Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

C-REACTIVE PROTEIN

Facility

$91.00

Service Code	HCPCS 86140
Hospital Charge Code	4086140
Hospital Revenue Code	300
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: BCBS MT CHIP	$81.90
Rate for Payer: BCBS MT Closed Plan Network	$86.45
Rate for Payer: BCBS MT HealthLink	$81.90
Rate for Payer: BCBS MT Medicare	$81.90
Rate for Payer: BCBS MT POS	$86.45
Rate for Payer: BCBS MT Traditional	$91.00
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cigna Commercial	$86.45
Rate for Payer: Cigna Medicare	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

C-REACTIVE PROTEIN

Facility

$91.00

Service Code	HCPCS 86140
Hospital Charge Code	4086140
Hospital Revenue Code	300
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: BCBS MT CHIP	$81.90
Rate for Payer: BCBS MT Closed Plan Network	$86.45
Rate for Payer: BCBS MT HealthLink	$81.90
Rate for Payer: BCBS MT Medicare	$81.90
Rate for Payer: BCBS MT POS	$86.45
Rate for Payer: BCBS MT Traditional	$91.00
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cigna Commercial	$86.45
Rate for Payer: Cigna Medicare	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

CREATINE KINASE, TOTAL

Facility

$96.00

Service Code	HCPCS 82550
Hospital Charge Code	4082550
Hospital Revenue Code	301
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare	$86.40
Rate for Payer: BCBS MT CHIP	$86.40
Rate for Payer: BCBS MT Closed Plan Network	$91.20
Rate for Payer: BCBS MT HealthLink	$86.40
Rate for Payer: BCBS MT Medicare	$86.40
Rate for Payer: BCBS MT POS	$91.20
Rate for Payer: BCBS MT Traditional	$96.00
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial	$91.20
Rate for Payer: Cigna Medicare	$86.40
Rate for Payer: Medicaid All Medicaid	$88.32
Rate for Payer: Medicare All Medicare	$67.20
Rate for Payer: Monida Allegiance	$91.20
Rate for Payer: Monida First Choice Health	$93.12
Rate for Payer: Monida Montana Health Co-op	$91.20
Rate for Payer: Monida PacificSource	$91.20

CREATINE KINASE, TOTAL

Facility

$96.00

Service Code	HCPCS 82550
Hospital Charge Code	4082550
Hospital Revenue Code	301
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare	$86.40
Rate for Payer: BCBS MT CHIP	$86.40
Rate for Payer: BCBS MT Closed Plan Network	$91.20
Rate for Payer: BCBS MT HealthLink	$86.40
Rate for Payer: BCBS MT Medicare	$86.40
Rate for Payer: BCBS MT POS	$91.20
Rate for Payer: BCBS MT Traditional	$96.00
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial	$91.20
Rate for Payer: Cigna Medicare	$86.40
Rate for Payer: Medicaid All Medicaid	$88.32
Rate for Payer: Medicare All Medicare	$67.20
Rate for Payer: Monida Allegiance	$91.20
Rate for Payer: Monida First Choice Health	$93.12
Rate for Payer: Monida Montana Health Co-op	$91.20
Rate for Payer: Monida PacificSource	$91.20

CREATININE

Facility

$65.00

Service Code	HCPCS 82565
Hospital Charge Code	4082565
Hospital Revenue Code	301
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

CREATININE

Facility

$65.00

Service Code	HCPCS 82565
Hospital Charge Code	4082565
Hospital Revenue Code	301
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

CREATININE, 24 HOUR URINE

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	4082570
Hospital Revenue Code	300
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

CREATININE, 24 HOUR URINE

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	4082570
Hospital Revenue Code	300
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

CREATININE CLEARANCE (003004)

Facility

$25.00

Service Code	HCPCS 82575
Hospital Charge Code	4082575
Hospital Revenue Code	301
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

CREATININE CLEARANCE (003004)

Facility

$25.00

Service Code	HCPCS 82575
Hospital Charge Code	4082575
Hospital Revenue Code	301
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

.CREATININE, URINE, RANDOM

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	4000043
Hospital Revenue Code	300
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

.CREATININE, URINE, RANDOM

Facility

$71.00

Service Code	HCPCS 82570
Hospital Charge Code	4000043
Hospital Revenue Code	300
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

.CREATININE, URINE, RANDOM (LABCORP)

Facility

$12.00

Service Code	HCPCS 82570
Hospital Charge Code	4025701
Hospital Revenue Code	300
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare	$10.80
Rate for Payer: BCBS MT CHIP	$10.80
Rate for Payer: BCBS MT Closed Plan Network	$11.40
Rate for Payer: BCBS MT HealthLink	$10.80
Rate for Payer: BCBS MT Medicare	$10.80
Rate for Payer: BCBS MT POS	$11.40
Rate for Payer: BCBS MT Traditional	$12.00
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna Commercial	$11.40
Rate for Payer: Cigna Medicare	$10.80
Rate for Payer: Medicaid All Medicaid	$11.04
Rate for Payer: Medicare All Medicare	$8.40
Rate for Payer: Monida Allegiance	$11.40
Rate for Payer: Monida First Choice Health	$11.64
Rate for Payer: Monida Montana Health Co-op	$11.40
Rate for Payer: Monida PacificSource	$11.40

.CREATININE, URINE, RANDOM (LABCORP)

Facility

$12.00

Service Code	HCPCS 82570
Hospital Charge Code	4025701
Hospital Revenue Code	300
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare	$10.80
Rate for Payer: BCBS MT CHIP	$10.80
Rate for Payer: BCBS MT Closed Plan Network	$11.40
Rate for Payer: BCBS MT HealthLink	$10.80
Rate for Payer: BCBS MT Medicare	$10.80
Rate for Payer: BCBS MT POS	$11.40
Rate for Payer: BCBS MT Traditional	$12.00
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna Commercial	$11.40
Rate for Payer: Cigna Medicare	$10.80
Rate for Payer: Medicaid All Medicaid	$11.04
Rate for Payer: Medicare All Medicare	$8.40
Rate for Payer: Monida Allegiance	$11.40
Rate for Payer: Monida First Choice Health	$11.64
Rate for Payer: Monida Montana Health Co-op	$11.40
Rate for Payer: Monida PacificSource	$11.40

CRITICAL CARE 1ST HOUR

Facility

$2,490.00

Service Code	HCPCS 99291 25
Hospital Charge Code	1010102
Hospital Revenue Code	450
Min. Negotiated Rate	$1,743.00
Max. Negotiated Rate	$2,490.00
Rate for Payer: Aetna Commercial	$2,365.50
Rate for Payer: Aetna Medicare	$2,241.00
Rate for Payer: BCBS MT CHIP	$2,241.00
Rate for Payer: BCBS MT Closed Plan Network	$2,365.50
Rate for Payer: BCBS MT HealthLink	$2,241.00
Rate for Payer: BCBS MT Medicare	$2,241.00
Rate for Payer: BCBS MT POS	$2,365.50
Rate for Payer: BCBS MT Traditional	$2,490.00
Rate for Payer: Cash Price	$2,241.00
Rate for Payer: Cigna Commercial	$2,365.50
Rate for Payer: Cigna Medicare	$2,241.00
Rate for Payer: Medicaid All Medicaid	$2,290.80
Rate for Payer: Medicare All Medicare	$1,743.00
Rate for Payer: Monida Allegiance	$2,365.50
Rate for Payer: Monida First Choice Health	$2,415.30
Rate for Payer: Monida Montana Health Co-op	$2,365.50
Rate for Payer: Monida PacificSource	$2,365.50

CRITICAL CARE 1ST HOUR

Facility

$2,490.00

Service Code	HCPCS 99291 25
Hospital Charge Code	1010102
Hospital Revenue Code	450
Min. Negotiated Rate	$1,743.00
Max. Negotiated Rate	$2,490.00
Rate for Payer: Aetna Commercial	$2,365.50
Rate for Payer: Aetna Medicare	$2,241.00
Rate for Payer: BCBS MT CHIP	$2,241.00
Rate for Payer: BCBS MT Closed Plan Network	$2,365.50
Rate for Payer: BCBS MT HealthLink	$2,241.00
Rate for Payer: BCBS MT Medicare	$2,241.00
Rate for Payer: BCBS MT POS	$2,365.50
Rate for Payer: BCBS MT Traditional	$2,490.00
Rate for Payer: Cash Price	$2,241.00
Rate for Payer: Cigna Commercial	$2,365.50
Rate for Payer: Cigna Medicare	$2,241.00
Rate for Payer: Medicaid All Medicaid	$2,290.80
Rate for Payer: Medicare All Medicare	$1,743.00
Rate for Payer: Monida Allegiance	$2,365.50
Rate for Payer: Monida First Choice Health	$2,415.30
Rate for Payer: Monida Montana Health Co-op	$2,365.50
Rate for Payer: Monida PacificSource	$2,365.50

CRITICAL CARE (EA 1/2 HR)

Facility

$628.00

Service Code	HCPCS 99292 25
Hospital Charge Code	1010108
Hospital Revenue Code	450
Min. Negotiated Rate	$439.60
Max. Negotiated Rate	$628.00
Rate for Payer: Aetna Commercial	$596.60
Rate for Payer: Aetna Medicare	$565.20
Rate for Payer: BCBS MT CHIP	$565.20
Rate for Payer: BCBS MT Closed Plan Network	$596.60
Rate for Payer: BCBS MT HealthLink	$565.20
Rate for Payer: BCBS MT Medicare	$565.20
Rate for Payer: BCBS MT POS	$596.60
Rate for Payer: BCBS MT Traditional	$628.00
Rate for Payer: Cash Price	$565.20
Rate for Payer: Cigna Commercial	$596.60
Rate for Payer: Cigna Medicare	$565.20
Rate for Payer: Medicaid All Medicaid	$577.76
Rate for Payer: Medicare All Medicare	$439.60
Rate for Payer: Monida Allegiance	$596.60
Rate for Payer: Monida First Choice Health	$609.16
Rate for Payer: Monida Montana Health Co-op	$596.60
Rate for Payer: Monida PacificSource	$596.60

CRITICAL CARE (EA 1/2 HR)

Facility

$628.00

Service Code	HCPCS 99292 25
Hospital Charge Code	1010108
Hospital Revenue Code	450
Min. Negotiated Rate	$439.60
Max. Negotiated Rate	$628.00
Rate for Payer: Aetna Commercial	$596.60
Rate for Payer: Aetna Medicare	$565.20
Rate for Payer: BCBS MT CHIP	$565.20
Rate for Payer: BCBS MT Closed Plan Network	$596.60
Rate for Payer: BCBS MT HealthLink	$565.20
Rate for Payer: BCBS MT Medicare	$565.20
Rate for Payer: BCBS MT POS	$596.60
Rate for Payer: BCBS MT Traditional	$628.00
Rate for Payer: Cash Price	$565.20
Rate for Payer: Cigna Commercial	$596.60
Rate for Payer: Cigna Medicare	$565.20
Rate for Payer: Medicaid All Medicaid	$577.76
Rate for Payer: Medicare All Medicare	$439.60
Rate for Payer: Monida Allegiance	$596.60
Rate for Payer: Monida First Choice Health	$609.16
Rate for Payer: Monida Montana Health Co-op	$596.60
Rate for Payer: Monida PacificSource	$596.60

CROTALIDAE IMMUNE FAB2 VIAL

Facility

$2,218.00

Service Code	HCPCS J0841
Hospital Charge Code	3000537
Hospital Revenue Code	259
Min. Negotiated Rate	$1,552.60
Max. Negotiated Rate	$2,218.00
Rate for Payer: Aetna Commercial	$2,107.10
Rate for Payer: Aetna Medicare	$1,996.20
Rate for Payer: BCBS MT CHIP	$1,996.20
Rate for Payer: BCBS MT Closed Plan Network	$2,107.10
Rate for Payer: BCBS MT HealthLink	$1,996.20
Rate for Payer: BCBS MT Medicare	$1,996.20
Rate for Payer: BCBS MT POS	$2,107.10
Rate for Payer: BCBS MT Traditional	$2,218.00
Rate for Payer: Cash Price	$1,996.20
Rate for Payer: Cigna Commercial	$2,107.10
Rate for Payer: Cigna Medicare	$1,996.20
Rate for Payer: Medicaid All Medicaid	$2,040.56
Rate for Payer: Medicare All Medicare	$1,552.60
Rate for Payer: Monida Allegiance	$2,107.10
Rate for Payer: Monida First Choice Health	$2,151.46
Rate for Payer: Monida Montana Health Co-op	$2,107.10
Rate for Payer: Monida PacificSource	$2,107.10

CROTALIDAE IMMUNE FAB2 VIAL

Facility

$2,218.00

Service Code	HCPCS J0841
Hospital Charge Code	3000537
Hospital Revenue Code	259
Min. Negotiated Rate	$1,552.60
Max. Negotiated Rate	$2,218.00
Rate for Payer: Aetna Commercial	$2,107.10
Rate for Payer: Aetna Medicare	$1,996.20
Rate for Payer: BCBS MT CHIP	$1,996.20
Rate for Payer: BCBS MT Closed Plan Network	$2,107.10
Rate for Payer: BCBS MT HealthLink	$1,996.20
Rate for Payer: BCBS MT Medicare	$1,996.20
Rate for Payer: BCBS MT POS	$2,107.10
Rate for Payer: BCBS MT Traditional	$2,218.00
Rate for Payer: Cash Price	$1,996.20
Rate for Payer: Cigna Commercial	$2,107.10
Rate for Payer: Cigna Medicare	$1,996.20
Rate for Payer: Medicaid All Medicaid	$2,040.56
Rate for Payer: Medicare All Medicare	$1,552.60
Rate for Payer: Monida Allegiance	$2,107.10
Rate for Payer: Monida First Choice Health	$2,151.46
Rate for Payer: Monida Montana Health Co-op	$2,107.10
Rate for Payer: Monida PacificSource	$2,107.10

CRP HIGH SENSITIVITY (120766)

Facility

$32.00

Service Code	HCPCS 86141
Hospital Charge Code	4086141
Hospital Revenue Code	300
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare	$28.80
Rate for Payer: BCBS MT CHIP	$28.80
Rate for Payer: BCBS MT Closed Plan Network	$30.40
Rate for Payer: BCBS MT HealthLink	$28.80
Rate for Payer: BCBS MT Medicare	$28.80
Rate for Payer: BCBS MT POS	$30.40
Rate for Payer: BCBS MT Traditional	$32.00
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial	$30.40
Rate for Payer: Cigna Medicare	$28.80
Rate for Payer: Medicaid All Medicaid	$29.44
Rate for Payer: Medicare All Medicare	$22.40
Rate for Payer: Monida Allegiance	$30.40
Rate for Payer: Monida First Choice Health	$31.04
Rate for Payer: Monida Montana Health Co-op	$30.40
Rate for Payer: Monida PacificSource	$30.40

CRP HIGH SENSITIVITY (120766)

Facility

$32.00

Service Code	HCPCS 86141
Hospital Charge Code	4086141
Hospital Revenue Code	300
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare	$28.80
Rate for Payer: BCBS MT CHIP	$28.80
Rate for Payer: BCBS MT Closed Plan Network	$30.40
Rate for Payer: BCBS MT HealthLink	$28.80
Rate for Payer: BCBS MT Medicare	$28.80
Rate for Payer: BCBS MT POS	$30.40
Rate for Payer: BCBS MT Traditional	$32.00
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial	$30.40
Rate for Payer: Cigna Medicare	$28.80
Rate for Payer: Medicaid All Medicaid	$29.44
Rate for Payer: Medicare All Medicare	$22.40
Rate for Payer: Monida Allegiance	$30.40
Rate for Payer: Monida First Choice Health	$31.04
Rate for Payer: Monida Montana Health Co-op	$30.40
Rate for Payer: Monida PacificSource	$30.40

CRUTCH ADULT 5'1-5'9

Facility

$54.00

Service Code	HCPCS E0116
Hospital Charge Code	2893283
Hospital Revenue Code	290
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$48.60
Rate for Payer: BCBS MT CHIP	$48.60
Rate for Payer: BCBS MT Closed Plan Network	$51.30
Rate for Payer: BCBS MT HealthLink	$48.60
Rate for Payer: BCBS MT Medicare	$48.60
Rate for Payer: BCBS MT POS	$51.30
Rate for Payer: BCBS MT Traditional	$54.00
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cigna Commercial	$51.30
Rate for Payer: Cigna Medicare	$48.60
Rate for Payer: Medicaid All Medicaid	$49.68
Rate for Payer: Medicare All Medicare	$37.80
Rate for Payer: Monida Allegiance	$51.30
Rate for Payer: Monida First Choice Health	$52.38
Rate for Payer: Monida Montana Health Co-op	$51.30
Rate for Payer: Monida PacificSource	$51.30

CRUTCH ADULT 5'1-5'9

Facility

$54.00

Service Code	HCPCS E0116
Hospital Charge Code	2893283
Hospital Revenue Code	290
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$48.60
Rate for Payer: BCBS MT CHIP	$48.60
Rate for Payer: BCBS MT Closed Plan Network	$51.30
Rate for Payer: BCBS MT HealthLink	$48.60
Rate for Payer: BCBS MT Medicare	$48.60
Rate for Payer: BCBS MT POS	$51.30
Rate for Payer: BCBS MT Traditional	$54.00
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cigna Commercial	$51.30
Rate for Payer: Cigna Medicare	$48.60
Rate for Payer: Medicaid All Medicaid	$49.68
Rate for Payer: Medicare All Medicare	$37.80
Rate for Payer: Monida Allegiance	$51.30
Rate for Payer: Monida First Choice Health	$52.38
Rate for Payer: Monida Montana Health Co-op	$51.30
Rate for Payer: Monida PacificSource	$51.30

CRUTCH ADULT TALL 5'10"

Facility

$95.00

Service Code	HCPCS E0116
Hospital Charge Code	2893282
Hospital Revenue Code	270
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$90.25
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: BCBS MT CHIP	$85.50
Rate for Payer: BCBS MT Closed Plan Network	$90.25
Rate for Payer: BCBS MT HealthLink	$85.50
Rate for Payer: BCBS MT Medicare	$85.50
Rate for Payer: BCBS MT POS	$90.25
Rate for Payer: BCBS MT Traditional	$95.00
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna Commercial	$90.25
Rate for Payer: Cigna Medicare	$85.50
Rate for Payer: Medicaid All Medicaid	$87.40
Rate for Payer: Medicare All Medicare	$66.50
Rate for Payer: Monida Allegiance	$90.25
Rate for Payer: Monida First Choice Health	$92.15
Rate for Payer: Monida Montana Health Co-op	$90.25
Rate for Payer: Monida PacificSource	$90.25

Know your out-of-pocket cost for care.

All Charges