Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

CREATININE

Facility

$65.00

Service Code	CPT 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	CPT 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	CPT 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

$64.00

Service Code	CPT 82575
Hospital Charge Code	4082575
Hospital Revenue Code	301
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare	$57.60
Rate for Payer: BCBS MT CHIP	$57.60
Rate for Payer: BCBS MT Closed Plan Network	$60.80
Rate for Payer: BCBS MT HealthLink	$57.60
Rate for Payer: BCBS MT Medicare	$57.60
Rate for Payer: BCBS MT POS	$60.80
Rate for Payer: BCBS MT Traditional	$64.00
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna Commercial	$60.80
Rate for Payer: Cigna Medicare	$57.60
Rate for Payer: Medicaid All Medicaid	$58.88
Rate for Payer: Medicare All Medicare	$44.80
Rate for Payer: Monida Allegiance	$60.80
Rate for Payer: Monida First Choice Health	$62.08
Rate for Payer: Monida Montana Health Co-op	$60.80
Rate for Payer: Monida PacificSource	$60.80

CREATININE CLEARANCE (003004)

Facility

$64.00

Service Code	CPT 82575
Hospital Charge Code	4082575
Hospital Revenue Code	301
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare	$57.60
Rate for Payer: BCBS MT CHIP	$57.60
Rate for Payer: BCBS MT Closed Plan Network	$60.80
Rate for Payer: BCBS MT HealthLink	$57.60
Rate for Payer: BCBS MT Medicare	$57.60
Rate for Payer: BCBS MT POS	$60.80
Rate for Payer: BCBS MT Traditional	$64.00
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cigna Commercial	$60.80
Rate for Payer: Cigna Medicare	$57.60
Rate for Payer: Medicaid All Medicaid	$58.88
Rate for Payer: Medicare All Medicare	$44.80
Rate for Payer: Monida Allegiance	$60.80
Rate for Payer: Monida First Choice Health	$62.08
Rate for Payer: Monida Montana Health Co-op	$60.80
Rate for Payer: Monida PacificSource	$60.80

CREATININE URINE

Facility

$154.00

Service Code	CPT 82540
Hospital Charge Code	4082540
Hospital Revenue Code	300
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

CREATININE URINE

Facility

$154.00

Service Code	CPT 82540
Hospital Charge Code	4082540
Hospital Revenue Code	300
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

.CREATININE, URINE, RANDOM

Facility

$71.00

Service Code	CPT 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	CPT 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

$58.00

Service Code	CPT 82570
Hospital Charge Code	4025701
Hospital Revenue Code	300
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$58.00
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare	$52.20
Rate for Payer: BCBS MT CHIP	$52.20
Rate for Payer: BCBS MT Closed Plan Network	$55.10
Rate for Payer: BCBS MT HealthLink	$52.20
Rate for Payer: BCBS MT Medicare	$52.20
Rate for Payer: BCBS MT POS	$55.10
Rate for Payer: BCBS MT Traditional	$58.00
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial	$55.10
Rate for Payer: Cigna Medicare	$52.20
Rate for Payer: Medicaid All Medicaid	$53.36
Rate for Payer: Medicare All Medicare	$40.60
Rate for Payer: Monida Allegiance	$55.10
Rate for Payer: Monida First Choice Health	$56.26
Rate for Payer: Monida Montana Health Co-op	$55.10
Rate for Payer: Monida PacificSource	$55.10

.CREATININE, URINE, RANDOM (LABCORP)

Facility

$58.00

Service Code	CPT 82570
Hospital Charge Code	4025701
Hospital Revenue Code	300
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$58.00
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare	$52.20
Rate for Payer: BCBS MT CHIP	$52.20
Rate for Payer: BCBS MT Closed Plan Network	$55.10
Rate for Payer: BCBS MT HealthLink	$52.20
Rate for Payer: BCBS MT Medicare	$52.20
Rate for Payer: BCBS MT POS	$55.10
Rate for Payer: BCBS MT Traditional	$58.00
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial	$55.10
Rate for Payer: Cigna Medicare	$52.20
Rate for Payer: Medicaid All Medicaid	$53.36
Rate for Payer: Medicare All Medicare	$40.60
Rate for Payer: Monida Allegiance	$55.10
Rate for Payer: Monida First Choice Health	$56.26
Rate for Payer: Monida Montana Health Co-op	$55.10
Rate for Payer: Monida PacificSource	$55.10

CRITICAL CARE 1ST HOUR

Facility

$2,639.00

Service Code	CPT 99291
Hospital Charge Code	1010102
Hospital Revenue Code	450
Min. Negotiated Rate	$1,847.30
Max. Negotiated Rate	$2,639.00
Rate for Payer: Aetna Commercial	$2,507.05
Rate for Payer: Aetna Medicare	$2,375.10
Rate for Payer: BCBS MT CHIP	$2,375.10
Rate for Payer: BCBS MT Closed Plan Network	$2,507.05
Rate for Payer: BCBS MT HealthLink	$2,375.10
Rate for Payer: BCBS MT Medicare	$2,375.10
Rate for Payer: BCBS MT POS	$2,507.05
Rate for Payer: BCBS MT Traditional	$2,639.00
Rate for Payer: Cash Price	$2,375.10
Rate for Payer: Cigna Commercial	$2,507.05
Rate for Payer: Cigna Medicare	$2,375.10
Rate for Payer: Medicaid All Medicaid	$2,427.88
Rate for Payer: Medicare All Medicare	$1,847.30
Rate for Payer: Monida Allegiance	$2,507.05
Rate for Payer: Monida First Choice Health	$2,559.83
Rate for Payer: Monida Montana Health Co-op	$2,507.05
Rate for Payer: Monida PacificSource	$2,507.05

CRITICAL CARE 1ST HOUR

Facility

$2,639.00

Service Code	CPT 99291
Hospital Charge Code	1010102
Hospital Revenue Code	450
Min. Negotiated Rate	$1,847.30
Max. Negotiated Rate	$2,639.00
Rate for Payer: Aetna Commercial	$2,507.05
Rate for Payer: Aetna Medicare	$2,375.10
Rate for Payer: BCBS MT CHIP	$2,375.10
Rate for Payer: BCBS MT Closed Plan Network	$2,507.05
Rate for Payer: BCBS MT HealthLink	$2,375.10
Rate for Payer: BCBS MT Medicare	$2,375.10
Rate for Payer: BCBS MT POS	$2,507.05
Rate for Payer: BCBS MT Traditional	$2,639.00
Rate for Payer: Cash Price	$2,375.10
Rate for Payer: Cigna Commercial	$2,507.05
Rate for Payer: Cigna Medicare	$2,375.10
Rate for Payer: Medicaid All Medicaid	$2,427.88
Rate for Payer: Medicare All Medicare	$1,847.30
Rate for Payer: Monida Allegiance	$2,507.05
Rate for Payer: Monida First Choice Health	$2,559.83
Rate for Payer: Monida Montana Health Co-op	$2,507.05
Rate for Payer: Monida PacificSource	$2,507.05

CRITICAL CARE (EA 1/2 HR)

Facility

$628.00

Service Code	CPT 99292
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	CPT 99292
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

$69.00

Service Code	CPT 86141
Hospital Charge Code	4086141
Hospital Revenue Code	300
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna Medicare	$62.10
Rate for Payer: BCBS MT CHIP	$62.10
Rate for Payer: BCBS MT Closed Plan Network	$65.55
Rate for Payer: BCBS MT HealthLink	$62.10
Rate for Payer: BCBS MT Medicare	$62.10
Rate for Payer: BCBS MT POS	$65.55
Rate for Payer: BCBS MT Traditional	$69.00
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna Commercial	$65.55
Rate for Payer: Cigna Medicare	$62.10
Rate for Payer: Medicaid All Medicaid	$63.48
Rate for Payer: Medicare All Medicare	$48.30
Rate for Payer: Monida Allegiance	$65.55
Rate for Payer: Monida First Choice Health	$66.93
Rate for Payer: Monida Montana Health Co-op	$65.55
Rate for Payer: Monida PacificSource	$65.55

CRP HIGH SENSITIVITY (120766)

Facility

$69.00

Service Code	CPT 86141
Hospital Charge Code	4086141
Hospital Revenue Code	300
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$65.55
Rate for Payer: Aetna Medicare	$62.10
Rate for Payer: BCBS MT CHIP	$62.10
Rate for Payer: BCBS MT Closed Plan Network	$65.55
Rate for Payer: BCBS MT HealthLink	$62.10
Rate for Payer: BCBS MT Medicare	$62.10
Rate for Payer: BCBS MT POS	$65.55
Rate for Payer: BCBS MT Traditional	$69.00
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cigna Commercial	$65.55
Rate for Payer: Cigna Medicare	$62.10
Rate for Payer: Medicaid All Medicaid	$63.48
Rate for Payer: Medicare All Medicare	$48.30
Rate for Payer: Monida Allegiance	$65.55
Rate for Payer: Monida First Choice Health	$66.93
Rate for Payer: Monida Montana Health Co-op	$65.55
Rate for Payer: Monida PacificSource	$65.55

CRUTCH ADULT 5'1-5'9

Facility

$57.00

Service Code	HCPCS E0116
Hospital Charge Code	2893283
Hospital Revenue Code	290
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare	$51.30
Rate for Payer: BCBS MT CHIP	$51.30
Rate for Payer: BCBS MT Closed Plan Network	$54.15
Rate for Payer: BCBS MT HealthLink	$51.30
Rate for Payer: BCBS MT Medicare	$51.30
Rate for Payer: BCBS MT POS	$54.15
Rate for Payer: BCBS MT Traditional	$57.00
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cigna Commercial	$54.15
Rate for Payer: Cigna Medicare	$51.30
Rate for Payer: Medicaid All Medicaid	$52.44
Rate for Payer: Medicare All Medicare	$39.90
Rate for Payer: Monida Allegiance	$54.15
Rate for Payer: Monida First Choice Health	$55.29
Rate for Payer: Monida Montana Health Co-op	$54.15
Rate for Payer: Monida PacificSource	$54.15

CRUTCH ADULT 5'1-5'9

Facility

$57.00

Service Code	HCPCS E0116
Hospital Charge Code	2893283
Hospital Revenue Code	290
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare	$51.30
Rate for Payer: BCBS MT CHIP	$51.30
Rate for Payer: BCBS MT Closed Plan Network	$54.15
Rate for Payer: BCBS MT HealthLink	$51.30
Rate for Payer: BCBS MT Medicare	$51.30
Rate for Payer: BCBS MT POS	$54.15
Rate for Payer: BCBS MT Traditional	$57.00
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cigna Commercial	$54.15
Rate for Payer: Cigna Medicare	$51.30
Rate for Payer: Medicaid All Medicaid	$52.44
Rate for Payer: Medicare All Medicare	$39.90
Rate for Payer: Monida Allegiance	$54.15
Rate for Payer: Monida First Choice Health	$55.29
Rate for Payer: Monida Montana Health Co-op	$54.15
Rate for Payer: Monida PacificSource	$54.15

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

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

CRUTCH DRESSED CHILD

Facility

$57.00

Service Code	HCPCS E0116
Hospital Charge Code	2893284
Hospital Revenue Code	290
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare	$51.30
Rate for Payer: BCBS MT CHIP	$51.30
Rate for Payer: BCBS MT Closed Plan Network	$54.15
Rate for Payer: BCBS MT HealthLink	$51.30
Rate for Payer: BCBS MT Medicare	$51.30
Rate for Payer: BCBS MT POS	$54.15
Rate for Payer: BCBS MT Traditional	$57.00
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cigna Commercial	$54.15
Rate for Payer: Cigna Medicare	$51.30
Rate for Payer: Medicaid All Medicaid	$52.44
Rate for Payer: Medicare All Medicare	$39.90
Rate for Payer: Monida Allegiance	$54.15
Rate for Payer: Monida First Choice Health	$55.29
Rate for Payer: Monida Montana Health Co-op	$54.15
Rate for Payer: Monida PacificSource	$54.15

CRUTCH DRESSED CHILD

Facility

$57.00

Service Code	HCPCS E0116
Hospital Charge Code	2893284
Hospital Revenue Code	290
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare	$51.30
Rate for Payer: BCBS MT CHIP	$51.30
Rate for Payer: BCBS MT Closed Plan Network	$54.15
Rate for Payer: BCBS MT HealthLink	$51.30
Rate for Payer: BCBS MT Medicare	$51.30
Rate for Payer: BCBS MT POS	$54.15
Rate for Payer: BCBS MT Traditional	$57.00
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cigna Commercial	$54.15
Rate for Payer: Cigna Medicare	$51.30
Rate for Payer: Medicaid All Medicaid	$52.44
Rate for Payer: Medicare All Medicare	$39.90
Rate for Payer: Monida Allegiance	$54.15
Rate for Payer: Monida First Choice Health	$55.29
Rate for Payer: Monida Montana Health Co-op	$54.15
Rate for Payer: Monida PacificSource	$54.15

Know your out-of-pocket cost for care.

All Charges