Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

BLADDER SCAN

Facility

$151.00

Service Code	CPT 51798
Hospital Charge Code	151798
Hospital Revenue Code	920
Min. Negotiated Rate	$105.70
Max. Negotiated Rate	$151.00
Rate for Payer: Aetna Commercial	$143.45
Rate for Payer: Aetna Medicare	$135.90
Rate for Payer: BCBS MT CHIP	$135.90
Rate for Payer: BCBS MT Closed Plan Network	$143.45
Rate for Payer: BCBS MT HealthLink	$135.90
Rate for Payer: BCBS MT Medicare	$135.90
Rate for Payer: BCBS MT POS	$143.45
Rate for Payer: BCBS MT Traditional	$151.00
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial	$143.45
Rate for Payer: Cigna Medicare	$135.90
Rate for Payer: Medicaid All Medicaid	$138.92
Rate for Payer: Medicare All Medicare	$105.70
Rate for Payer: Monida Allegiance	$143.45
Rate for Payer: Monida First Choice Health	$146.47
Rate for Payer: Monida Montana Health Co-op	$143.45
Rate for Payer: Monida PacificSource	$143.45

BLADDER SCAN

Facility

$151.00

Service Code	CPT 51798
Hospital Charge Code	151798
Hospital Revenue Code	920
Min. Negotiated Rate	$105.70
Max. Negotiated Rate	$151.00
Rate for Payer: Aetna Commercial	$143.45
Rate for Payer: Aetna Medicare	$135.90
Rate for Payer: BCBS MT CHIP	$135.90
Rate for Payer: BCBS MT Closed Plan Network	$143.45
Rate for Payer: BCBS MT HealthLink	$135.90
Rate for Payer: BCBS MT Medicare	$135.90
Rate for Payer: BCBS MT POS	$143.45
Rate for Payer: BCBS MT Traditional	$151.00
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial	$143.45
Rate for Payer: Cigna Medicare	$135.90
Rate for Payer: Medicaid All Medicaid	$138.92
Rate for Payer: Medicare All Medicare	$105.70
Rate for Payer: Monida Allegiance	$143.45
Rate for Payer: Monida First Choice Health	$146.47
Rate for Payer: Monida Montana Health Co-op	$143.45
Rate for Payer: Monida PacificSource	$143.45

BLADDER SCANNER VITASCAN

Facility

$142.00

Hospital Charge Code	90196515
Hospital Revenue Code	270
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$142.00
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare	$127.80
Rate for Payer: BCBS MT CHIP	$127.80
Rate for Payer: BCBS MT Closed Plan Network	$134.90
Rate for Payer: BCBS MT HealthLink	$127.80
Rate for Payer: BCBS MT Medicare	$127.80
Rate for Payer: BCBS MT POS	$134.90
Rate for Payer: BCBS MT Traditional	$142.00
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cigna Commercial	$134.90
Rate for Payer: Cigna Medicare	$127.80
Rate for Payer: Medicaid All Medicaid	$130.64
Rate for Payer: Medicare All Medicare	$99.40
Rate for Payer: Monida Allegiance	$134.90
Rate for Payer: Monida First Choice Health	$137.74
Rate for Payer: Monida Montana Health Co-op	$134.90
Rate for Payer: Monida PacificSource	$134.90

BLADDER SCANNER VITASCAN

Facility

$142.00

Hospital Charge Code	90196515
Hospital Revenue Code	270
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$142.00
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare	$127.80
Rate for Payer: BCBS MT CHIP	$127.80
Rate for Payer: BCBS MT Closed Plan Network	$134.90
Rate for Payer: BCBS MT HealthLink	$127.80
Rate for Payer: BCBS MT Medicare	$127.80
Rate for Payer: BCBS MT POS	$134.90
Rate for Payer: BCBS MT Traditional	$142.00
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cigna Commercial	$134.90
Rate for Payer: Cigna Medicare	$127.80
Rate for Payer: Medicaid All Medicaid	$130.64
Rate for Payer: Medicare All Medicare	$99.40
Rate for Payer: Monida Allegiance	$134.90
Rate for Payer: Monida First Choice Health	$137.74
Rate for Payer: Monida Montana Health Co-op	$134.90
Rate for Payer: Monida PacificSource	$134.90

BLEEDING DIATHESIS PROFILE

Facility

$120.42

Service Code	CPT 85397
Hospital Charge Code	4088009
Hospital Revenue Code	302
Min. Negotiated Rate	$84.29
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$114.40
Rate for Payer: Aetna Medicare	$108.38
Rate for Payer: BCBS MT CHIP	$108.38
Rate for Payer: BCBS MT Closed Plan Network	$114.40
Rate for Payer: BCBS MT HealthLink	$108.38
Rate for Payer: BCBS MT Medicare	$108.38
Rate for Payer: BCBS MT POS	$114.40
Rate for Payer: BCBS MT Traditional	$120.42
Rate for Payer: Cash Price	$108.38
Rate for Payer: Cigna Commercial	$114.40
Rate for Payer: Cigna Medicare	$108.38
Rate for Payer: Medicaid All Medicaid	$110.79
Rate for Payer: Medicare All Medicare	$84.29
Rate for Payer: Monida Allegiance	$114.40
Rate for Payer: Monida First Choice Health	$116.81
Rate for Payer: Monida Montana Health Co-op	$114.40
Rate for Payer: Monida PacificSource	$114.40

BLEEDING DIATHESIS PROFILE

Facility

$120.42

Service Code	CPT 85397
Hospital Charge Code	4088009
Hospital Revenue Code	302
Min. Negotiated Rate	$84.29
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$114.40
Rate for Payer: Aetna Medicare	$108.38
Rate for Payer: BCBS MT CHIP	$108.38
Rate for Payer: BCBS MT Closed Plan Network	$114.40
Rate for Payer: BCBS MT HealthLink	$108.38
Rate for Payer: BCBS MT Medicare	$108.38
Rate for Payer: BCBS MT POS	$114.40
Rate for Payer: BCBS MT Traditional	$120.42
Rate for Payer: Cash Price	$108.38
Rate for Payer: Cigna Commercial	$114.40
Rate for Payer: Cigna Medicare	$108.38
Rate for Payer: Medicaid All Medicaid	$110.79
Rate for Payer: Medicare All Medicare	$84.29
Rate for Payer: Monida Allegiance	$114.40
Rate for Payer: Monida First Choice Health	$116.81
Rate for Payer: Monida Montana Health Co-op	$114.40
Rate for Payer: Monida PacificSource	$114.40

BLOOD CULTURE

Facility

$121.00

Hospital Charge Code	4070402
Hospital Revenue Code	306
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$114.95
Rate for Payer: Aetna Medicare	$108.90
Rate for Payer: BCBS MT CHIP	$108.90
Rate for Payer: BCBS MT Closed Plan Network	$114.95
Rate for Payer: BCBS MT HealthLink	$108.90
Rate for Payer: BCBS MT Medicare	$108.90
Rate for Payer: BCBS MT POS	$114.95
Rate for Payer: BCBS MT Traditional	$121.00
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial	$114.95
Rate for Payer: Cigna Medicare	$108.90
Rate for Payer: Medicaid All Medicaid	$111.32
Rate for Payer: Medicare All Medicare	$84.70
Rate for Payer: Monida Allegiance	$114.95
Rate for Payer: Monida First Choice Health	$117.37
Rate for Payer: Monida Montana Health Co-op	$114.95
Rate for Payer: Monida PacificSource	$114.95

BLOOD CULTURE

Facility

$121.00

Hospital Charge Code	4070402
Hospital Revenue Code	306
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$114.95
Rate for Payer: Aetna Medicare	$108.90
Rate for Payer: BCBS MT CHIP	$108.90
Rate for Payer: BCBS MT Closed Plan Network	$114.95
Rate for Payer: BCBS MT HealthLink	$108.90
Rate for Payer: BCBS MT Medicare	$108.90
Rate for Payer: BCBS MT POS	$114.95
Rate for Payer: BCBS MT Traditional	$121.00
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial	$114.95
Rate for Payer: Cigna Medicare	$108.90
Rate for Payer: Medicaid All Medicaid	$111.32
Rate for Payer: Medicare All Medicare	$84.70
Rate for Payer: Monida Allegiance	$114.95
Rate for Payer: Monida First Choice Health	$117.37
Rate for Payer: Monida Montana Health Co-op	$114.95
Rate for Payer: Monida PacificSource	$114.95

BLOOD CULTURE LINE DRAW

Facility

$120.00

Service Code	CPT 87040
Hospital Charge Code	4088066
Hospital Revenue Code	302
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS MT CHIP	$108.00
Rate for Payer: BCBS MT Closed Plan Network	$114.00
Rate for Payer: BCBS MT HealthLink	$108.00
Rate for Payer: BCBS MT Medicare	$108.00
Rate for Payer: BCBS MT POS	$114.00
Rate for Payer: BCBS MT Traditional	$120.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: Cigna Medicare	$108.00
Rate for Payer: Medicaid All Medicaid	$110.40
Rate for Payer: Medicare All Medicare	$84.00
Rate for Payer: Monida Allegiance	$114.00
Rate for Payer: Monida First Choice Health	$116.40
Rate for Payer: Monida Montana Health Co-op	$114.00
Rate for Payer: Monida PacificSource	$114.00

BLOOD CULTURE LINE DRAW

Facility

$120.00

Service Code	CPT 87040
Hospital Charge Code	4088066
Hospital Revenue Code	302
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS MT CHIP	$108.00
Rate for Payer: BCBS MT Closed Plan Network	$114.00
Rate for Payer: BCBS MT HealthLink	$108.00
Rate for Payer: BCBS MT Medicare	$108.00
Rate for Payer: BCBS MT POS	$114.00
Rate for Payer: BCBS MT Traditional	$120.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: Cigna Medicare	$108.00
Rate for Payer: Medicaid All Medicaid	$110.40
Rate for Payer: Medicare All Medicare	$84.00
Rate for Payer: Monida Allegiance	$114.00
Rate for Payer: Monida First Choice Health	$116.40
Rate for Payer: Monida Montana Health Co-op	$114.00
Rate for Payer: Monida PacificSource	$114.00

BLOOD CULTURE, PEDIATRIC (008300)

Facility

$65.00

Service Code	CPT 87040
Hospital Charge Code	4070403
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

BLOOD CULTURE, PEDIATRIC (008300)

Facility

$65.00

Service Code	CPT 87040
Hospital Charge Code	4070403
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

BLOOD CULTURE, SET 1 (008300)

Facility

$65.00

Service Code	CPT 87040
Hospital Charge Code	4087040
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

BLOOD CULTURE, SET 1 (008300)

Facility

$65.00

Service Code	CPT 87040
Hospital Charge Code	4087040
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

BLOOD CULTURE, SET 2 (008300)

Facility

$65.00

Service Code	CPT 87040
Hospital Charge Code	4070401
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

BLOOD CULTURE, SET 2 (008300)

Facility

$65.00

Service Code	CPT 87040
Hospital Charge Code	4070401
Hospital Revenue Code	306
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

BLOOD DRAW-IMPLANTED VENOUS DEVICE

Facility

$134.00

Service Code	CPT 36591
Hospital Charge Code	1036591
Hospital Revenue Code	450
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

BLOOD DRAW-IMPLANTED VENOUS DEVICE

Facility

$134.00

Service Code	CPT 36591
Hospital Charge Code	1036591
Hospital Revenue Code	450
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

BLOOD DRAW-PICC LINE

Facility

$124.00

Service Code	CPT 36592
Hospital Charge Code	1036592
Hospital Revenue Code	450
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare	$111.60
Rate for Payer: BCBS MT CHIP	$111.60
Rate for Payer: BCBS MT Closed Plan Network	$117.80
Rate for Payer: BCBS MT HealthLink	$111.60
Rate for Payer: BCBS MT Medicare	$111.60
Rate for Payer: BCBS MT POS	$117.80
Rate for Payer: BCBS MT Traditional	$124.00
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial	$117.80
Rate for Payer: Cigna Medicare	$111.60
Rate for Payer: Medicaid All Medicaid	$114.08
Rate for Payer: Medicare All Medicare	$86.80
Rate for Payer: Monida Allegiance	$117.80
Rate for Payer: Monida First Choice Health	$120.28
Rate for Payer: Monida Montana Health Co-op	$117.80
Rate for Payer: Monida PacificSource	$117.80

BLOOD DRAW-PICC LINE

Facility

$124.00

Service Code	CPT 36592
Hospital Charge Code	1036592
Hospital Revenue Code	450
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare	$111.60
Rate for Payer: BCBS MT CHIP	$111.60
Rate for Payer: BCBS MT Closed Plan Network	$117.80
Rate for Payer: BCBS MT HealthLink	$111.60
Rate for Payer: BCBS MT Medicare	$111.60
Rate for Payer: BCBS MT POS	$117.80
Rate for Payer: BCBS MT Traditional	$124.00
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial	$117.80
Rate for Payer: Cigna Medicare	$111.60
Rate for Payer: Medicaid All Medicaid	$114.08
Rate for Payer: Medicare All Medicare	$86.80
Rate for Payer: Monida Allegiance	$117.80
Rate for Payer: Monida First Choice Health	$120.28
Rate for Payer: Monida Montana Health Co-op	$117.80
Rate for Payer: Monida PacificSource	$117.80

BLOOD GASES, ARTERIAL

Facility

$293.00

Service Code	CPT 82803
Hospital Charge Code	4082803
Hospital Revenue Code	301
Min. Negotiated Rate	$205.10
Max. Negotiated Rate	$293.00
Rate for Payer: Aetna Commercial	$278.35
Rate for Payer: Aetna Medicare	$263.70
Rate for Payer: BCBS MT CHIP	$263.70
Rate for Payer: BCBS MT Closed Plan Network	$278.35
Rate for Payer: BCBS MT HealthLink	$263.70
Rate for Payer: BCBS MT Medicare	$263.70
Rate for Payer: BCBS MT POS	$278.35
Rate for Payer: BCBS MT Traditional	$293.00
Rate for Payer: Cash Price	$263.70
Rate for Payer: Cigna Commercial	$278.35
Rate for Payer: Cigna Medicare	$263.70
Rate for Payer: Medicaid All Medicaid	$269.56
Rate for Payer: Medicare All Medicare	$205.10
Rate for Payer: Monida Allegiance	$278.35
Rate for Payer: Monida First Choice Health	$284.21
Rate for Payer: Monida Montana Health Co-op	$278.35
Rate for Payer: Monida PacificSource	$278.35

BLOOD GASES, ARTERIAL

Facility

$293.00

Service Code	CPT 82803
Hospital Charge Code	4082803
Hospital Revenue Code	301
Min. Negotiated Rate	$205.10
Max. Negotiated Rate	$293.00
Rate for Payer: Aetna Commercial	$278.35
Rate for Payer: Aetna Medicare	$263.70
Rate for Payer: BCBS MT CHIP	$263.70
Rate for Payer: BCBS MT Closed Plan Network	$278.35
Rate for Payer: BCBS MT HealthLink	$263.70
Rate for Payer: BCBS MT Medicare	$263.70
Rate for Payer: BCBS MT POS	$278.35
Rate for Payer: BCBS MT Traditional	$293.00
Rate for Payer: Cash Price	$263.70
Rate for Payer: Cigna Commercial	$278.35
Rate for Payer: Cigna Medicare	$263.70
Rate for Payer: Medicaid All Medicaid	$269.56
Rate for Payer: Medicare All Medicare	$205.10
Rate for Payer: Monida Allegiance	$278.35
Rate for Payer: Monida First Choice Health	$284.21
Rate for Payer: Monida Montana Health Co-op	$278.35
Rate for Payer: Monida PacificSource	$278.35

BLOOD GASES, VENOUS

Facility

$293.00

Service Code	CPT 82803
Hospital Charge Code	4000077
Hospital Revenue Code	301
Min. Negotiated Rate	$205.10
Max. Negotiated Rate	$293.00
Rate for Payer: Aetna Commercial	$278.35
Rate for Payer: Aetna Medicare	$263.70
Rate for Payer: BCBS MT CHIP	$263.70
Rate for Payer: BCBS MT Closed Plan Network	$278.35
Rate for Payer: BCBS MT HealthLink	$263.70
Rate for Payer: BCBS MT Medicare	$263.70
Rate for Payer: BCBS MT POS	$278.35
Rate for Payer: BCBS MT Traditional	$293.00
Rate for Payer: Cash Price	$263.70
Rate for Payer: Cigna Commercial	$278.35
Rate for Payer: Cigna Medicare	$263.70
Rate for Payer: Medicaid All Medicaid	$269.56
Rate for Payer: Medicare All Medicare	$205.10
Rate for Payer: Monida Allegiance	$278.35
Rate for Payer: Monida First Choice Health	$284.21
Rate for Payer: Monida Montana Health Co-op	$278.35
Rate for Payer: Monida PacificSource	$278.35

BLOOD GASES, VENOUS

Facility

$293.00

Service Code	CPT 82803
Hospital Charge Code	4000077
Hospital Revenue Code	301
Min. Negotiated Rate	$205.10
Max. Negotiated Rate	$293.00
Rate for Payer: Aetna Commercial	$278.35
Rate for Payer: Aetna Medicare	$263.70
Rate for Payer: BCBS MT CHIP	$263.70
Rate for Payer: BCBS MT Closed Plan Network	$278.35
Rate for Payer: BCBS MT HealthLink	$263.70
Rate for Payer: BCBS MT Medicare	$263.70
Rate for Payer: BCBS MT POS	$278.35
Rate for Payer: BCBS MT Traditional	$293.00
Rate for Payer: Cash Price	$263.70
Rate for Payer: Cigna Commercial	$278.35
Rate for Payer: Cigna Medicare	$263.70
Rate for Payer: Medicaid All Medicaid	$269.56
Rate for Payer: Medicare All Medicare	$205.10
Rate for Payer: Monida Allegiance	$278.35
Rate for Payer: Monida First Choice Health	$284.21
Rate for Payer: Monida Montana Health Co-op	$278.35
Rate for Payer: Monida PacificSource	$278.35

BLOOD TRANSFER DEVICE (NURSING ONLY)

Facility

$3.00

Hospital Charge Code	80040231
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare	$2.70
Rate for Payer: BCBS MT CHIP	$2.70
Rate for Payer: BCBS MT Closed Plan Network	$2.85
Rate for Payer: BCBS MT HealthLink	$2.70
Rate for Payer: BCBS MT Medicare	$2.70
Rate for Payer: BCBS MT POS	$2.85
Rate for Payer: BCBS MT Traditional	$3.00
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna Commercial	$2.85
Rate for Payer: Cigna Medicare	$2.70
Rate for Payer: Medicaid All Medicaid	$2.76
Rate for Payer: Medicare All Medicare	$2.10
Rate for Payer: Monida Allegiance	$2.85
Rate for Payer: Monida First Choice Health	$2.91
Rate for Payer: Monida Montana Health Co-op	$2.85
Rate for Payer: Monida PacificSource	$2.85

Know your out-of-pocket cost for care.

All Charges