Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

SKIN STAPLER

Facility

$39.00

Hospital Charge Code	80040149
Hospital Revenue Code	270
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$37.05
Rate for Payer: Aetna Medicare	$35.10
Rate for Payer: BCBS MT CHIP	$35.10
Rate for Payer: BCBS MT Closed Plan Network	$37.05
Rate for Payer: BCBS MT HealthLink	$35.10
Rate for Payer: BCBS MT Medicare	$35.10
Rate for Payer: BCBS MT POS	$37.05
Rate for Payer: BCBS MT Traditional	$39.00
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cigna Commercial	$37.05
Rate for Payer: Cigna Medicare	$35.10
Rate for Payer: Medicaid All Medicaid	$35.88
Rate for Payer: Medicare All Medicare	$27.30
Rate for Payer: Monida Allegiance	$37.05
Rate for Payer: Monida First Choice Health	$37.83
Rate for Payer: Monida Montana Health Co-op	$37.05
Rate for Payer: Monida PacificSource	$37.05

SKIN STAPLER

Facility

$39.00

Hospital Charge Code	80040149
Hospital Revenue Code	270
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Commercial	$37.05
Rate for Payer: Aetna Medicare	$35.10
Rate for Payer: BCBS MT CHIP	$35.10
Rate for Payer: BCBS MT Closed Plan Network	$37.05
Rate for Payer: BCBS MT HealthLink	$35.10
Rate for Payer: BCBS MT Medicare	$35.10
Rate for Payer: BCBS MT POS	$37.05
Rate for Payer: BCBS MT Traditional	$39.00
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cigna Commercial	$37.05
Rate for Payer: Cigna Medicare	$35.10
Rate for Payer: Medicaid All Medicaid	$35.88
Rate for Payer: Medicare All Medicare	$27.30
Rate for Payer: Monida Allegiance	$37.05
Rate for Payer: Monida First Choice Health	$37.83
Rate for Payer: Monida Montana Health Co-op	$37.05
Rate for Payer: Monida PacificSource	$37.05

SKIN STAPLER REMOVER

Facility

$25.00

Hospital Charge Code	80030261
Hospital Revenue Code	270
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS MT CHIP	$22.50
Rate for Payer: BCBS MT Closed Plan Network	$23.75
Rate for Payer: BCBS MT HealthLink	$22.50
Rate for Payer: BCBS MT Medicare	$22.50
Rate for Payer: BCBS MT POS	$23.75
Rate for Payer: BCBS MT Traditional	$25.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: Cigna Medicare	$22.50
Rate for Payer: Medicaid All Medicaid	$23.00
Rate for Payer: Medicare All Medicare	$17.50
Rate for Payer: Monida Allegiance	$23.75
Rate for Payer: Monida First Choice Health	$24.25
Rate for Payer: Monida Montana Health Co-op	$23.75
Rate for Payer: Monida PacificSource	$23.75

SKIN STAPLER REMOVER

Facility

$25.00

Hospital Charge Code	80030261
Hospital Revenue Code	270
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS MT CHIP	$22.50
Rate for Payer: BCBS MT Closed Plan Network	$23.75
Rate for Payer: BCBS MT HealthLink	$22.50
Rate for Payer: BCBS MT Medicare	$22.50
Rate for Payer: BCBS MT POS	$23.75
Rate for Payer: BCBS MT Traditional	$25.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: Cigna Medicare	$22.50
Rate for Payer: Medicaid All Medicaid	$23.00
Rate for Payer: Medicare All Medicare	$17.50
Rate for Payer: Monida Allegiance	$23.75
Rate for Payer: Monida First Choice Health	$24.25
Rate for Payer: Monida Montana Health Co-op	$23.75
Rate for Payer: Monida PacificSource	$23.75

SKIN SUB APPLIC H,FT,FC 1ST100SQCM 15277

Facility

$1,960.00

Service Code	CPT 15277
Hospital Charge Code	8015277
Hospital Revenue Code	761
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$1,960.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare	$1,764.00
Rate for Payer: BCBS MT CHIP	$1,764.00
Rate for Payer: BCBS MT Closed Plan Network	$1,862.00
Rate for Payer: BCBS MT HealthLink	$1,764.00
Rate for Payer: BCBS MT Medicare	$1,764.00
Rate for Payer: BCBS MT POS	$1,862.00
Rate for Payer: BCBS MT Traditional	$1,960.00
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Cigna Commercial	$1,862.00
Rate for Payer: Cigna Medicare	$1,764.00
Rate for Payer: Medicaid All Medicaid	$1,803.20
Rate for Payer: Medicare All Medicare	$1,372.00
Rate for Payer: Monida Allegiance	$1,862.00
Rate for Payer: Monida First Choice Health	$1,901.20
Rate for Payer: Monida Montana Health Co-op	$1,862.00
Rate for Payer: Monida PacificSource	$1,862.00

SKIN SUB APPLIC H,FT,FC 1ST100SQCM 15277

Facility

$1,960.00

Service Code	CPT 15277
Hospital Charge Code	8015277
Hospital Revenue Code	761
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$1,960.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare	$1,764.00
Rate for Payer: BCBS MT CHIP	$1,764.00
Rate for Payer: BCBS MT Closed Plan Network	$1,862.00
Rate for Payer: BCBS MT HealthLink	$1,764.00
Rate for Payer: BCBS MT Medicare	$1,764.00
Rate for Payer: BCBS MT POS	$1,862.00
Rate for Payer: BCBS MT Traditional	$1,960.00
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Cigna Commercial	$1,862.00
Rate for Payer: Cigna Medicare	$1,764.00
Rate for Payer: Medicaid All Medicaid	$1,803.20
Rate for Payer: Medicare All Medicare	$1,372.00
Rate for Payer: Monida Allegiance	$1,862.00
Rate for Payer: Monida First Choice Health	$1,901.20
Rate for Payer: Monida Montana Health Co-op	$1,862.00
Rate for Payer: Monida PacificSource	$1,862.00

SKIN SUBS APP H,FT,FC EA 100+ SQCM 15278

Facility

$1,315.00

Service Code	CPT 15278
Hospital Charge Code	8015278
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$1,315.00
Rate for Payer: Aetna Commercial	$1,249.25
Rate for Payer: Aetna Medicare	$1,183.50
Rate for Payer: BCBS MT CHIP	$1,183.50
Rate for Payer: BCBS MT Closed Plan Network	$1,249.25
Rate for Payer: BCBS MT HealthLink	$1,183.50
Rate for Payer: BCBS MT Medicare	$1,183.50
Rate for Payer: BCBS MT POS	$1,249.25
Rate for Payer: BCBS MT Traditional	$1,315.00
Rate for Payer: Cash Price	$1,183.50
Rate for Payer: Cigna Commercial	$1,249.25
Rate for Payer: Cigna Medicare	$1,183.50
Rate for Payer: Medicaid All Medicaid	$1,209.80
Rate for Payer: Medicare All Medicare	$920.50
Rate for Payer: Monida Allegiance	$1,249.25
Rate for Payer: Monida First Choice Health	$1,275.55
Rate for Payer: Monida Montana Health Co-op	$1,249.25
Rate for Payer: Monida PacificSource	$1,249.25

SKIN SUBS APP H,FT,FC EA 100+ SQCM 15278

Facility

$1,315.00

Service Code	CPT 15278
Hospital Charge Code	8015278
Hospital Revenue Code	761
Min. Negotiated Rate	$920.50
Max. Negotiated Rate	$1,315.00
Rate for Payer: Aetna Commercial	$1,249.25
Rate for Payer: Aetna Medicare	$1,183.50
Rate for Payer: BCBS MT CHIP	$1,183.50
Rate for Payer: BCBS MT Closed Plan Network	$1,249.25
Rate for Payer: BCBS MT HealthLink	$1,183.50
Rate for Payer: BCBS MT Medicare	$1,183.50
Rate for Payer: BCBS MT POS	$1,249.25
Rate for Payer: BCBS MT Traditional	$1,315.00
Rate for Payer: Cash Price	$1,183.50
Rate for Payer: Cigna Commercial	$1,249.25
Rate for Payer: Cigna Medicare	$1,183.50
Rate for Payer: Medicaid All Medicaid	$1,209.80
Rate for Payer: Medicare All Medicare	$920.50
Rate for Payer: Monida Allegiance	$1,249.25
Rate for Payer: Monida First Choice Health	$1,275.55
Rate for Payer: Monida Montana Health Co-op	$1,249.25
Rate for Payer: Monida PacificSource	$1,249.25

SKIN SUBS APPLIC H,FT,FC, 1-25SQCM 15275

Facility

$1,855.00

Service Code	CPT 15275
Hospital Charge Code	8015275
Hospital Revenue Code	761
Min. Negotiated Rate	$1,298.50
Max. Negotiated Rate	$1,855.00
Rate for Payer: Aetna Commercial	$1,762.25
Rate for Payer: Aetna Medicare	$1,669.50
Rate for Payer: BCBS MT CHIP	$1,669.50
Rate for Payer: BCBS MT Closed Plan Network	$1,762.25
Rate for Payer: BCBS MT HealthLink	$1,669.50
Rate for Payer: BCBS MT Medicare	$1,669.50
Rate for Payer: BCBS MT POS	$1,762.25
Rate for Payer: BCBS MT Traditional	$1,855.00
Rate for Payer: Cash Price	$1,669.50
Rate for Payer: Cigna Commercial	$1,762.25
Rate for Payer: Cigna Medicare	$1,669.50
Rate for Payer: Medicaid All Medicaid	$1,706.60
Rate for Payer: Medicare All Medicare	$1,298.50
Rate for Payer: Monida Allegiance	$1,762.25
Rate for Payer: Monida First Choice Health	$1,799.35
Rate for Payer: Monida Montana Health Co-op	$1,762.25
Rate for Payer: Monida PacificSource	$1,762.25

SKIN SUBS APPLIC H,FT,FC, 1-25SQCM 15275

Facility

$1,855.00

Service Code	CPT 15275
Hospital Charge Code	8015275
Hospital Revenue Code	761
Min. Negotiated Rate	$1,298.50
Max. Negotiated Rate	$1,855.00
Rate for Payer: Aetna Commercial	$1,762.25
Rate for Payer: Aetna Medicare	$1,669.50
Rate for Payer: BCBS MT CHIP	$1,669.50
Rate for Payer: BCBS MT Closed Plan Network	$1,762.25
Rate for Payer: BCBS MT HealthLink	$1,669.50
Rate for Payer: BCBS MT Medicare	$1,669.50
Rate for Payer: BCBS MT POS	$1,762.25
Rate for Payer: BCBS MT Traditional	$1,855.00
Rate for Payer: Cash Price	$1,669.50
Rate for Payer: Cigna Commercial	$1,762.25
Rate for Payer: Cigna Medicare	$1,669.50
Rate for Payer: Medicaid All Medicaid	$1,706.60
Rate for Payer: Medicare All Medicare	$1,298.50
Rate for Payer: Monida Allegiance	$1,762.25
Rate for Payer: Monida First Choice Health	$1,799.35
Rate for Payer: Monida Montana Health Co-op	$1,762.25
Rate for Payer: Monida PacificSource	$1,762.25

SKIN SUBS APPLIC H,FT,FC EA 25SQCM 15276

Facility

$588.00

Service Code	CPT 15276
Hospital Charge Code	8015276
Hospital Revenue Code	761
Min. Negotiated Rate	$411.60
Max. Negotiated Rate	$588.00
Rate for Payer: Aetna Commercial	$558.60
Rate for Payer: Aetna Medicare	$529.20
Rate for Payer: BCBS MT CHIP	$529.20
Rate for Payer: BCBS MT Closed Plan Network	$558.60
Rate for Payer: BCBS MT HealthLink	$529.20
Rate for Payer: BCBS MT Medicare	$529.20
Rate for Payer: BCBS MT POS	$558.60
Rate for Payer: BCBS MT Traditional	$588.00
Rate for Payer: Cash Price	$529.20
Rate for Payer: Cigna Commercial	$558.60
Rate for Payer: Cigna Medicare	$529.20
Rate for Payer: Medicaid All Medicaid	$540.96
Rate for Payer: Medicare All Medicare	$411.60
Rate for Payer: Monida Allegiance	$558.60
Rate for Payer: Monida First Choice Health	$570.36
Rate for Payer: Monida Montana Health Co-op	$558.60
Rate for Payer: Monida PacificSource	$558.60

SKIN SUBS APPLIC H,FT,FC EA 25SQCM 15276

Facility

$588.00

Service Code	CPT 15276
Hospital Charge Code	8015276
Hospital Revenue Code	761
Min. Negotiated Rate	$411.60
Max. Negotiated Rate	$588.00
Rate for Payer: Aetna Commercial	$558.60
Rate for Payer: Aetna Medicare	$529.20
Rate for Payer: BCBS MT CHIP	$529.20
Rate for Payer: BCBS MT Closed Plan Network	$558.60
Rate for Payer: BCBS MT HealthLink	$529.20
Rate for Payer: BCBS MT Medicare	$529.20
Rate for Payer: BCBS MT POS	$558.60
Rate for Payer: BCBS MT Traditional	$588.00
Rate for Payer: Cash Price	$529.20
Rate for Payer: Cigna Commercial	$558.60
Rate for Payer: Cigna Medicare	$529.20
Rate for Payer: Medicaid All Medicaid	$540.96
Rate for Payer: Medicare All Medicare	$411.60
Rate for Payer: Monida Allegiance	$558.60
Rate for Payer: Monida First Choice Health	$570.36
Rate for Payer: Monida Montana Health Co-op	$558.60
Rate for Payer: Monida PacificSource	$558.60

SKIN SUBS APPLIC T,A,L 1-25 SQCM 15271

Facility

$1,752.00

Service Code	CPT 15271
Hospital Charge Code	8015271
Hospital Revenue Code	761
Min. Negotiated Rate	$1,226.40
Max. Negotiated Rate	$1,752.00
Rate for Payer: Aetna Commercial	$1,664.40
Rate for Payer: Aetna Medicare	$1,576.80
Rate for Payer: BCBS MT CHIP	$1,576.80
Rate for Payer: BCBS MT Closed Plan Network	$1,664.40
Rate for Payer: BCBS MT HealthLink	$1,576.80
Rate for Payer: BCBS MT Medicare	$1,576.80
Rate for Payer: BCBS MT POS	$1,664.40
Rate for Payer: BCBS MT Traditional	$1,752.00
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Cigna Commercial	$1,664.40
Rate for Payer: Cigna Medicare	$1,576.80
Rate for Payer: Medicaid All Medicaid	$1,611.84
Rate for Payer: Medicare All Medicare	$1,226.40
Rate for Payer: Monida Allegiance	$1,664.40
Rate for Payer: Monida First Choice Health	$1,699.44
Rate for Payer: Monida Montana Health Co-op	$1,664.40
Rate for Payer: Monida PacificSource	$1,664.40

SKIN SUBS APPLIC T,A,L 1-25 SQCM 15271

Facility

$1,752.00

Service Code	CPT 15271
Hospital Charge Code	8015271
Hospital Revenue Code	761
Min. Negotiated Rate	$1,226.40
Max. Negotiated Rate	$1,752.00
Rate for Payer: Aetna Commercial	$1,664.40
Rate for Payer: Aetna Medicare	$1,576.80
Rate for Payer: BCBS MT CHIP	$1,576.80
Rate for Payer: BCBS MT Closed Plan Network	$1,664.40
Rate for Payer: BCBS MT HealthLink	$1,576.80
Rate for Payer: BCBS MT Medicare	$1,576.80
Rate for Payer: BCBS MT POS	$1,664.40
Rate for Payer: BCBS MT Traditional	$1,752.00
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Cigna Commercial	$1,664.40
Rate for Payer: Cigna Medicare	$1,576.80
Rate for Payer: Medicaid All Medicaid	$1,611.84
Rate for Payer: Medicare All Medicare	$1,226.40
Rate for Payer: Monida Allegiance	$1,664.40
Rate for Payer: Monida First Choice Health	$1,699.44
Rate for Payer: Monida Montana Health Co-op	$1,664.40
Rate for Payer: Monida PacificSource	$1,664.40

SKIN SUBS APPLIC T,A,L 1ST100 SQCM 15273

Facility

$1,914.00

Service Code	CPT 15273
Hospital Charge Code	8015273
Hospital Revenue Code	761
Min. Negotiated Rate	$1,339.80
Max. Negotiated Rate	$1,914.00
Rate for Payer: Aetna Commercial	$1,818.30
Rate for Payer: Aetna Medicare	$1,722.60
Rate for Payer: BCBS MT CHIP	$1,722.60
Rate for Payer: BCBS MT Closed Plan Network	$1,818.30
Rate for Payer: BCBS MT HealthLink	$1,722.60
Rate for Payer: BCBS MT Medicare	$1,722.60
Rate for Payer: BCBS MT POS	$1,818.30
Rate for Payer: BCBS MT Traditional	$1,914.00
Rate for Payer: Cash Price	$1,722.60
Rate for Payer: Cigna Commercial	$1,818.30
Rate for Payer: Cigna Medicare	$1,722.60
Rate for Payer: Medicaid All Medicaid	$1,760.88
Rate for Payer: Medicare All Medicare	$1,339.80
Rate for Payer: Monida Allegiance	$1,818.30
Rate for Payer: Monida First Choice Health	$1,856.58
Rate for Payer: Monida Montana Health Co-op	$1,818.30
Rate for Payer: Monida PacificSource	$1,818.30

SKIN SUBS APPLIC T,A,L 1ST100 SQCM 15273

Facility

$1,914.00

Service Code	CPT 15273
Hospital Charge Code	8015273
Hospital Revenue Code	761
Min. Negotiated Rate	$1,339.80
Max. Negotiated Rate	$1,914.00
Rate for Payer: Aetna Commercial	$1,818.30
Rate for Payer: Aetna Medicare	$1,722.60
Rate for Payer: BCBS MT CHIP	$1,722.60
Rate for Payer: BCBS MT Closed Plan Network	$1,818.30
Rate for Payer: BCBS MT HealthLink	$1,722.60
Rate for Payer: BCBS MT Medicare	$1,722.60
Rate for Payer: BCBS MT POS	$1,818.30
Rate for Payer: BCBS MT Traditional	$1,914.00
Rate for Payer: Cash Price	$1,722.60
Rate for Payer: Cigna Commercial	$1,818.30
Rate for Payer: Cigna Medicare	$1,722.60
Rate for Payer: Medicaid All Medicaid	$1,760.88
Rate for Payer: Medicare All Medicare	$1,339.80
Rate for Payer: Monida Allegiance	$1,818.30
Rate for Payer: Monida First Choice Health	$1,856.58
Rate for Payer: Monida Montana Health Co-op	$1,818.30
Rate for Payer: Monida PacificSource	$1,818.30

SKIN SUBS APPLIC T,A,L EA100+ SQCM 15274

Facility

$815.00

Service Code	CPT 15274
Hospital Charge Code	8015274
Hospital Revenue Code	761
Min. Negotiated Rate	$570.50
Max. Negotiated Rate	$815.00
Rate for Payer: Aetna Commercial	$774.25
Rate for Payer: Aetna Medicare	$733.50
Rate for Payer: BCBS MT CHIP	$733.50
Rate for Payer: BCBS MT Closed Plan Network	$774.25
Rate for Payer: BCBS MT HealthLink	$733.50
Rate for Payer: BCBS MT Medicare	$733.50
Rate for Payer: BCBS MT POS	$774.25
Rate for Payer: BCBS MT Traditional	$815.00
Rate for Payer: Cash Price	$733.50
Rate for Payer: Cigna Commercial	$774.25
Rate for Payer: Cigna Medicare	$733.50
Rate for Payer: Medicaid All Medicaid	$749.80
Rate for Payer: Medicare All Medicare	$570.50
Rate for Payer: Monida Allegiance	$774.25
Rate for Payer: Monida First Choice Health	$790.55
Rate for Payer: Monida Montana Health Co-op	$774.25
Rate for Payer: Monida PacificSource	$774.25

SKIN SUBS APPLIC T,A,L EA100+ SQCM 15274

Facility

$815.00

Service Code	CPT 15274
Hospital Charge Code	8015274
Hospital Revenue Code	761
Min. Negotiated Rate	$570.50
Max. Negotiated Rate	$815.00
Rate for Payer: Aetna Commercial	$774.25
Rate for Payer: Aetna Medicare	$733.50
Rate for Payer: BCBS MT CHIP	$733.50
Rate for Payer: BCBS MT Closed Plan Network	$774.25
Rate for Payer: BCBS MT HealthLink	$733.50
Rate for Payer: BCBS MT Medicare	$733.50
Rate for Payer: BCBS MT POS	$774.25
Rate for Payer: BCBS MT Traditional	$815.00
Rate for Payer: Cash Price	$733.50
Rate for Payer: Cigna Commercial	$774.25
Rate for Payer: Cigna Medicare	$733.50
Rate for Payer: Medicaid All Medicaid	$749.80
Rate for Payer: Medicare All Medicare	$570.50
Rate for Payer: Monida Allegiance	$774.25
Rate for Payer: Monida First Choice Health	$790.55
Rate for Payer: Monida Montana Health Co-op	$774.25
Rate for Payer: Monida PacificSource	$774.25

SKIN SUBS APPLIC T,A,L EA 25 SQCM 15272

Facility

$493.00

Service Code	CPT 15272
Hospital Charge Code	8015272
Hospital Revenue Code	761
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$493.00
Rate for Payer: Aetna Commercial	$468.35
Rate for Payer: Aetna Medicare	$443.70
Rate for Payer: BCBS MT CHIP	$443.70
Rate for Payer: BCBS MT Closed Plan Network	$468.35
Rate for Payer: BCBS MT HealthLink	$443.70
Rate for Payer: BCBS MT Medicare	$443.70
Rate for Payer: BCBS MT POS	$468.35
Rate for Payer: BCBS MT Traditional	$493.00
Rate for Payer: Cash Price	$443.70
Rate for Payer: Cigna Commercial	$468.35
Rate for Payer: Cigna Medicare	$443.70
Rate for Payer: Medicaid All Medicaid	$453.56
Rate for Payer: Medicare All Medicare	$345.10
Rate for Payer: Monida Allegiance	$468.35
Rate for Payer: Monida First Choice Health	$478.21
Rate for Payer: Monida Montana Health Co-op	$468.35
Rate for Payer: Monida PacificSource	$468.35

SKIN SUBS APPLIC T,A,L EA 25 SQCM 15272

Facility

$493.00

Service Code	CPT 15272
Hospital Charge Code	8015272
Hospital Revenue Code	761
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$493.00
Rate for Payer: Aetna Commercial	$468.35
Rate for Payer: Aetna Medicare	$443.70
Rate for Payer: BCBS MT CHIP	$443.70
Rate for Payer: BCBS MT Closed Plan Network	$468.35
Rate for Payer: BCBS MT HealthLink	$443.70
Rate for Payer: BCBS MT Medicare	$443.70
Rate for Payer: BCBS MT POS	$468.35
Rate for Payer: BCBS MT Traditional	$493.00
Rate for Payer: Cash Price	$443.70
Rate for Payer: Cigna Commercial	$468.35
Rate for Payer: Cigna Medicare	$443.70
Rate for Payer: Medicaid All Medicaid	$453.56
Rate for Payer: Medicare All Medicare	$345.10
Rate for Payer: Monida Allegiance	$468.35
Rate for Payer: Monida First Choice Health	$478.21
Rate for Payer: Monida Montana Health Co-op	$468.35
Rate for Payer: Monida PacificSource	$468.35

SLING AND SWATHE LG

Facility

$37.00

Hospital Charge Code	2893511
Hospital Revenue Code	290
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: BCBS MT CHIP	$33.30
Rate for Payer: BCBS MT Closed Plan Network	$35.15
Rate for Payer: BCBS MT HealthLink	$33.30
Rate for Payer: BCBS MT Medicare	$33.30
Rate for Payer: BCBS MT POS	$35.15
Rate for Payer: BCBS MT Traditional	$37.00
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial	$35.15
Rate for Payer: Cigna Medicare	$33.30
Rate for Payer: Medicaid All Medicaid	$34.04
Rate for Payer: Medicare All Medicare	$25.90
Rate for Payer: Monida Allegiance	$35.15
Rate for Payer: Monida First Choice Health	$35.89
Rate for Payer: Monida Montana Health Co-op	$35.15
Rate for Payer: Monida PacificSource	$35.15

SLING AND SWATHE LG

Facility

$37.00

Hospital Charge Code	2893511
Hospital Revenue Code	290
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: BCBS MT CHIP	$33.30
Rate for Payer: BCBS MT Closed Plan Network	$35.15
Rate for Payer: BCBS MT HealthLink	$33.30
Rate for Payer: BCBS MT Medicare	$33.30
Rate for Payer: BCBS MT POS	$35.15
Rate for Payer: BCBS MT Traditional	$37.00
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial	$35.15
Rate for Payer: Cigna Medicare	$33.30
Rate for Payer: Medicaid All Medicaid	$34.04
Rate for Payer: Medicare All Medicare	$25.90
Rate for Payer: Monida Allegiance	$35.15
Rate for Payer: Monida First Choice Health	$35.89
Rate for Payer: Monida Montana Health Co-op	$35.15
Rate for Payer: Monida PacificSource	$35.15

SLING AND SWATHE MD

Facility

$37.00

Hospital Charge Code	2893510
Hospital Revenue Code	290
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: BCBS MT CHIP	$33.30
Rate for Payer: BCBS MT Closed Plan Network	$35.15
Rate for Payer: BCBS MT HealthLink	$33.30
Rate for Payer: BCBS MT Medicare	$33.30
Rate for Payer: BCBS MT POS	$35.15
Rate for Payer: BCBS MT Traditional	$37.00
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial	$35.15
Rate for Payer: Cigna Medicare	$33.30
Rate for Payer: Medicaid All Medicaid	$34.04
Rate for Payer: Medicare All Medicare	$25.90
Rate for Payer: Monida Allegiance	$35.15
Rate for Payer: Monida First Choice Health	$35.89
Rate for Payer: Monida Montana Health Co-op	$35.15
Rate for Payer: Monida PacificSource	$35.15

SLING AND SWATHE MD

Facility

$37.00

Hospital Charge Code	2893510
Hospital Revenue Code	290
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: BCBS MT CHIP	$33.30
Rate for Payer: BCBS MT Closed Plan Network	$35.15
Rate for Payer: BCBS MT HealthLink	$33.30
Rate for Payer: BCBS MT Medicare	$33.30
Rate for Payer: BCBS MT POS	$35.15
Rate for Payer: BCBS MT Traditional	$37.00
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial	$35.15
Rate for Payer: Cigna Medicare	$33.30
Rate for Payer: Medicaid All Medicaid	$34.04
Rate for Payer: Medicare All Medicare	$25.90
Rate for Payer: Monida Allegiance	$35.15
Rate for Payer: Monida First Choice Health	$35.89
Rate for Payer: Monida Montana Health Co-op	$35.15
Rate for Payer: Monida PacificSource	$35.15

SLING AND SWATHE SM

Facility

$43.00

Hospital Charge Code	2840095
Hospital Revenue Code	270
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare	$38.70
Rate for Payer: BCBS MT CHIP	$38.70
Rate for Payer: BCBS MT Closed Plan Network	$40.85
Rate for Payer: BCBS MT HealthLink	$38.70
Rate for Payer: BCBS MT Medicare	$38.70
Rate for Payer: BCBS MT POS	$40.85
Rate for Payer: BCBS MT Traditional	$43.00
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial	$40.85
Rate for Payer: Cigna Medicare	$38.70
Rate for Payer: Medicaid All Medicaid	$39.56
Rate for Payer: Medicare All Medicare	$30.10
Rate for Payer: Monida Allegiance	$40.85
Rate for Payer: Monida First Choice Health	$41.71
Rate for Payer: Monida Montana Health Co-op	$40.85
Rate for Payer: Monida PacificSource	$40.85

Know your out-of-pocket cost for care.

All Charges