Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PSYCHOTHERAPY CRISIS +30 MIN

Facility

$156.00

Service Code	HCPCS 90840
Hospital Charge Code	8190840
Hospital Revenue Code	900
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare	$140.40
Rate for Payer: BCBS MT CHIP	$140.40
Rate for Payer: BCBS MT Closed Plan Network	$148.20
Rate for Payer: BCBS MT HealthLink	$140.40
Rate for Payer: BCBS MT Medicare	$140.40
Rate for Payer: BCBS MT POS	$148.20
Rate for Payer: BCBS MT Traditional	$156.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial	$148.20
Rate for Payer: Cigna Medicare	$140.40
Rate for Payer: Medicaid All Medicaid	$143.52
Rate for Payer: Medicare All Medicare	$109.20
Rate for Payer: Monida Allegiance	$148.20
Rate for Payer: Monida First Choice Health	$151.32
Rate for Payer: Monida Montana Health Co-op	$148.20
Rate for Payer: Monida PacificSource	$148.20

PSYCHOTHERAPY W/ PT 30 MIN

Facility

$156.00

Service Code	HCPCS 90832
Hospital Charge Code	8190832
Hospital Revenue Code	900
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare	$140.40
Rate for Payer: BCBS MT CHIP	$140.40
Rate for Payer: BCBS MT Closed Plan Network	$148.20
Rate for Payer: BCBS MT HealthLink	$140.40
Rate for Payer: BCBS MT Medicare	$140.40
Rate for Payer: BCBS MT POS	$148.20
Rate for Payer: BCBS MT Traditional	$156.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial	$148.20
Rate for Payer: Cigna Medicare	$140.40
Rate for Payer: Medicaid All Medicaid	$143.52
Rate for Payer: Medicare All Medicare	$109.20
Rate for Payer: Monida Allegiance	$148.20
Rate for Payer: Monida First Choice Health	$151.32
Rate for Payer: Monida Montana Health Co-op	$148.20
Rate for Payer: Monida PacificSource	$148.20

PSYCHOTHERAPY W/ PT 30 MIN

Facility

$156.00

Service Code	HCPCS 90832
Hospital Charge Code	8190832
Hospital Revenue Code	900
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare	$140.40
Rate for Payer: BCBS MT CHIP	$140.40
Rate for Payer: BCBS MT Closed Plan Network	$148.20
Rate for Payer: BCBS MT HealthLink	$140.40
Rate for Payer: BCBS MT Medicare	$140.40
Rate for Payer: BCBS MT POS	$148.20
Rate for Payer: BCBS MT Traditional	$156.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial	$148.20
Rate for Payer: Cigna Medicare	$140.40
Rate for Payer: Medicaid All Medicaid	$143.52
Rate for Payer: Medicare All Medicare	$109.20
Rate for Payer: Monida Allegiance	$148.20
Rate for Payer: Monida First Choice Health	$151.32
Rate for Payer: Monida Montana Health Co-op	$148.20
Rate for Payer: Monida PacificSource	$148.20

PSYCHOTHERAPY W/ PT 30 MIN W E/M

Facility

$162.00

Service Code	HCPCS 90833
Hospital Charge Code	8190833
Hospital Revenue Code	900
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare	$145.80
Rate for Payer: BCBS MT CHIP	$145.80
Rate for Payer: BCBS MT Closed Plan Network	$153.90
Rate for Payer: BCBS MT HealthLink	$145.80
Rate for Payer: BCBS MT Medicare	$145.80
Rate for Payer: BCBS MT POS	$153.90
Rate for Payer: BCBS MT Traditional	$162.00
Rate for Payer: Cash Price	$145.80
Rate for Payer: Cigna Commercial	$153.90
Rate for Payer: Cigna Medicare	$145.80
Rate for Payer: Medicaid All Medicaid	$149.04
Rate for Payer: Medicare All Medicare	$113.40
Rate for Payer: Monida Allegiance	$153.90
Rate for Payer: Monida First Choice Health	$157.14
Rate for Payer: Monida Montana Health Co-op	$153.90
Rate for Payer: Monida PacificSource	$153.90

PSYCHOTHERAPY W/ PT 30 MIN W E/M

Facility

$162.00

Service Code	HCPCS 90833
Hospital Charge Code	8190833
Hospital Revenue Code	900
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare	$145.80
Rate for Payer: BCBS MT CHIP	$145.80
Rate for Payer: BCBS MT Closed Plan Network	$153.90
Rate for Payer: BCBS MT HealthLink	$145.80
Rate for Payer: BCBS MT Medicare	$145.80
Rate for Payer: BCBS MT POS	$153.90
Rate for Payer: BCBS MT Traditional	$162.00
Rate for Payer: Cash Price	$145.80
Rate for Payer: Cigna Commercial	$153.90
Rate for Payer: Cigna Medicare	$145.80
Rate for Payer: Medicaid All Medicaid	$149.04
Rate for Payer: Medicare All Medicare	$113.40
Rate for Payer: Monida Allegiance	$153.90
Rate for Payer: Monida First Choice Health	$157.14
Rate for Payer: Monida Montana Health Co-op	$153.90
Rate for Payer: Monida PacificSource	$153.90

PSYCHOTHERAPY W/ PT 45 MIN

Facility

$208.00

Service Code	HCPCS 90834
Hospital Charge Code	8190834
Hospital Revenue Code	900
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare	$187.20
Rate for Payer: BCBS MT CHIP	$187.20
Rate for Payer: BCBS MT Closed Plan Network	$197.60
Rate for Payer: BCBS MT HealthLink	$187.20
Rate for Payer: BCBS MT Medicare	$187.20
Rate for Payer: BCBS MT POS	$197.60
Rate for Payer: BCBS MT Traditional	$208.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial	$197.60
Rate for Payer: Cigna Medicare	$187.20
Rate for Payer: Medicaid All Medicaid	$191.36
Rate for Payer: Medicare All Medicare	$145.60
Rate for Payer: Monida Allegiance	$197.60
Rate for Payer: Monida First Choice Health	$201.76
Rate for Payer: Monida Montana Health Co-op	$197.60
Rate for Payer: Monida PacificSource	$197.60

PSYCHOTHERAPY W/ PT 45 MIN

Facility

$208.00

Service Code	HCPCS 90834
Hospital Charge Code	8190834
Hospital Revenue Code	900
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare	$187.20
Rate for Payer: BCBS MT CHIP	$187.20
Rate for Payer: BCBS MT Closed Plan Network	$197.60
Rate for Payer: BCBS MT HealthLink	$187.20
Rate for Payer: BCBS MT Medicare	$187.20
Rate for Payer: BCBS MT POS	$197.60
Rate for Payer: BCBS MT Traditional	$208.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial	$197.60
Rate for Payer: Cigna Medicare	$187.20
Rate for Payer: Medicaid All Medicaid	$191.36
Rate for Payer: Medicare All Medicare	$145.60
Rate for Payer: Monida Allegiance	$197.60
Rate for Payer: Monida First Choice Health	$201.76
Rate for Payer: Monida Montana Health Co-op	$197.60
Rate for Payer: Monida PacificSource	$197.60

PSYCHOTHERAPY W/ PT 45 W/ E/M

Facility

$201.00

Service Code	HCPCS 90836
Hospital Charge Code	8190836
Hospital Revenue Code	900
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$190.95
Rate for Payer: Aetna Medicare	$180.90
Rate for Payer: BCBS MT CHIP	$180.90
Rate for Payer: BCBS MT Closed Plan Network	$190.95
Rate for Payer: BCBS MT HealthLink	$180.90
Rate for Payer: BCBS MT Medicare	$180.90
Rate for Payer: BCBS MT POS	$190.95
Rate for Payer: BCBS MT Traditional	$201.00
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cigna Commercial	$190.95
Rate for Payer: Cigna Medicare	$180.90
Rate for Payer: Medicaid All Medicaid	$184.92
Rate for Payer: Medicare All Medicare	$140.70
Rate for Payer: Monida Allegiance	$190.95
Rate for Payer: Monida First Choice Health	$194.97
Rate for Payer: Monida Montana Health Co-op	$190.95
Rate for Payer: Monida PacificSource	$190.95

PSYCHOTHERAPY W/ PT 45 W/ E/M

Facility

$201.00

Service Code	HCPCS 90836
Hospital Charge Code	8190836
Hospital Revenue Code	900
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$190.95
Rate for Payer: Aetna Medicare	$180.90
Rate for Payer: BCBS MT CHIP	$180.90
Rate for Payer: BCBS MT Closed Plan Network	$190.95
Rate for Payer: BCBS MT HealthLink	$180.90
Rate for Payer: BCBS MT Medicare	$180.90
Rate for Payer: BCBS MT POS	$190.95
Rate for Payer: BCBS MT Traditional	$201.00
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cigna Commercial	$190.95
Rate for Payer: Cigna Medicare	$180.90
Rate for Payer: Medicaid All Medicaid	$184.92
Rate for Payer: Medicare All Medicare	$140.70
Rate for Payer: Monida Allegiance	$190.95
Rate for Payer: Monida First Choice Health	$194.97
Rate for Payer: Monida Montana Health Co-op	$190.95
Rate for Payer: Monida PacificSource	$190.95

PSYCHOTHERAPY W/ PT 60 MIN

Facility

$307.00

Service Code	HCPCS 90837
Hospital Charge Code	8190837
Hospital Revenue Code	900
Min. Negotiated Rate	$214.90
Max. Negotiated Rate	$307.00
Rate for Payer: Aetna Commercial	$291.65
Rate for Payer: Aetna Medicare	$276.30
Rate for Payer: BCBS MT CHIP	$276.30
Rate for Payer: BCBS MT Closed Plan Network	$291.65
Rate for Payer: BCBS MT HealthLink	$276.30
Rate for Payer: BCBS MT Medicare	$276.30
Rate for Payer: BCBS MT POS	$291.65
Rate for Payer: BCBS MT Traditional	$307.00
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cigna Commercial	$291.65
Rate for Payer: Cigna Medicare	$276.30
Rate for Payer: Medicaid All Medicaid	$282.44
Rate for Payer: Medicare All Medicare	$214.90
Rate for Payer: Monida Allegiance	$291.65
Rate for Payer: Monida First Choice Health	$297.79
Rate for Payer: Monida Montana Health Co-op	$291.65
Rate for Payer: Monida PacificSource	$291.65

PSYCHOTHERAPY W/ PT 60 MIN

Facility

$307.00

Service Code	HCPCS 90837
Hospital Charge Code	8190837
Hospital Revenue Code	900
Min. Negotiated Rate	$214.90
Max. Negotiated Rate	$307.00
Rate for Payer: Aetna Commercial	$291.65
Rate for Payer: Aetna Medicare	$276.30
Rate for Payer: BCBS MT CHIP	$276.30
Rate for Payer: BCBS MT Closed Plan Network	$291.65
Rate for Payer: BCBS MT HealthLink	$276.30
Rate for Payer: BCBS MT Medicare	$276.30
Rate for Payer: BCBS MT POS	$291.65
Rate for Payer: BCBS MT Traditional	$307.00
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cigna Commercial	$291.65
Rate for Payer: Cigna Medicare	$276.30
Rate for Payer: Medicaid All Medicaid	$282.44
Rate for Payer: Medicare All Medicare	$214.90
Rate for Payer: Monida Allegiance	$291.65
Rate for Payer: Monida First Choice Health	$297.79
Rate for Payer: Monida Montana Health Co-op	$291.65
Rate for Payer: Monida PacificSource	$291.65

PSYCHOTHERAPY W/ PT 60 MIN W E/M

Facility

$266.00

Service Code	HCPCS 90838
Hospital Charge Code	8090838
Hospital Revenue Code	900
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$266.00
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare	$239.40
Rate for Payer: BCBS MT CHIP	$239.40
Rate for Payer: BCBS MT Closed Plan Network	$252.70
Rate for Payer: BCBS MT HealthLink	$239.40
Rate for Payer: BCBS MT Medicare	$239.40
Rate for Payer: BCBS MT POS	$252.70
Rate for Payer: BCBS MT Traditional	$266.00
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cigna Commercial	$252.70
Rate for Payer: Cigna Medicare	$239.40
Rate for Payer: Medicaid All Medicaid	$244.72
Rate for Payer: Medicare All Medicare	$186.20
Rate for Payer: Monida Allegiance	$252.70
Rate for Payer: Monida First Choice Health	$258.02
Rate for Payer: Monida Montana Health Co-op	$252.70
Rate for Payer: Monida PacificSource	$252.70

PSYCHOTHERAPY W/ PT 60 MIN W E/M

Facility

$266.00

Service Code	HCPCS 90838
Hospital Charge Code	8090838
Hospital Revenue Code	900
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$266.00
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare	$239.40
Rate for Payer: BCBS MT CHIP	$239.40
Rate for Payer: BCBS MT Closed Plan Network	$252.70
Rate for Payer: BCBS MT HealthLink	$239.40
Rate for Payer: BCBS MT Medicare	$239.40
Rate for Payer: BCBS MT POS	$252.70
Rate for Payer: BCBS MT Traditional	$266.00
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cigna Commercial	$252.70
Rate for Payer: Cigna Medicare	$239.40
Rate for Payer: Medicaid All Medicaid	$244.72
Rate for Payer: Medicare All Medicare	$186.20
Rate for Payer: Monida Allegiance	$252.70
Rate for Payer: Monida First Choice Health	$258.02
Rate for Payer: Monida Montana Health Co-op	$252.70
Rate for Payer: Monida PacificSource	$252.70

PSYCHOTHERAPY W/ PT 60 W/ E/M

Facility

$266.00

Service Code	HCPCS 90838
Hospital Charge Code	8190838
Hospital Revenue Code	900
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$266.00
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare	$239.40
Rate for Payer: BCBS MT CHIP	$239.40
Rate for Payer: BCBS MT Closed Plan Network	$252.70
Rate for Payer: BCBS MT HealthLink	$239.40
Rate for Payer: BCBS MT Medicare	$239.40
Rate for Payer: BCBS MT POS	$252.70
Rate for Payer: BCBS MT Traditional	$266.00
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cigna Commercial	$252.70
Rate for Payer: Cigna Medicare	$239.40
Rate for Payer: Medicaid All Medicaid	$244.72
Rate for Payer: Medicare All Medicare	$186.20
Rate for Payer: Monida Allegiance	$252.70
Rate for Payer: Monida First Choice Health	$258.02
Rate for Payer: Monida Montana Health Co-op	$252.70
Rate for Payer: Monida PacificSource	$252.70

PSYCHOTHERAPY W/ PT 60 W/ E/M

Facility

$266.00

Service Code	HCPCS 90838
Hospital Charge Code	8190838
Hospital Revenue Code	900
Min. Negotiated Rate	$186.20
Max. Negotiated Rate	$266.00
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare	$239.40
Rate for Payer: BCBS MT CHIP	$239.40
Rate for Payer: BCBS MT Closed Plan Network	$252.70
Rate for Payer: BCBS MT HealthLink	$239.40
Rate for Payer: BCBS MT Medicare	$239.40
Rate for Payer: BCBS MT POS	$252.70
Rate for Payer: BCBS MT Traditional	$266.00
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cigna Commercial	$252.70
Rate for Payer: Cigna Medicare	$239.40
Rate for Payer: Medicaid All Medicaid	$244.72
Rate for Payer: Medicare All Medicare	$186.20
Rate for Payer: Monida Allegiance	$252.70
Rate for Payer: Monida First Choice Health	$258.02
Rate for Payer: Monida Montana Health Co-op	$252.70
Rate for Payer: Monida PacificSource	$252.70

PSYLLIUM PACKET [28 %]

Facility

$5.00

Service Code	HCPCS J3490
Hospital Charge Code	3000409
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS MT CHIP	$4.50
Rate for Payer: BCBS MT Closed Plan Network	$4.75
Rate for Payer: BCBS MT HealthLink	$4.50
Rate for Payer: BCBS MT Medicare	$4.50
Rate for Payer: BCBS MT POS	$4.75
Rate for Payer: BCBS MT Traditional	$5.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: Cigna Medicare	$4.50
Rate for Payer: Medicaid All Medicaid	$4.60
Rate for Payer: Medicare All Medicare	$3.50
Rate for Payer: Monida Allegiance	$4.75
Rate for Payer: Monida First Choice Health	$4.85
Rate for Payer: Monida Montana Health Co-op	$4.75
Rate for Payer: Monida PacificSource	$4.75

PSYLLIUM PACKET [28 %]

Facility

$5.00

Service Code	HCPCS J3490
Hospital Charge Code	3000409
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS MT CHIP	$4.50
Rate for Payer: BCBS MT Closed Plan Network	$4.75
Rate for Payer: BCBS MT HealthLink	$4.50
Rate for Payer: BCBS MT Medicare	$4.50
Rate for Payer: BCBS MT POS	$4.75
Rate for Payer: BCBS MT Traditional	$5.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: Cigna Medicare	$4.50
Rate for Payer: Medicaid All Medicaid	$4.60
Rate for Payer: Medicare All Medicare	$3.50
Rate for Payer: Monida Allegiance	$4.75
Rate for Payer: Monida First Choice Health	$4.85
Rate for Payer: Monida Montana Health Co-op	$4.75
Rate for Payer: Monida PacificSource	$4.75

PSYTX CRISIS INITIAL 60 MIN

Facility

$220.00

Service Code	HCPCS 90839
Hospital Charge Code	8190839
Hospital Revenue Code	900
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare	$198.00
Rate for Payer: BCBS MT CHIP	$198.00
Rate for Payer: BCBS MT Closed Plan Network	$209.00
Rate for Payer: BCBS MT HealthLink	$198.00
Rate for Payer: BCBS MT Medicare	$198.00
Rate for Payer: BCBS MT POS	$209.00
Rate for Payer: BCBS MT Traditional	$220.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare	$198.00
Rate for Payer: Medicaid All Medicaid	$202.40
Rate for Payer: Medicare All Medicare	$154.00
Rate for Payer: Monida Allegiance	$209.00
Rate for Payer: Monida First Choice Health	$213.40
Rate for Payer: Monida Montana Health Co-op	$209.00
Rate for Payer: Monida PacificSource	$209.00

PSYTX CRISIS INITIAL 60 MIN

Facility

$220.00

Service Code	HCPCS 90839
Hospital Charge Code	8190839
Hospital Revenue Code	900
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare	$198.00
Rate for Payer: BCBS MT CHIP	$198.00
Rate for Payer: BCBS MT Closed Plan Network	$209.00
Rate for Payer: BCBS MT HealthLink	$198.00
Rate for Payer: BCBS MT Medicare	$198.00
Rate for Payer: BCBS MT POS	$209.00
Rate for Payer: BCBS MT Traditional	$220.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare	$198.00
Rate for Payer: Medicaid All Medicaid	$202.40
Rate for Payer: Medicare All Medicare	$154.00
Rate for Payer: Monida Allegiance	$209.00
Rate for Payer: Monida First Choice Health	$213.40
Rate for Payer: Monida Montana Health Co-op	$209.00
Rate for Payer: Monida PacificSource	$209.00

PT ASSISTED BATH

Facility

$35.00

Hospital Charge Code	6130069
Hospital Revenue Code	420
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$33.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS MT CHIP	$31.50
Rate for Payer: BCBS MT Closed Plan Network	$33.25
Rate for Payer: BCBS MT HealthLink	$31.50
Rate for Payer: BCBS MT Medicare	$31.50
Rate for Payer: BCBS MT POS	$33.25
Rate for Payer: BCBS MT Traditional	$35.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial	$33.25
Rate for Payer: Cigna Medicare	$31.50
Rate for Payer: Medicaid All Medicaid	$32.20
Rate for Payer: Medicare All Medicare	$24.50
Rate for Payer: Monida Allegiance	$33.25
Rate for Payer: Monida First Choice Health	$33.95
Rate for Payer: Monida Montana Health Co-op	$33.25
Rate for Payer: Monida PacificSource	$33.25

PT ASSISTED BATH

Facility

$35.00

Hospital Charge Code	6130069
Hospital Revenue Code	420
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$33.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS MT CHIP	$31.50
Rate for Payer: BCBS MT Closed Plan Network	$33.25
Rate for Payer: BCBS MT HealthLink	$31.50
Rate for Payer: BCBS MT Medicare	$31.50
Rate for Payer: BCBS MT POS	$33.25
Rate for Payer: BCBS MT Traditional	$35.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial	$33.25
Rate for Payer: Cigna Medicare	$31.50
Rate for Payer: Medicaid All Medicaid	$32.20
Rate for Payer: Medicare All Medicare	$24.50
Rate for Payer: Monida Allegiance	$33.25
Rate for Payer: Monida First Choice Health	$33.95
Rate for Payer: Monida Montana Health Co-op	$33.25
Rate for Payer: Monida PacificSource	$33.25

PT CANALITH REPOSITIONING PROC

Facility

$137.00

Service Code	HCPCS 95992 GP
Hospital Charge Code	6195992
Hospital Revenue Code	420
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$137.00
Rate for Payer: Aetna Commercial	$130.15
Rate for Payer: Aetna Medicare	$123.30
Rate for Payer: BCBS MT CHIP	$123.30
Rate for Payer: BCBS MT Closed Plan Network	$130.15
Rate for Payer: BCBS MT HealthLink	$123.30
Rate for Payer: BCBS MT Medicare	$123.30
Rate for Payer: BCBS MT POS	$130.15
Rate for Payer: BCBS MT Traditional	$137.00
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cigna Commercial	$130.15
Rate for Payer: Cigna Medicare	$123.30
Rate for Payer: Medicaid All Medicaid	$126.04
Rate for Payer: Medicare All Medicare	$95.90
Rate for Payer: Monida Allegiance	$130.15
Rate for Payer: Monida First Choice Health	$132.89
Rate for Payer: Monida Montana Health Co-op	$130.15
Rate for Payer: Monida PacificSource	$130.15

PT CANALITH REPOSITIONING PROC

Facility

$137.00

Service Code	HCPCS 95992 GP
Hospital Charge Code	6195992
Hospital Revenue Code	420
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$137.00
Rate for Payer: Aetna Commercial	$130.15
Rate for Payer: Aetna Medicare	$123.30
Rate for Payer: BCBS MT CHIP	$123.30
Rate for Payer: BCBS MT Closed Plan Network	$130.15
Rate for Payer: BCBS MT HealthLink	$123.30
Rate for Payer: BCBS MT Medicare	$123.30
Rate for Payer: BCBS MT POS	$130.15
Rate for Payer: BCBS MT Traditional	$137.00
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cigna Commercial	$130.15
Rate for Payer: Cigna Medicare	$123.30
Rate for Payer: Medicaid All Medicaid	$126.04
Rate for Payer: Medicare All Medicare	$95.90
Rate for Payer: Monida Allegiance	$130.15
Rate for Payer: Monida First Choice Health	$132.89
Rate for Payer: Monida Montana Health Co-op	$130.15
Rate for Payer: Monida PacificSource	$130.15

PT COMMUNITY/WORK REINTEGRATION

Facility

$92.00

Service Code	HCPCS 97537 GP
Hospital Charge Code	6197537
Hospital Revenue Code	420
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare	$82.80
Rate for Payer: BCBS MT CHIP	$82.80
Rate for Payer: BCBS MT Closed Plan Network	$87.40
Rate for Payer: BCBS MT HealthLink	$82.80
Rate for Payer: BCBS MT Medicare	$82.80
Rate for Payer: BCBS MT POS	$87.40
Rate for Payer: BCBS MT Traditional	$92.00
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial	$87.40
Rate for Payer: Cigna Medicare	$82.80
Rate for Payer: Medicaid All Medicaid	$84.64
Rate for Payer: Medicare All Medicare	$64.40
Rate for Payer: Monida Allegiance	$87.40
Rate for Payer: Monida First Choice Health	$89.24
Rate for Payer: Monida Montana Health Co-op	$87.40
Rate for Payer: Monida PacificSource	$87.40

PT COMMUNITY/WORK REINTEGRATION

Facility

$92.00

Service Code	HCPCS 97537 GP
Hospital Charge Code	6197537
Hospital Revenue Code	420
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare	$82.80
Rate for Payer: BCBS MT CHIP	$82.80
Rate for Payer: BCBS MT Closed Plan Network	$87.40
Rate for Payer: BCBS MT HealthLink	$82.80
Rate for Payer: BCBS MT Medicare	$82.80
Rate for Payer: BCBS MT POS	$87.40
Rate for Payer: BCBS MT Traditional	$92.00
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial	$87.40
Rate for Payer: Cigna Medicare	$82.80
Rate for Payer: Medicaid All Medicaid	$84.64
Rate for Payer: Medicare All Medicare	$64.40
Rate for Payer: Monida Allegiance	$87.40
Rate for Payer: Monida First Choice Health	$89.24
Rate for Payer: Monida Montana Health Co-op	$87.40
Rate for Payer: Monida PacificSource	$87.40

Know your out-of-pocket cost for care.

All Charges