Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

US ABDOMEN DOPP LMT

Facility

$499.00

Service Code	CPT 93976
Hospital Charge Code	5193976
Hospital Revenue Code	402
Min. Negotiated Rate	$349.30
Max. Negotiated Rate	$499.00
Rate for Payer: Aetna Commercial	$474.05
Rate for Payer: Aetna Medicare	$449.10
Rate for Payer: BCBS MT CHIP	$449.10
Rate for Payer: BCBS MT Closed Plan Network	$474.05
Rate for Payer: BCBS MT HealthLink	$449.10
Rate for Payer: BCBS MT Medicare	$449.10
Rate for Payer: BCBS MT POS	$474.05
Rate for Payer: BCBS MT Traditional	$499.00
Rate for Payer: Cash Price	$449.10
Rate for Payer: Cigna Commercial	$474.05
Rate for Payer: Cigna Medicare	$449.10
Rate for Payer: Medicaid All Medicaid	$459.08
Rate for Payer: Medicare All Medicare	$349.30
Rate for Payer: Monida Allegiance	$474.05
Rate for Payer: Monida First Choice Health	$484.03
Rate for Payer: Monida Montana Health Co-op	$474.05
Rate for Payer: Monida PacificSource	$474.05

US ABDOMEN DUPLEX COMPLETE

Facility

$708.00

Service Code	CPT 93975
Hospital Charge Code	5193975
Hospital Revenue Code	402
Min. Negotiated Rate	$495.60
Max. Negotiated Rate	$708.00
Rate for Payer: Aetna Commercial	$672.60
Rate for Payer: Aetna Medicare	$637.20
Rate for Payer: BCBS MT CHIP	$637.20
Rate for Payer: BCBS MT Closed Plan Network	$672.60
Rate for Payer: BCBS MT HealthLink	$637.20
Rate for Payer: BCBS MT Medicare	$637.20
Rate for Payer: BCBS MT POS	$672.60
Rate for Payer: BCBS MT Traditional	$708.00
Rate for Payer: Cash Price	$637.20
Rate for Payer: Cigna Commercial	$672.60
Rate for Payer: Cigna Medicare	$637.20
Rate for Payer: Medicaid All Medicaid	$651.36
Rate for Payer: Medicare All Medicare	$495.60
Rate for Payer: Monida Allegiance	$672.60
Rate for Payer: Monida First Choice Health	$686.76
Rate for Payer: Monida Montana Health Co-op	$672.60
Rate for Payer: Monida PacificSource	$672.60

US ABDOMEN DUPLEX COMPLETE

Facility

$708.00

Service Code	CPT 93975
Hospital Charge Code	5193975
Hospital Revenue Code	402
Min. Negotiated Rate	$495.60
Max. Negotiated Rate	$708.00
Rate for Payer: Aetna Commercial	$672.60
Rate for Payer: Aetna Medicare	$637.20
Rate for Payer: BCBS MT CHIP	$637.20
Rate for Payer: BCBS MT Closed Plan Network	$672.60
Rate for Payer: BCBS MT HealthLink	$637.20
Rate for Payer: BCBS MT Medicare	$637.20
Rate for Payer: BCBS MT POS	$672.60
Rate for Payer: BCBS MT Traditional	$708.00
Rate for Payer: Cash Price	$637.20
Rate for Payer: Cigna Commercial	$672.60
Rate for Payer: Cigna Medicare	$637.20
Rate for Payer: Medicaid All Medicaid	$651.36
Rate for Payer: Medicare All Medicare	$495.60
Rate for Payer: Monida Allegiance	$672.60
Rate for Payer: Monida First Choice Health	$686.76
Rate for Payer: Monida Montana Health Co-op	$672.60
Rate for Payer: Monida PacificSource	$672.60

US ABDOMEN LIMITED

Facility

$443.00

Service Code	CPT 76705
Hospital Charge Code	5176705
Hospital Revenue Code	402
Min. Negotiated Rate	$310.10
Max. Negotiated Rate	$443.00
Rate for Payer: Aetna Commercial	$420.85
Rate for Payer: Aetna Medicare	$398.70
Rate for Payer: BCBS MT CHIP	$398.70
Rate for Payer: BCBS MT Closed Plan Network	$420.85
Rate for Payer: BCBS MT HealthLink	$398.70
Rate for Payer: BCBS MT Medicare	$398.70
Rate for Payer: BCBS MT POS	$420.85
Rate for Payer: BCBS MT Traditional	$443.00
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cigna Commercial	$420.85
Rate for Payer: Cigna Medicare	$398.70
Rate for Payer: Medicaid All Medicaid	$407.56
Rate for Payer: Medicare All Medicare	$310.10
Rate for Payer: Monida Allegiance	$420.85
Rate for Payer: Monida First Choice Health	$429.71
Rate for Payer: Monida Montana Health Co-op	$420.85
Rate for Payer: Monida PacificSource	$420.85

US ABDOMEN LIMITED

Facility

$443.00

Service Code	CPT 76705
Hospital Charge Code	5176705
Hospital Revenue Code	402
Min. Negotiated Rate	$310.10
Max. Negotiated Rate	$443.00
Rate for Payer: Aetna Commercial	$420.85
Rate for Payer: Aetna Medicare	$398.70
Rate for Payer: BCBS MT CHIP	$398.70
Rate for Payer: BCBS MT Closed Plan Network	$420.85
Rate for Payer: BCBS MT HealthLink	$398.70
Rate for Payer: BCBS MT Medicare	$398.70
Rate for Payer: BCBS MT POS	$420.85
Rate for Payer: BCBS MT Traditional	$443.00
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cigna Commercial	$420.85
Rate for Payer: Cigna Medicare	$398.70
Rate for Payer: Medicaid All Medicaid	$407.56
Rate for Payer: Medicare All Medicare	$310.10
Rate for Payer: Monida Allegiance	$420.85
Rate for Payer: Monida First Choice Health	$429.71
Rate for Payer: Monida Montana Health Co-op	$420.85
Rate for Payer: Monida PacificSource	$420.85

US ABI

Facility

$289.00

Service Code	CPT 93922
Hospital Charge Code	5193922
Hospital Revenue Code	402
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$289.00
Rate for Payer: Aetna Commercial	$274.55
Rate for Payer: Aetna Medicare	$260.10
Rate for Payer: BCBS MT CHIP	$260.10
Rate for Payer: BCBS MT Closed Plan Network	$274.55
Rate for Payer: BCBS MT HealthLink	$260.10
Rate for Payer: BCBS MT Medicare	$260.10
Rate for Payer: BCBS MT POS	$274.55
Rate for Payer: BCBS MT Traditional	$289.00
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cigna Commercial	$274.55
Rate for Payer: Cigna Medicare	$260.10
Rate for Payer: Medicaid All Medicaid	$265.88
Rate for Payer: Medicare All Medicare	$202.30
Rate for Payer: Monida Allegiance	$274.55
Rate for Payer: Monida First Choice Health	$280.33
Rate for Payer: Monida Montana Health Co-op	$274.55
Rate for Payer: Monida PacificSource	$274.55

US ABI

Facility

$289.00

Service Code	CPT 93922
Hospital Charge Code	5193922
Hospital Revenue Code	402
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$289.00
Rate for Payer: Aetna Commercial	$274.55
Rate for Payer: Aetna Medicare	$260.10
Rate for Payer: BCBS MT CHIP	$260.10
Rate for Payer: BCBS MT Closed Plan Network	$274.55
Rate for Payer: BCBS MT HealthLink	$260.10
Rate for Payer: BCBS MT Medicare	$260.10
Rate for Payer: BCBS MT POS	$274.55
Rate for Payer: BCBS MT Traditional	$289.00
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cigna Commercial	$274.55
Rate for Payer: Cigna Medicare	$260.10
Rate for Payer: Medicaid All Medicaid	$265.88
Rate for Payer: Medicare All Medicare	$202.30
Rate for Payer: Monida Allegiance	$274.55
Rate for Payer: Monida First Choice Health	$280.33
Rate for Payer: Monida Montana Health Co-op	$274.55
Rate for Payer: Monida PacificSource	$274.55

US AORTA DUPLEX - DIAGNOSTIC

Facility

$374.00

Service Code	CPT 93979
Hospital Charge Code	5100004
Hospital Revenue Code	402
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$374.00
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare	$336.60
Rate for Payer: BCBS MT CHIP	$336.60
Rate for Payer: BCBS MT Closed Plan Network	$355.30
Rate for Payer: BCBS MT HealthLink	$336.60
Rate for Payer: BCBS MT Medicare	$336.60
Rate for Payer: BCBS MT POS	$355.30
Rate for Payer: BCBS MT Traditional	$374.00
Rate for Payer: Cash Price	$336.60
Rate for Payer: Cigna Commercial	$355.30
Rate for Payer: Cigna Medicare	$336.60
Rate for Payer: Medicaid All Medicaid	$344.08
Rate for Payer: Medicare All Medicare	$261.80
Rate for Payer: Monida Allegiance	$355.30
Rate for Payer: Monida First Choice Health	$362.78
Rate for Payer: Monida Montana Health Co-op	$355.30
Rate for Payer: Monida PacificSource	$355.30

US AORTA DUPLEX - DIAGNOSTIC

Facility

$374.00

Service Code	CPT 93979
Hospital Charge Code	5100004
Hospital Revenue Code	402
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$374.00
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare	$336.60
Rate for Payer: BCBS MT CHIP	$336.60
Rate for Payer: BCBS MT Closed Plan Network	$355.30
Rate for Payer: BCBS MT HealthLink	$336.60
Rate for Payer: BCBS MT Medicare	$336.60
Rate for Payer: BCBS MT POS	$355.30
Rate for Payer: BCBS MT Traditional	$374.00
Rate for Payer: Cash Price	$336.60
Rate for Payer: Cigna Commercial	$355.30
Rate for Payer: Cigna Medicare	$336.60
Rate for Payer: Medicaid All Medicaid	$344.08
Rate for Payer: Medicare All Medicare	$261.80
Rate for Payer: Monida Allegiance	$355.30
Rate for Payer: Monida First Choice Health	$362.78
Rate for Payer: Monida Montana Health Co-op	$355.30
Rate for Payer: Monida PacificSource	$355.30

US AORTA SCREENING

Facility

$266.00

Service Code	CPT 76706
Hospital Charge Code	5176706
Hospital Revenue Code	402
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

US AORTA SCREENING

Facility

$266.00

Service Code	CPT 76706
Hospital Charge Code	5176706
Hospital Revenue Code	402
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

US ARTERIAL LOWER EXT BILATERAL DUPLEX

Facility

$668.00

Service Code	CPT 93925
Hospital Charge Code	5193925
Hospital Revenue Code	402
Min. Negotiated Rate	$467.60
Max. Negotiated Rate	$668.00
Rate for Payer: Aetna Commercial	$634.60
Rate for Payer: Aetna Medicare	$601.20
Rate for Payer: BCBS MT CHIP	$601.20
Rate for Payer: BCBS MT Closed Plan Network	$634.60
Rate for Payer: BCBS MT HealthLink	$601.20
Rate for Payer: BCBS MT Medicare	$601.20
Rate for Payer: BCBS MT POS	$634.60
Rate for Payer: BCBS MT Traditional	$668.00
Rate for Payer: Cash Price	$601.20
Rate for Payer: Cigna Commercial	$634.60
Rate for Payer: Cigna Medicare	$601.20
Rate for Payer: Medicaid All Medicaid	$614.56
Rate for Payer: Medicare All Medicare	$467.60
Rate for Payer: Monida Allegiance	$634.60
Rate for Payer: Monida First Choice Health	$647.96
Rate for Payer: Monida Montana Health Co-op	$634.60
Rate for Payer: Monida PacificSource	$634.60

US ARTERIAL LOWER EXT BILATERAL DUPLEX

Facility

$668.00

Service Code	CPT 93925
Hospital Charge Code	5193925
Hospital Revenue Code	402
Min. Negotiated Rate	$467.60
Max. Negotiated Rate	$668.00
Rate for Payer: Aetna Commercial	$634.60
Rate for Payer: Aetna Medicare	$601.20
Rate for Payer: BCBS MT CHIP	$601.20
Rate for Payer: BCBS MT Closed Plan Network	$634.60
Rate for Payer: BCBS MT HealthLink	$601.20
Rate for Payer: BCBS MT Medicare	$601.20
Rate for Payer: BCBS MT POS	$634.60
Rate for Payer: BCBS MT Traditional	$668.00
Rate for Payer: Cash Price	$601.20
Rate for Payer: Cigna Commercial	$634.60
Rate for Payer: Cigna Medicare	$601.20
Rate for Payer: Medicaid All Medicaid	$614.56
Rate for Payer: Medicare All Medicare	$467.60
Rate for Payer: Monida Allegiance	$634.60
Rate for Payer: Monida First Choice Health	$647.96
Rate for Payer: Monida Montana Health Co-op	$634.60
Rate for Payer: Monida PacificSource	$634.60

US ARTERIAL LOWER EXT UNILATERAL DUPLEX

Facility

$480.00

Service Code	CPT 93926
Hospital Charge Code	5193926
Hospital Revenue Code	402
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare	$432.00
Rate for Payer: BCBS MT CHIP	$432.00
Rate for Payer: BCBS MT Closed Plan Network	$456.00
Rate for Payer: BCBS MT HealthLink	$432.00
Rate for Payer: BCBS MT Medicare	$432.00
Rate for Payer: BCBS MT POS	$456.00
Rate for Payer: BCBS MT Traditional	$480.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna Commercial	$456.00
Rate for Payer: Cigna Medicare	$432.00
Rate for Payer: Medicaid All Medicaid	$441.60
Rate for Payer: Medicare All Medicare	$336.00
Rate for Payer: Monida Allegiance	$456.00
Rate for Payer: Monida First Choice Health	$465.60
Rate for Payer: Monida Montana Health Co-op	$456.00
Rate for Payer: Monida PacificSource	$456.00

US ARTERIAL LOWER EXT UNILATERAL DUPLEX

Facility

$480.00

Service Code	CPT 93926
Hospital Charge Code	5193926
Hospital Revenue Code	402
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare	$432.00
Rate for Payer: BCBS MT CHIP	$432.00
Rate for Payer: BCBS MT Closed Plan Network	$456.00
Rate for Payer: BCBS MT HealthLink	$432.00
Rate for Payer: BCBS MT Medicare	$432.00
Rate for Payer: BCBS MT POS	$456.00
Rate for Payer: BCBS MT Traditional	$480.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna Commercial	$456.00
Rate for Payer: Cigna Medicare	$432.00
Rate for Payer: Medicaid All Medicaid	$441.60
Rate for Payer: Medicare All Medicare	$336.00
Rate for Payer: Monida Allegiance	$456.00
Rate for Payer: Monida First Choice Health	$465.60
Rate for Payer: Monida Montana Health Co-op	$456.00
Rate for Payer: Monida PacificSource	$456.00

US ARTERIAL UPPER EXT BILATERAL DUPLEX

Facility

$945.00

Service Code	CPT 93930
Hospital Charge Code	5193930
Hospital Revenue Code	402
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna Commercial	$897.75
Rate for Payer: Aetna Medicare	$850.50
Rate for Payer: BCBS MT CHIP	$850.50
Rate for Payer: BCBS MT Closed Plan Network	$897.75
Rate for Payer: BCBS MT HealthLink	$850.50
Rate for Payer: BCBS MT Medicare	$850.50
Rate for Payer: BCBS MT POS	$897.75
Rate for Payer: BCBS MT Traditional	$945.00
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cigna Commercial	$897.75
Rate for Payer: Cigna Medicare	$850.50
Rate for Payer: Medicaid All Medicaid	$869.40
Rate for Payer: Medicare All Medicare	$661.50
Rate for Payer: Monida Allegiance	$897.75
Rate for Payer: Monida First Choice Health	$916.65
Rate for Payer: Monida Montana Health Co-op	$897.75
Rate for Payer: Monida PacificSource	$897.75

US ARTERIAL UPPER EXT BILATERAL DUPLEX

Facility

$945.00

Service Code	CPT 93930
Hospital Charge Code	5193930
Hospital Revenue Code	402
Min. Negotiated Rate	$661.50
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna Commercial	$897.75
Rate for Payer: Aetna Medicare	$850.50
Rate for Payer: BCBS MT CHIP	$850.50
Rate for Payer: BCBS MT Closed Plan Network	$897.75
Rate for Payer: BCBS MT HealthLink	$850.50
Rate for Payer: BCBS MT Medicare	$850.50
Rate for Payer: BCBS MT POS	$897.75
Rate for Payer: BCBS MT Traditional	$945.00
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cigna Commercial	$897.75
Rate for Payer: Cigna Medicare	$850.50
Rate for Payer: Medicaid All Medicaid	$869.40
Rate for Payer: Medicare All Medicare	$661.50
Rate for Payer: Monida Allegiance	$897.75
Rate for Payer: Monida First Choice Health	$916.65
Rate for Payer: Monida Montana Health Co-op	$897.75
Rate for Payer: Monida PacificSource	$897.75

US ARTERIAL UPPER EXT UNILATERAL DUPLEX

Facility

$480.00

Service Code	CPT 93931
Hospital Charge Code	5193928
Hospital Revenue Code	402
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare	$432.00
Rate for Payer: BCBS MT CHIP	$432.00
Rate for Payer: BCBS MT Closed Plan Network	$456.00
Rate for Payer: BCBS MT HealthLink	$432.00
Rate for Payer: BCBS MT Medicare	$432.00
Rate for Payer: BCBS MT POS	$456.00
Rate for Payer: BCBS MT Traditional	$480.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna Commercial	$456.00
Rate for Payer: Cigna Medicare	$432.00
Rate for Payer: Medicaid All Medicaid	$441.60
Rate for Payer: Medicare All Medicare	$336.00
Rate for Payer: Monida Allegiance	$456.00
Rate for Payer: Monida First Choice Health	$465.60
Rate for Payer: Monida Montana Health Co-op	$456.00
Rate for Payer: Monida PacificSource	$456.00

US ARTERIAL UPPER EXT UNILATERAL DUPLEX

Facility

$480.00

Service Code	CPT 93931
Hospital Charge Code	5193928
Hospital Revenue Code	402
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare	$432.00
Rate for Payer: BCBS MT CHIP	$432.00
Rate for Payer: BCBS MT Closed Plan Network	$456.00
Rate for Payer: BCBS MT HealthLink	$432.00
Rate for Payer: BCBS MT Medicare	$432.00
Rate for Payer: BCBS MT POS	$456.00
Rate for Payer: BCBS MT Traditional	$480.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna Commercial	$456.00
Rate for Payer: Cigna Medicare	$432.00
Rate for Payer: Medicaid All Medicaid	$441.60
Rate for Payer: Medicare All Medicare	$336.00
Rate for Payer: Monida Allegiance	$456.00
Rate for Payer: Monida First Choice Health	$465.60
Rate for Payer: Monida Montana Health Co-op	$456.00
Rate for Payer: Monida PacificSource	$456.00

US BLADDER PRE/POST

Facility

$230.00

Service Code	CPT 76857
Hospital Charge Code	5176857
Hospital Revenue Code	402
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare	$207.00
Rate for Payer: BCBS MT CHIP	$207.00
Rate for Payer: BCBS MT Closed Plan Network	$218.50
Rate for Payer: BCBS MT HealthLink	$207.00
Rate for Payer: BCBS MT Medicare	$207.00
Rate for Payer: BCBS MT POS	$218.50
Rate for Payer: BCBS MT Traditional	$230.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna Commercial	$218.50
Rate for Payer: Cigna Medicare	$207.00
Rate for Payer: Medicaid All Medicaid	$211.60
Rate for Payer: Medicare All Medicare	$161.00
Rate for Payer: Monida Allegiance	$218.50
Rate for Payer: Monida First Choice Health	$223.10
Rate for Payer: Monida Montana Health Co-op	$218.50
Rate for Payer: Monida PacificSource	$218.50

US BLADDER PRE/POST

Facility

$230.00

Service Code	CPT 76857
Hospital Charge Code	5176857
Hospital Revenue Code	402
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare	$207.00
Rate for Payer: BCBS MT CHIP	$207.00
Rate for Payer: BCBS MT Closed Plan Network	$218.50
Rate for Payer: BCBS MT HealthLink	$207.00
Rate for Payer: BCBS MT Medicare	$207.00
Rate for Payer: BCBS MT POS	$218.50
Rate for Payer: BCBS MT Traditional	$230.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna Commercial	$218.50
Rate for Payer: Cigna Medicare	$207.00
Rate for Payer: Medicaid All Medicaid	$211.60
Rate for Payer: Medicare All Medicare	$161.00
Rate for Payer: Monida Allegiance	$218.50
Rate for Payer: Monida First Choice Health	$223.10
Rate for Payer: Monida Montana Health Co-op	$218.50
Rate for Payer: Monida PacificSource	$218.50

US BLADDER SCANNER POST

Facility

$151.00

Service Code	CPT 51798
Hospital Charge Code	151799
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

US BLADDER SCANNER POST

Facility

$151.00

Service Code	CPT 51798
Hospital Charge Code	151799
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

US BREAST COMPLETE

Facility

$298.00

Service Code	CPT 76641
Hospital Charge Code	5176641
Hospital Revenue Code	402
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$298.00
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare	$268.20
Rate for Payer: BCBS MT CHIP	$268.20
Rate for Payer: BCBS MT Closed Plan Network	$283.10
Rate for Payer: BCBS MT HealthLink	$268.20
Rate for Payer: BCBS MT Medicare	$268.20
Rate for Payer: BCBS MT POS	$283.10
Rate for Payer: BCBS MT Traditional	$298.00
Rate for Payer: Cash Price	$268.20
Rate for Payer: Cigna Commercial	$283.10
Rate for Payer: Cigna Medicare	$268.20
Rate for Payer: Medicaid All Medicaid	$274.16
Rate for Payer: Medicare All Medicare	$208.60
Rate for Payer: Monida Allegiance	$283.10
Rate for Payer: Monida First Choice Health	$289.06
Rate for Payer: Monida Montana Health Co-op	$283.10
Rate for Payer: Monida PacificSource	$283.10

US BREAST COMPLETE

Facility

$298.00

Service Code	CPT 76641
Hospital Charge Code	5176641
Hospital Revenue Code	402
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$298.00
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare	$268.20
Rate for Payer: BCBS MT CHIP	$268.20
Rate for Payer: BCBS MT Closed Plan Network	$283.10
Rate for Payer: BCBS MT HealthLink	$268.20
Rate for Payer: BCBS MT Medicare	$268.20
Rate for Payer: BCBS MT POS	$283.10
Rate for Payer: BCBS MT Traditional	$298.00
Rate for Payer: Cash Price	$268.20
Rate for Payer: Cigna Commercial	$283.10
Rate for Payer: Cigna Medicare	$268.20
Rate for Payer: Medicaid All Medicaid	$274.16
Rate for Payer: Medicare All Medicare	$208.60
Rate for Payer: Monida Allegiance	$283.10
Rate for Payer: Monida First Choice Health	$289.06
Rate for Payer: Monida Montana Health Co-op	$283.10
Rate for Payer: Monida PacificSource	$283.10

Know your out-of-pocket cost for care.

All Charges