Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

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

US BREAST LIMITED

Facility

$298.00

Service Code	CPT 76642
Hospital Charge Code	5176642
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 LIMITED

Facility

$298.00

Service Code	CPT 76642
Hospital Charge Code	5176642
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 CAROTID BILATERAL

Facility

$694.00

Service Code	CPT 93880
Hospital Charge Code	5193880
Hospital Revenue Code	402
Min. Negotiated Rate	$485.80
Max. Negotiated Rate	$694.00
Rate for Payer: Aetna Commercial	$659.30
Rate for Payer: Aetna Medicare	$624.60
Rate for Payer: BCBS MT CHIP	$624.60
Rate for Payer: BCBS MT Closed Plan Network	$659.30
Rate for Payer: BCBS MT HealthLink	$624.60
Rate for Payer: BCBS MT Medicare	$624.60
Rate for Payer: BCBS MT POS	$659.30
Rate for Payer: BCBS MT Traditional	$694.00
Rate for Payer: Cash Price	$624.60
Rate for Payer: Cigna Commercial	$659.30
Rate for Payer: Cigna Medicare	$624.60
Rate for Payer: Medicaid All Medicaid	$638.48
Rate for Payer: Medicare All Medicare	$485.80
Rate for Payer: Monida Allegiance	$659.30
Rate for Payer: Monida First Choice Health	$673.18
Rate for Payer: Monida Montana Health Co-op	$659.30
Rate for Payer: Monida PacificSource	$659.30

US CAROTID BILATERAL

Facility

$694.00

Service Code	CPT 93880
Hospital Charge Code	5193880
Hospital Revenue Code	402
Min. Negotiated Rate	$485.80
Max. Negotiated Rate	$694.00
Rate for Payer: Aetna Commercial	$659.30
Rate for Payer: Aetna Medicare	$624.60
Rate for Payer: BCBS MT CHIP	$624.60
Rate for Payer: BCBS MT Closed Plan Network	$659.30
Rate for Payer: BCBS MT HealthLink	$624.60
Rate for Payer: BCBS MT Medicare	$624.60
Rate for Payer: BCBS MT POS	$659.30
Rate for Payer: BCBS MT Traditional	$694.00
Rate for Payer: Cash Price	$624.60
Rate for Payer: Cigna Commercial	$659.30
Rate for Payer: Cigna Medicare	$624.60
Rate for Payer: Medicaid All Medicaid	$638.48
Rate for Payer: Medicare All Medicare	$485.80
Rate for Payer: Monida Allegiance	$659.30
Rate for Payer: Monida First Choice Health	$673.18
Rate for Payer: Monida Montana Health Co-op	$659.30
Rate for Payer: Monida PacificSource	$659.30

US CAROTID UNILATERAL

Facility

$410.00

Service Code	CPT 93882
Hospital Charge Code	5193882
Hospital Revenue Code	402
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare	$369.00
Rate for Payer: BCBS MT CHIP	$369.00
Rate for Payer: BCBS MT Closed Plan Network	$389.50
Rate for Payer: BCBS MT HealthLink	$369.00
Rate for Payer: BCBS MT Medicare	$369.00
Rate for Payer: BCBS MT POS	$389.50
Rate for Payer: BCBS MT Traditional	$410.00
Rate for Payer: Cash Price	$369.00
Rate for Payer: Cigna Commercial	$389.50
Rate for Payer: Cigna Medicare	$369.00
Rate for Payer: Medicaid All Medicaid	$377.20
Rate for Payer: Medicare All Medicare	$287.00
Rate for Payer: Monida Allegiance	$389.50
Rate for Payer: Monida First Choice Health	$397.70
Rate for Payer: Monida Montana Health Co-op	$389.50
Rate for Payer: Monida PacificSource	$389.50

US CAROTID UNILATERAL

Facility

$410.00

Service Code	CPT 93882
Hospital Charge Code	5193882
Hospital Revenue Code	402
Min. Negotiated Rate	$287.00
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare	$369.00
Rate for Payer: BCBS MT CHIP	$369.00
Rate for Payer: BCBS MT Closed Plan Network	$389.50
Rate for Payer: BCBS MT HealthLink	$369.00
Rate for Payer: BCBS MT Medicare	$369.00
Rate for Payer: BCBS MT POS	$389.50
Rate for Payer: BCBS MT Traditional	$410.00
Rate for Payer: Cash Price	$369.00
Rate for Payer: Cigna Commercial	$389.50
Rate for Payer: Cigna Medicare	$369.00
Rate for Payer: Medicaid All Medicaid	$377.20
Rate for Payer: Medicare All Medicare	$287.00
Rate for Payer: Monida Allegiance	$389.50
Rate for Payer: Monida First Choice Health	$397.70
Rate for Payer: Monida Montana Health Co-op	$389.50
Rate for Payer: Monida PacificSource	$389.50

USCIS FEE

Facility

$960.00

Hospital Charge Code	90197116
Min. Negotiated Rate	$672.00
Max. Negotiated Rate	$960.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare	$864.00
Rate for Payer: BCBS MT CHIP	$864.00
Rate for Payer: BCBS MT Closed Plan Network	$912.00
Rate for Payer: BCBS MT HealthLink	$864.00
Rate for Payer: BCBS MT Medicare	$864.00
Rate for Payer: BCBS MT POS	$912.00
Rate for Payer: BCBS MT Traditional	$960.00
Rate for Payer: Cash Price	$864.00
Rate for Payer: Cigna Commercial	$912.00
Rate for Payer: Cigna Medicare	$864.00
Rate for Payer: Medicaid All Medicaid	$883.20
Rate for Payer: Medicare All Medicare	$672.00
Rate for Payer: Monida Allegiance	$912.00
Rate for Payer: Monida First Choice Health	$931.20
Rate for Payer: Monida Montana Health Co-op	$912.00
Rate for Payer: Monida PacificSource	$912.00

Know your out-of-pocket cost for care.

All Charges