payer: Cash Price	$427.50
Rate for Payer: Cigna Commercial	$451.25
Rate for Payer: Cigna Medicare	$427.50
Rate for Payer: Medicaid All Medicaid	$437.00
Rate for Payer: Medicare All Medicare	$332.50
Rate for Payer: Monida Allegiance	$451.25
Rate for Payer: Monida First Choice Health	$460.75
Rate for Payer: Monida Montana Health Co-op	$451.25
Rate for Payer: Monida PacificSource	$451.25

TROPONIN I, HIGH SENSITIVITY

Facility

$194.00

Service Code	HCPCS 84484
Hospital Charge Code	4000484
Hospital Revenue Code	300
Min. Negotiated Rate	$135.80
Max. Negotiated Rate	$194.00
Rate for Payer: Aetna Commercial	$184.30
Rate for Payer: Aetna Medicare	$174.60
Rate for Payer: BCBS MT CHIP	$174.60
Rate for Payer: BCBS MT Closed Plan Network	$184.30
Rate for Payer: BCBS MT HealthLink	$174.60
Rate for Payer: BCBS MT Medicare	$174.60
Rate for Payer: BCBS MT POS	$184.30
Rate for Payer: BCBS MT Traditional	$194.00
Rate for Payer: Cash Price	$174.60
Rate for Payer: Cigna Commercial	$184.30
Rate for Payer: Cigna Medicare	$174.60
Rate for Payer: Medicaid All Medicaid	$178.48
Rate for Payer: Medicare All Medicare	$135.80
Rate for Payer: Monida Allegiance	$184.30
Rate for Payer: Monida First Choice Health	$188.18
Rate for Payer: Monida Montana Health Co-op	$184.30
Rate for Payer: Monida PacificSource	$184.30

TROPONIN I, HIGH SENSITIVITY

Facility

$194.00

Service Code	HCPCS 84484
Hospital Charge Code	4000484
Hospital Revenue Code	300
Min. Negotiated Rate	$135.80
Max. Negotiated Rate	$194.00
Rate for Payer: Aetna Commercial	$184.30
Rate for Payer: Aetna Medicare	$174.60
Rate for Payer: BCBS MT CHIP	$174.60
Rate for Payer: BCBS MT Closed Plan Network	$184.30
Rate for Payer: BCBS MT HealthLink	$174.60
Rate for Payer: BCBS MT Medicare	$174.60
Rate for Payer: BCBS MT POS	$184.30
Rate for Payer: BCBS MT Traditional	$194.00
Rate for Payer: Cash Price	$174.60
Rate for Payer: Cigna Commercial	$184.30
Rate for Payer: Cigna Medicare	$174.60
Rate for Payer: Medicaid All Medicaid	$178.48
Rate for Payer: Medicare All Medicare	$135.80
Rate for Payer: Monida Allegiance	$184.30
Rate for Payer: Monida First Choice Health	$188.18
Rate for Payer: Monida Montana Health Co-op	$184.30
Rate for Payer: Monida PacificSource	$184.30

TR REMOVE FOREIGN BODY FROM EAR

Facility

$191.00

Service Code	HCPCS 69200
Hospital Charge Code	569200
Hospital Revenue Code	761
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$191.00
Rate for Payer: Aetna Commercial	$181.45
Rate for Payer: Aetna Medicare	$171.90
Rate for Payer: BCBS MT CHIP	$171.90
Rate for Payer: BCBS MT Closed Plan Network	$181.45
Rate for Payer: BCBS MT HealthLink	$171.90
Rate for Payer: BCBS MT Medicare	$171.90
Rate for Payer: BCBS MT POS	$181.45
Rate for Payer: BCBS MT Traditional	$191.00
Rate for Payer: Cash Price	$171.90
Rate for Payer: Cigna Commercial	$181.45
Rate for Payer: Cigna Medicare	$171.90
Rate for Payer: Medicaid All Medicaid	$175.72
Rate for Payer: Medicare All Medicare	$133.70
Rate for Payer: Monida Allegiance	$181.45
Rate for Payer: Monida First Choice Health	$185.27
Rate for Payer: Monida Montana Health Co-op	$181.45
Rate for Payer: Monida PacificSource	$181.45

TR REMOVE FOREIGN BODY FROM EAR

Facility

$191.00

Service Code	HCPCS 69200
Hospital Charge Code	569200
Hospital Revenue Code	761
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$191.00
Rate for Payer: Aetna Commercial	$181.45
Rate for Payer: Aetna Medicare	$171.90
Rate for Payer: BCBS MT CHIP	$171.90
Rate for Payer: BCBS MT Closed Plan Network	$181.45
Rate for Payer: BCBS MT HealthLink	$171.90
Rate for Payer: BCBS MT Medicare	$171.90
Rate for Payer: BCBS MT POS	$181.45
Rate for Payer: BCBS MT Traditional	$191.00
Rate for Payer: Cash Price	$171.90
Rate for Payer: Cigna Commercial	$181.45
Rate for Payer: Cigna Medicare	$171.90
Rate for Payer: Medicaid All Medicaid	$175.72
Rate for Payer: Medicare All Medicare	$133.70
Rate for Payer: Monida Allegiance	$181.45
Rate for Payer: Monida First Choice Health	$185.27
Rate for Payer: Monida Montana Health Co-op	$181.45
Rate for Payer: Monida PacificSource	$181.45

TR REMOVE IMPACTED CERUMEN

Facility

$104.00

Service Code	HCPCS 69209
Hospital Charge Code	569209
Hospital Revenue Code	761
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare	$93.60
Rate for Payer: BCBS MT CHIP	$93.60
Rate for Payer: BCBS MT Closed Plan Network	$98.80
Rate for Payer: BCBS MT HealthLink	$93.60
Rate for Payer: BCBS MT Medicare	$93.60
Rate for Payer: BCBS MT POS	$98.80
Rate for Payer: BCBS MT Traditional	$104.00
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial	$98.80
Rate for Payer: Cigna Medicare	$93.60
Rate for Payer: Medicaid All Medicaid	$95.68
Rate for Payer: Medicare All Medicare	$72.80
Rate for Payer: Monida Allegiance	$98.80
Rate for Payer: Monida First Choice Health	$100.88
Rate for Payer: Monida Montana Health Co-op	$98.80
Rate for Payer: Monida PacificSource	$98.80

Know your out-of-pocket cost for care.

All Charges