Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

TRIGLYCERIDES

Facility

$76.00

Service Code	CPT 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

TRIMETHYLAMIN N-OXIDE

Facility

$150.00

Service Code	CPT 82542
Hospital Charge Code	4087937
Hospital Revenue Code	300
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare	$135.00
Rate for Payer: BCBS MT CHIP	$135.00
Rate for Payer: BCBS MT Closed Plan Network	$142.50
Rate for Payer: BCBS MT HealthLink	$135.00
Rate for Payer: BCBS MT Medicare	$135.00
Rate for Payer: BCBS MT POS	$142.50
Rate for Payer: BCBS MT Traditional	$150.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: Cigna Medicare	$135.00
Rate for Payer: Medicaid All Medicaid	$138.00
Rate for Payer: Medicare All Medicare	$105.00
Rate for Payer: Monida Allegiance	$142.50
Rate for Payer: Monida First Choice Health	$145.50
Rate for Payer: Monida Montana Health Co-op	$142.50
Rate for Payer: Monida PacificSource	$142.50

TRIMETHYLAMIN N-OXIDE

Facility

$150.00

Service Code	CPT 82542
Hospital Charge Code	4087937
Hospital Revenue Code	300
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare	$135.00
Rate for Payer: BCBS MT CHIP	$135.00
Rate for Payer: BCBS MT Closed Plan Network	$142.50
Rate for Payer: BCBS MT HealthLink	$135.00
Rate for Payer: BCBS MT Medicare	$135.00
Rate for Payer: BCBS MT POS	$142.50
Rate for Payer: BCBS MT Traditional	$150.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: Cigna Medicare	$135.00
Rate for Payer: Medicaid All Medicaid	$138.00
Rate for Payer: Medicare All Medicare	$105.00
Rate for Payer: Monida Allegiance	$142.50
Rate for Payer: Monida First Choice Health	$145.50
Rate for Payer: Monida Montana Health Co-op	$142.50
Rate for Payer: Monida PacificSource	$142.50

TRIMMING DYSTROPHIC NAILS-ANY # G0127

Facility

$98.00

Service Code	HCPCS G0127
Hospital Charge Code	8000127
Hospital Revenue Code	521
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$98.00
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare	$88.20
Rate for Payer: BCBS MT CHIP	$88.20
Rate for Payer: BCBS MT Closed Plan Network	$93.10
Rate for Payer: BCBS MT HealthLink	$88.20
Rate for Payer: BCBS MT Medicare	$88.20
Rate for Payer: BCBS MT POS	$93.10
Rate for Payer: BCBS MT Traditional	$98.00
Rate for Payer: Cash Price	$88.20
Rate for Payer: Cigna Commercial	$93.10
Rate for Payer: Cigna Medicare	$88.20
Rate for Payer: Medicaid All Medicaid	$90.16
Rate for Payer: Medicare All Medicare	$68.60
Rate for Payer: Monida Allegiance	$93.10
Rate for Payer: Monida First Choice Health	$95.06
Rate for Payer: Monida Montana Health Co-op	$93.10
Rate for Payer: Monida PacificSource	$93.10

TRIMMING DYSTROPHIC NAILS-ANY # G0127

Facility

$98.00

Service Code	HCPCS G0127
Hospital Charge Code	8000127
Hospital Revenue Code	521
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$98.00
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare	$88.20
Rate for Payer: BCBS MT CHIP	$88.20
Rate for Payer: BCBS MT Closed Plan Network	$93.10
Rate for Payer: BCBS MT HealthLink	$88.20
Rate for Payer: BCBS MT Medicare	$88.20
Rate for Payer: BCBS MT POS	$93.10
Rate for Payer: BCBS MT Traditional	$98.00
Rate for Payer: Cash Price	$88.20
Rate for Payer: Cigna Commercial	$93.10
Rate for Payer: Cigna Medicare	$88.20
Rate for Payer: Medicaid All Medicaid	$90.16
Rate for Payer: Medicare All Medicare	$68.60
Rate for Payer: Monida Allegiance	$93.10
Rate for Payer: Monida First Choice Health	$95.06
Rate for Payer: Monida Montana Health Co-op	$93.10
Rate for Payer: Monida PacificSource	$93.10

TRIMMING DYSTROPHIC NAILS-ANY # TR G0127

Facility

$343.00

Service Code	HCPCS G0127
Hospital Charge Code	590127
Hospital Revenue Code	761
Min. Negotiated Rate	$240.10
Max. Negotiated Rate	$343.00
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare	$308.70
Rate for Payer: BCBS MT CHIP	$308.70
Rate for Payer: BCBS MT Closed Plan Network	$325.85
Rate for Payer: BCBS MT HealthLink	$308.70
Rate for Payer: BCBS MT Medicare	$308.70
Rate for Payer: BCBS MT POS	$325.85
Rate for Payer: BCBS MT Traditional	$343.00
Rate for Payer: Cash Price	$308.70
Rate for Payer: Cigna Commercial	$325.85
Rate for Payer: Cigna Medicare	$308.70
Rate for Payer: Medicaid All Medicaid	$315.56
Rate for Payer: Medicare All Medicare	$240.10
Rate for Payer: Monida Allegiance	$325.85
Rate for Payer: Monida First Choice Health	$332.71
Rate for Payer: Monida Montana Health Co-op	$325.85
Rate for Payer: Monida PacificSource	$325.85

TRIMMING DYSTROPHIC NAILS-ANY # TR G0127

Facility

$343.00

Service Code	HCPCS G0127
Hospital Charge Code	590127
Hospital Revenue Code	761
Min. Negotiated Rate	$240.10
Max. Negotiated Rate	$343.00
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare	$308.70
Rate for Payer: BCBS MT CHIP	$308.70
Rate for Payer: BCBS MT Closed Plan Network	$325.85
Rate for Payer: BCBS MT HealthLink	$308.70
Rate for Payer: BCBS MT Medicare	$308.70
Rate for Payer: BCBS MT POS	$325.85
Rate for Payer: BCBS MT Traditional	$343.00
Rate for Payer: Cash Price	$308.70
Rate for Payer: Cigna Commercial	$325.85
Rate for Payer: Cigna Medicare	$308.70
Rate for Payer: Medicaid All Medicaid	$315.56
Rate for Payer: Medicare All Medicare	$240.10
Rate for Payer: Monida Allegiance	$325.85
Rate for Payer: Monida First Choice Health	$332.71
Rate for Payer: Monida Montana Health Co-op	$325.85
Rate for Payer: Monida PacificSource	$325.85

TRIMMING NONDYSTROPHIC NAILS ANY #

Facility

$80.00

Service Code	CPT 11719
Hospital Charge Code	8011719
Hospital Revenue Code	521
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare	$72.00
Rate for Payer: BCBS MT CHIP	$72.00
Rate for Payer: BCBS MT Closed Plan Network	$76.00
Rate for Payer: BCBS MT HealthLink	$72.00
Rate for Payer: BCBS MT Medicare	$72.00
Rate for Payer: BCBS MT POS	$76.00
Rate for Payer: BCBS MT Traditional	$80.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare	$72.00
Rate for Payer: Medicaid All Medicaid	$73.60
Rate for Payer: Medicare All Medicare	$56.00
Rate for Payer: Monida Allegiance	$76.00
Rate for Payer: Monida First Choice Health	$77.60
Rate for Payer: Monida Montana Health Co-op	$76.00
Rate for Payer: Monida PacificSource	$76.00

TRIMMING NONDYSTROPHIC NAILS ANY #

Facility

$80.00

Service Code	CPT 11719
Hospital Charge Code	8011719
Hospital Revenue Code	521
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare	$72.00
Rate for Payer: BCBS MT CHIP	$72.00
Rate for Payer: BCBS MT Closed Plan Network	$76.00
Rate for Payer: BCBS MT HealthLink	$72.00
Rate for Payer: BCBS MT Medicare	$72.00
Rate for Payer: BCBS MT POS	$76.00
Rate for Payer: BCBS MT Traditional	$80.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare	$72.00
Rate for Payer: Medicaid All Medicaid	$73.60
Rate for Payer: Medicare All Medicare	$56.00
Rate for Payer: Monida Allegiance	$76.00
Rate for Payer: Monida First Choice Health	$77.60
Rate for Payer: Monida Montana Health Co-op	$76.00
Rate for Payer: Monida PacificSource	$76.00

TR IMMUNIZATION ADMIN EA ADDTL VACCINE

Facility

$38.00

Service Code	CPT 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	CPT 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

$73.00

Service Code	CPT 90471
Hospital Charge Code	590471
Hospital Revenue Code	771
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$69.35
Rate for Payer: Aetna Medicare	$65.70
Rate for Payer: BCBS MT CHIP	$65.70
Rate for Payer: BCBS MT Closed Plan Network	$69.35
Rate for Payer: BCBS MT HealthLink	$65.70
Rate for Payer: BCBS MT Medicare	$65.70
Rate for Payer: BCBS MT POS	$69.35
Rate for Payer: BCBS MT Traditional	$73.00
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: Cigna Medicare	$65.70
Rate for Payer: Medicaid All Medicaid	$67.16
Rate for Payer: Medicare All Medicare	$51.10
Rate for Payer: Monida Allegiance	$69.35
Rate for Payer: Monida First Choice Health	$70.81
Rate for Payer: Monida Montana Health Co-op	$69.35
Rate for Payer: Monida PacificSource	$69.35

TR IMMUNIZATION ADMIN - SINGLE VACCINE

Facility

$73.00

Service Code	CPT 90471
Hospital Charge Code	590471
Hospital Revenue Code	771
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$69.35
Rate for Payer: Aetna Medicare	$65.70
Rate for Payer: BCBS MT CHIP	$65.70
Rate for Payer: BCBS MT Closed Plan Network	$69.35
Rate for Payer: BCBS MT HealthLink	$65.70
Rate for Payer: BCBS MT Medicare	$65.70
Rate for Payer: BCBS MT POS	$69.35
Rate for Payer: BCBS MT Traditional	$73.00
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: Cigna Medicare	$65.70
Rate for Payer: Medicaid All Medicaid	$67.16
Rate for Payer: Medicare All Medicare	$51.10
Rate for Payer: Monida Allegiance	$69.35
Rate for Payer: Monida First Choice Health	$70.81
Rate for Payer: Monida Montana Health Co-op	$69.35
Rate for Payer: Monida PacificSource	$69.35

TR INCISION AND DRAINAGE

Facility

$506.00

Service Code	CPT 27603
Hospital Charge Code	1027603
Hospital Revenue Code	761
Min. Negotiated Rate	$354.20
Max. Negotiated Rate	$506.00
Rate for Payer: Aetna Commercial	$480.70
Rate for Payer: Aetna Medicare	$455.40
Rate for Payer: BCBS MT CHIP	$455.40
Rate for Payer: BCBS MT Closed Plan Network	$480.70
Rate for Payer: BCBS MT HealthLink	$455.40
Rate for Payer: BCBS MT Medicare	$455.40
Rate for Payer: BCBS MT POS	$480.70
Rate for Payer: BCBS MT Traditional	$506.00
Rate for Payer: Cash Price	$455.40
Rate for Payer: Cigna Commercial	$480.70
Rate for Payer: Cigna Medicare	$455.40
Rate for Payer: Medicaid All Medicaid	$465.52
Rate for Payer: Medicare All Medicare	$354.20
Rate for Payer: Monida Allegiance	$480.70
Rate for Payer: Monida First Choice Health	$490.82
Rate for Payer: Monida Montana Health Co-op	$480.70
Rate for Payer: Monida PacificSource	$480.70

TR INCISION AND DRAINAGE

Facility

$506.00

Service Code	CPT 27603
Hospital Charge Code	1027603
Hospital Revenue Code	761
Min. Negotiated Rate	$354.20
Max. Negotiated Rate	$506.00
Rate for Payer: Aetna Commercial	$480.70
Rate for Payer: Aetna Medicare	$455.40
Rate for Payer: BCBS MT CHIP	$455.40
Rate for Payer: BCBS MT Closed Plan Network	$480.70
Rate for Payer: BCBS MT HealthLink	$455.40
Rate for Payer: BCBS MT Medicare	$455.40
Rate for Payer: BCBS MT POS	$480.70
Rate for Payer: BCBS MT Traditional	$506.00
Rate for Payer: Cash Price	$455.40
Rate for Payer: Cigna Commercial	$480.70
Rate for Payer: Cigna Medicare	$455.40
Rate for Payer: Medicaid All Medicaid	$465.52
Rate for Payer: Medicare All Medicare	$354.20
Rate for Payer: Monida Allegiance	$480.70
Rate for Payer: Monida First Choice Health	$490.82
Rate for Payer: Monida Montana Health Co-op	$480.70
Rate for Payer: Monida PacificSource	$480.70

TR INCISION AND DRAINAGE ABCESS SIMPLE

Facility

$441.00

Service Code	CPT 10060
Hospital Charge Code	1010060
Hospital Revenue Code	761
Min. Negotiated Rate	$308.70
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna Commercial	$418.95
Rate for Payer: Aetna Medicare	$396.90
Rate for Payer: BCBS MT CHIP	$396.90
Rate for Payer: BCBS MT Closed Plan Network	$418.95
Rate for Payer: BCBS MT HealthLink	$396.90
Rate for Payer: BCBS MT Medicare	$396.90
Rate for Payer: BCBS MT POS	$418.95
Rate for Payer: BCBS MT Traditional	$441.00
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cigna Commercial	$418.95
Rate for Payer: Cigna Medicare	$396.90
Rate for Payer: Medicaid All Medicaid	$405.72
Rate for Payer: Medicare All Medicare	$308.70
Rate for Payer: Monida Allegiance	$418.95
Rate for Payer: Monida First Choice Health	$427.77
Rate for Payer: Monida Montana Health Co-op	$418.95
Rate for Payer: Monida PacificSource	$418.95

TR INCISION AND DRAINAGE ABCESS SIMPLE

Facility

$441.00

Service Code	CPT 10060
Hospital Charge Code	1010060
Hospital Revenue Code	761
Min. Negotiated Rate	$308.70
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna Commercial	$418.95
Rate for Payer: Aetna Medicare	$396.90
Rate for Payer: BCBS MT CHIP	$396.90
Rate for Payer: BCBS MT Closed Plan Network	$418.95
Rate for Payer: BCBS MT HealthLink	$396.90
Rate for Payer: BCBS MT Medicare	$396.90
Rate for Payer: BCBS MT POS	$418.95
Rate for Payer: BCBS MT Traditional	$441.00
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cigna Commercial	$418.95
Rate for Payer: Cigna Medicare	$396.90
Rate for Payer: Medicaid All Medicaid	$405.72
Rate for Payer: Medicare All Medicare	$308.70
Rate for Payer: Monida Allegiance	$418.95
Rate for Payer: Monida First Choice Health	$427.77
Rate for Payer: Monida Montana Health Co-op	$418.95
Rate for Payer: Monida PacificSource	$418.95

TR INJ TENDON SHEATH/LIGAMENT

Facility

$331.00

Service Code	CPT 20550
Hospital Charge Code	1020550
Hospital Revenue Code	761
Min. Negotiated Rate	$231.70
Max. Negotiated Rate	$331.00
Rate for Payer: Aetna Commercial	$314.45
Rate for Payer: Aetna Medicare	$297.90
Rate for Payer: BCBS MT CHIP	$297.90
Rate for Payer: BCBS MT Closed Plan Network	$314.45
Rate for Payer: BCBS MT HealthLink	$297.90
Rate for Payer: BCBS MT Medicare	$297.90
Rate for Payer: BCBS MT POS	$314.45
Rate for Payer: BCBS MT Traditional	$331.00
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cigna Commercial	$314.45
Rate for Payer: Cigna Medicare	$297.90
Rate for Payer: Medicaid All Medicaid	$304.52
Rate for Payer: Medicare All Medicare	$231.70
Rate for Payer: Monida Allegiance	$314.45
Rate for Payer: Monida First Choice Health	$321.07
Rate for Payer: Monida Montana Health Co-op	$314.45
Rate for Payer: Monida PacificSource	$314.45

TR INJ TENDON SHEATH/LIGAMENT

Facility

$331.00

Service Code	CPT 20550
Hospital Charge Code	1020550
Hospital Revenue Code	761
Min. Negotiated Rate	$231.70
Max. Negotiated Rate	$331.00
Rate for Payer: Aetna Commercial	$314.45
Rate for Payer: Aetna Medicare	$297.90
Rate for Payer: BCBS MT CHIP	$297.90
Rate for Payer: BCBS MT Closed Plan Network	$314.45
Rate for Payer: BCBS MT HealthLink	$297.90
Rate for Payer: BCBS MT Medicare	$297.90
Rate for Payer: BCBS MT POS	$314.45
Rate for Payer: BCBS MT Traditional	$331.00
Rate for Payer: Cash Price	$297.90
Rate for Payer: Cigna Commercial	$314.45
Rate for Payer: Cigna Medicare	$297.90
Rate for Payer: Medicaid All Medicaid	$304.52
Rate for Payer: Medicare All Medicare	$231.70
Rate for Payer: Monida Allegiance	$314.45
Rate for Payer: Monida First Choice Health	$321.07
Rate for Payer: Monida Montana Health Co-op	$314.45
Rate for Payer: Monida PacificSource	$314.45

TR: IRRIGATION OF BLADDER

Facility

$154.00

Service Code	CPT 51700
Hospital Charge Code	551700
Hospital Revenue Code	761
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$154.00
Rate for Payer: Aetna Commercial	$146.30
Rate for Payer: Aetna Medicare	$138.60
Rate for Payer: BCBS MT CHIP	$138.60
Rate for Payer: BCBS MT Closed Plan Network	$146.30
Rate for Payer: BCBS MT HealthLink	$138.60
Rate for Payer: BCBS MT Medicare	$138.60
Rate for Payer: BCBS MT POS	$146.30
Rate for Payer: BCBS MT Traditional	$154.00
Rate for Payer: Cash Price	$138.60
Rate for Payer: Cigna Commercial	$146.30
Rate for Payer: Cigna Medicare	$138.60
Rate for Payer: Medicaid All Medicaid	$141.68
Rate for Payer: Medicare All Medicare	$107.80
Rate for Payer: Monida Allegiance	$146.30
Rate for Payer: Monida First Choice Health	$149.38
Rate for Payer: Monida Montana Health Co-op	$146.30
Rate for Payer: Monida PacificSource	$146.30

TR: IRRIGATION OF BLADDER

Facility

$154.00

Service Code	CPT 51700
Hospital Charge Code	551700
Hospital Revenue Code	761
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$154.00
Rate for Payer: Aetna Commercial	$146.30
Rate for Payer: Aetna Medicare	$138.60
Rate for Payer: BCBS MT CHIP	$138.60
Rate for Payer: BCBS MT Closed Plan Network	$146.30
Rate for Payer: BCBS MT HealthLink	$138.60
Rate for Payer: BCBS MT Medicare	$138.60
Rate for Payer: BCBS MT POS	$146.30
Rate for Payer: BCBS MT Traditional	$154.00
Rate for Payer: Cash Price	$138.60
Rate for Payer: Cigna Commercial	$146.30
Rate for Payer: Cigna Medicare	$138.60
Rate for Payer: Medicaid All Medicaid	$141.68
Rate for Payer: Medicare All Medicare	$107.80
Rate for Payer: Monida Allegiance	$146.30
Rate for Payer: Monida First Choice Health	$149.38
Rate for Payer: Monida Montana Health Co-op	$146.30
Rate for Payer: Monida PacificSource	$146.30

TR LUMBAR PUNCTURE

Facility

$2,028.00

Service Code	CPT 62270
Hospital Charge Code	1062270
Hospital Revenue Code	761
Min. Negotiated Rate	$1,419.60
Max. Negotiated Rate	$2,028.00
Rate for Payer: Aetna Commercial	$1,926.60
Rate for Payer: Aetna Medicare	$1,825.20
Rate for Payer: BCBS MT CHIP	$1,825.20
Rate for Payer: BCBS MT Closed Plan Network	$1,926.60
Rate for Payer: BCBS MT HealthLink	$1,825.20
Rate for Payer: BCBS MT Medicare	$1,825.20
Rate for Payer: BCBS MT POS	$1,926.60
Rate for Payer: BCBS MT Traditional	$2,028.00
Rate for Payer: Cash Price	$1,825.20
Rate for Payer: Cigna Commercial	$1,926.60
Rate for Payer: Cigna Medicare	$1,825.20
Rate for Payer: Medicaid All Medicaid	$1,865.76
Rate for Payer: Medicare All Medicare	$1,419.60
Rate for Payer: Monida Allegiance	$1,926.60
Rate for Payer: Monida First Choice Health	$1,967.16
Rate for Payer: Monida Montana Health Co-op	$1,926.60
Rate for Payer: Monida PacificSource	$1,926.60

TR LUMBAR PUNCTURE

Facility

$2,028.00

Service Code	CPT 62270
Hospital Charge Code	1062270
Hospital Revenue Code	761
Min. Negotiated Rate	$1,419.60
Max. Negotiated Rate	$2,028.00
Rate for Payer: Aetna Commercial	$1,926.60
Rate for Payer: Aetna Medicare	$1,825.20
Rate for Payer: BCBS MT CHIP	$1,825.20
Rate for Payer: BCBS MT Closed Plan Network	$1,926.60
Rate for Payer: BCBS MT HealthLink	$1,825.20
Rate for Payer: BCBS MT Medicare	$1,825.20
Rate for Payer: BCBS MT POS	$1,926.60
Rate for Payer: BCBS MT Traditional	$2,028.00
Rate for Payer: Cash Price	$1,825.20
Rate for Payer: Cigna Commercial	$1,926.60
Rate for Payer: Cigna Medicare	$1,825.20
Rate for Payer: Medicaid All Medicaid	$1,865.76
Rate for Payer: Medicare All Medicare	$1,419.60
Rate for Payer: Monida Allegiance	$1,926.60
Rate for Payer: Monida First Choice Health	$1,967.16
Rate for Payer: Monida Montana Health Co-op	$1,926.60
Rate for Payer: Monida PacificSource	$1,926.60

TR NEG PRESS WOUND TX </=50CM

Facility

$442.00

Service Code	CPT 97605
Hospital Charge Code	1097605
Hospital Revenue Code	760
Min. Negotiated Rate	$309.40
Max. Negotiated Rate	$442.00
Rate for Payer: Aetna Commercial	$419.90
Rate for Payer: Aetna Medicare	$397.80
Rate for Payer: BCBS MT CHIP	$397.80
Rate for Payer: BCBS MT Closed Plan Network	$419.90
Rate for Payer: BCBS MT HealthLink	$397.80
Rate for Payer: BCBS MT Medicare	$397.80
Rate for Payer: BCBS MT POS	$419.90
Rate for Payer: BCBS MT Traditional	$442.00
Rate for Payer: Cash Price	$397.80
Rate for Payer: Cigna Commercial	$419.90
Rate for Payer: Cigna Medicare	$397.80
Rate for Payer: Medicaid All Medicaid	$406.64
Rate for Payer: Medicare All Medicare	$309.40
Rate for Payer: Monida Allegiance	$419.90
Rate for Payer: Monida First Choice Health	$428.74
Rate for Payer: Monida Montana Health Co-op	$419.90
Rate for Payer: Monida PacificSource	$419.90

TR NEG PRESS WOUND TX </=50CM

Facility

$442.00

Service Code	CPT 97605
Hospital Charge Code	1097605
Hospital Revenue Code	760
Min. Negotiated Rate	$309.40
Max. Negotiated Rate	$442.00
Rate for Payer: Aetna Commercial	$419.90
Rate for Payer: Aetna Medicare	$397.80
Rate for Payer: BCBS MT CHIP	$397.80
Rate for Payer: BCBS MT Closed Plan Network	$419.90
Rate for Payer: BCBS MT HealthLink	$397.80
Rate for Payer: BCBS MT Medicare	$397.80
Rate for Payer: BCBS MT POS	$419.90
Rate for Payer: BCBS MT Traditional	$442.00
Rate for Payer: Cash Price	$397.80
Rate for Payer: Cigna Commercial	$419.90
Rate for Payer: Cigna Medicare	$397.80
Rate for Payer: Medicaid All Medicaid	$406.64
Rate for Payer: Medicare All Medicare	$309.40
Rate for Payer: Monida Allegiance	$419.90
Rate for Payer: Monida First Choice Health	$428.74
Rate for Payer: Monida Montana Health Co-op	$419.90
Rate for Payer: Monida PacificSource	$419.90

Know your out-of-pocket cost for care.

All Charges