Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

ER APPLICATION OF FINGER SPLINT; DYNAMIC

Facility

$183.00

Service Code	CPT 29131
Hospital Charge Code	1029131
Hospital Revenue Code	450
Min. Negotiated Rate	$128.10
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$173.85
Rate for Payer: Aetna Medicare	$164.70
Rate for Payer: BCBS MT CHIP	$164.70
Rate for Payer: BCBS MT Closed Plan Network	$173.85
Rate for Payer: BCBS MT HealthLink	$164.70
Rate for Payer: BCBS MT Medicare	$164.70
Rate for Payer: BCBS MT POS	$173.85
Rate for Payer: BCBS MT Traditional	$183.00
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cigna Commercial	$173.85
Rate for Payer: Cigna Medicare	$164.70
Rate for Payer: Medicaid All Medicaid	$168.36
Rate for Payer: Medicare All Medicare	$128.10
Rate for Payer: Monida Allegiance	$173.85
Rate for Payer: Monida First Choice Health	$177.51
Rate for Payer: Monida Montana Health Co-op	$173.85
Rate for Payer: Monida PacificSource	$173.85

ER APPLICATION OF FINGER SPLINT; DYNAMIC

Facility

$183.00

Service Code	CPT 29131
Hospital Charge Code	1029131
Hospital Revenue Code	450
Min. Negotiated Rate	$128.10
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$173.85
Rate for Payer: Aetna Medicare	$164.70
Rate for Payer: BCBS MT CHIP	$164.70
Rate for Payer: BCBS MT Closed Plan Network	$173.85
Rate for Payer: BCBS MT HealthLink	$164.70
Rate for Payer: BCBS MT Medicare	$164.70
Rate for Payer: BCBS MT POS	$173.85
Rate for Payer: BCBS MT Traditional	$183.00
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cigna Commercial	$173.85
Rate for Payer: Cigna Medicare	$164.70
Rate for Payer: Medicaid All Medicaid	$168.36
Rate for Payer: Medicare All Medicare	$128.10
Rate for Payer: Monida Allegiance	$173.85
Rate for Payer: Monida First Choice Health	$177.51
Rate for Payer: Monida Montana Health Co-op	$173.85
Rate for Payer: Monida PacificSource	$173.85

ER APPLICATION OF FOREARM CAST

Facility

$284.00

Service Code	CPT 29075
Hospital Charge Code	1029075
Hospital Revenue Code	450
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$269.80
Rate for Payer: Aetna Medicare	$255.60
Rate for Payer: BCBS MT CHIP	$255.60
Rate for Payer: BCBS MT Closed Plan Network	$269.80
Rate for Payer: BCBS MT HealthLink	$255.60
Rate for Payer: BCBS MT Medicare	$255.60
Rate for Payer: BCBS MT POS	$269.80
Rate for Payer: BCBS MT Traditional	$284.00
Rate for Payer: Cash Price	$255.60
Rate for Payer: Cigna Commercial	$269.80
Rate for Payer: Cigna Medicare	$255.60
Rate for Payer: Medicaid All Medicaid	$261.28
Rate for Payer: Medicare All Medicare	$198.80
Rate for Payer: Monida Allegiance	$269.80
Rate for Payer: Monida First Choice Health	$275.48
Rate for Payer: Monida Montana Health Co-op	$269.80
Rate for Payer: Monida PacificSource	$269.80

ER APPLICATION OF FOREARM CAST

Facility

$284.00

Service Code	CPT 29075
Hospital Charge Code	1029075
Hospital Revenue Code	450
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$269.80
Rate for Payer: Aetna Medicare	$255.60
Rate for Payer: BCBS MT CHIP	$255.60
Rate for Payer: BCBS MT Closed Plan Network	$269.80
Rate for Payer: BCBS MT HealthLink	$255.60
Rate for Payer: BCBS MT Medicare	$255.60
Rate for Payer: BCBS MT POS	$269.80
Rate for Payer: BCBS MT Traditional	$284.00
Rate for Payer: Cash Price	$255.60
Rate for Payer: Cigna Commercial	$269.80
Rate for Payer: Cigna Medicare	$255.60
Rate for Payer: Medicaid All Medicaid	$261.28
Rate for Payer: Medicare All Medicare	$198.80
Rate for Payer: Monida Allegiance	$269.80
Rate for Payer: Monida First Choice Health	$275.48
Rate for Payer: Monida Montana Health Co-op	$269.80
Rate for Payer: Monida PacificSource	$269.80

ER APPLICATION OF SPLINT PROFEE

Facility

$330.00

Service Code	CPT 29125
Hospital Charge Code	8029126
Hospital Revenue Code	521
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare	$297.00
Rate for Payer: BCBS MT CHIP	$297.00
Rate for Payer: BCBS MT Closed Plan Network	$313.50
Rate for Payer: BCBS MT HealthLink	$297.00
Rate for Payer: BCBS MT Medicare	$297.00
Rate for Payer: BCBS MT POS	$313.50
Rate for Payer: BCBS MT Traditional	$330.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cigna Commercial	$313.50
Rate for Payer: Cigna Medicare	$297.00
Rate for Payer: Medicaid All Medicaid	$303.60
Rate for Payer: Medicare All Medicare	$231.00
Rate for Payer: Monida Allegiance	$313.50
Rate for Payer: Monida First Choice Health	$320.10
Rate for Payer: Monida Montana Health Co-op	$313.50
Rate for Payer: Monida PacificSource	$313.50

ER APPLICATION OF SPLINT PROFEE

Facility

$330.00

Service Code	CPT 29125
Hospital Charge Code	8029126
Hospital Revenue Code	521
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare	$297.00
Rate for Payer: BCBS MT CHIP	$297.00
Rate for Payer: BCBS MT Closed Plan Network	$313.50
Rate for Payer: BCBS MT HealthLink	$297.00
Rate for Payer: BCBS MT Medicare	$297.00
Rate for Payer: BCBS MT POS	$313.50
Rate for Payer: BCBS MT Traditional	$330.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cigna Commercial	$313.50
Rate for Payer: Cigna Medicare	$297.00
Rate for Payer: Medicaid All Medicaid	$303.60
Rate for Payer: Medicare All Medicare	$231.00
Rate for Payer: Monida Allegiance	$313.50
Rate for Payer: Monida First Choice Health	$320.10
Rate for Payer: Monida Montana Health Co-op	$313.50
Rate for Payer: Monida PacificSource	$313.50

ER APPLICATION SPLING TO ANKLE/AND OR FO

Facility

$179.00

Service Code	CPT 29540
Hospital Charge Code	1029540
Hospital Revenue Code	450
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$179.00
Rate for Payer: Aetna Commercial	$170.05
Rate for Payer: Aetna Medicare	$161.10
Rate for Payer: BCBS MT CHIP	$161.10
Rate for Payer: BCBS MT Closed Plan Network	$170.05
Rate for Payer: BCBS MT HealthLink	$161.10
Rate for Payer: BCBS MT Medicare	$161.10
Rate for Payer: BCBS MT POS	$170.05
Rate for Payer: BCBS MT Traditional	$179.00
Rate for Payer: Cash Price	$161.10
Rate for Payer: Cigna Commercial	$170.05
Rate for Payer: Cigna Medicare	$161.10
Rate for Payer: Medicaid All Medicaid	$164.68
Rate for Payer: Medicare All Medicare	$125.30
Rate for Payer: Monida Allegiance	$170.05
Rate for Payer: Monida First Choice Health	$173.63
Rate for Payer: Monida Montana Health Co-op	$170.05
Rate for Payer: Monida PacificSource	$170.05

ER APPLICATION SPLING TO ANKLE/AND OR FO

Facility

$179.00

Service Code	CPT 29540
Hospital Charge Code	1029540
Hospital Revenue Code	450
Min. Negotiated Rate	$125.30
Max. Negotiated Rate	$179.00
Rate for Payer: Aetna Commercial	$170.05
Rate for Payer: Aetna Medicare	$161.10
Rate for Payer: BCBS MT CHIP	$161.10
Rate for Payer: BCBS MT Closed Plan Network	$170.05
Rate for Payer: BCBS MT HealthLink	$161.10
Rate for Payer: BCBS MT Medicare	$161.10
Rate for Payer: BCBS MT POS	$170.05
Rate for Payer: BCBS MT Traditional	$179.00
Rate for Payer: Cash Price	$161.10
Rate for Payer: Cigna Commercial	$170.05
Rate for Payer: Cigna Medicare	$161.10
Rate for Payer: Medicaid All Medicaid	$164.68
Rate for Payer: Medicare All Medicare	$125.30
Rate for Payer: Monida Allegiance	$170.05
Rate for Payer: Monida First Choice Health	$173.63
Rate for Payer: Monida Montana Health Co-op	$170.05
Rate for Payer: Monida PacificSource	$170.05

ER APPLICATION SPLINT ARM SHORT

Facility

$330.00

Service Code	CPT 29125
Hospital Charge Code	1029125
Hospital Revenue Code	450
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare	$297.00
Rate for Payer: BCBS MT CHIP	$297.00
Rate for Payer: BCBS MT Closed Plan Network	$313.50
Rate for Payer: BCBS MT HealthLink	$297.00
Rate for Payer: BCBS MT Medicare	$297.00
Rate for Payer: BCBS MT POS	$313.50
Rate for Payer: BCBS MT Traditional	$330.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cigna Commercial	$313.50
Rate for Payer: Cigna Medicare	$297.00
Rate for Payer: Medicaid All Medicaid	$303.60
Rate for Payer: Medicare All Medicare	$231.00
Rate for Payer: Monida Allegiance	$313.50
Rate for Payer: Monida First Choice Health	$320.10
Rate for Payer: Monida Montana Health Co-op	$313.50
Rate for Payer: Monida PacificSource	$313.50

ER APPLICATION SPLINT ARM SHORT

Facility

$330.00

Service Code	CPT 29125
Hospital Charge Code	1029125
Hospital Revenue Code	450
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare	$297.00
Rate for Payer: BCBS MT CHIP	$297.00
Rate for Payer: BCBS MT Closed Plan Network	$313.50
Rate for Payer: BCBS MT HealthLink	$297.00
Rate for Payer: BCBS MT Medicare	$297.00
Rate for Payer: BCBS MT POS	$313.50
Rate for Payer: BCBS MT Traditional	$330.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cigna Commercial	$313.50
Rate for Payer: Cigna Medicare	$297.00
Rate for Payer: Medicaid All Medicaid	$303.60
Rate for Payer: Medicare All Medicare	$231.00
Rate for Payer: Monida Allegiance	$313.50
Rate for Payer: Monida First Choice Health	$320.10
Rate for Payer: Monida Montana Health Co-op	$313.50
Rate for Payer: Monida PacificSource	$313.50

ER APPLICATION SPLINT FINGER STATIC

Facility

$249.00

Service Code	CPT 29130
Hospital Charge Code	1029130
Hospital Revenue Code	450
Min. Negotiated Rate	$174.30
Max. Negotiated Rate	$249.00
Rate for Payer: Aetna Commercial	$236.55
Rate for Payer: Aetna Medicare	$224.10
Rate for Payer: BCBS MT CHIP	$224.10
Rate for Payer: BCBS MT Closed Plan Network	$236.55
Rate for Payer: BCBS MT HealthLink	$224.10
Rate for Payer: BCBS MT Medicare	$224.10
Rate for Payer: BCBS MT POS	$236.55
Rate for Payer: BCBS MT Traditional	$249.00
Rate for Payer: Cash Price	$224.10
Rate for Payer: Cigna Commercial	$236.55
Rate for Payer: Cigna Medicare	$224.10
Rate for Payer: Medicaid All Medicaid	$229.08
Rate for Payer: Medicare All Medicare	$174.30
Rate for Payer: Monida Allegiance	$236.55
Rate for Payer: Monida First Choice Health	$241.53
Rate for Payer: Monida Montana Health Co-op	$236.55
Rate for Payer: Monida PacificSource	$236.55

ER APPLICATION SPLINT FINGER STATIC

Facility

$249.00

Service Code	CPT 29130
Hospital Charge Code	1029130
Hospital Revenue Code	450
Min. Negotiated Rate	$174.30
Max. Negotiated Rate	$249.00
Rate for Payer: Aetna Commercial	$236.55
Rate for Payer: Aetna Medicare	$224.10
Rate for Payer: BCBS MT CHIP	$224.10
Rate for Payer: BCBS MT Closed Plan Network	$236.55
Rate for Payer: BCBS MT HealthLink	$224.10
Rate for Payer: BCBS MT Medicare	$224.10
Rate for Payer: BCBS MT POS	$236.55
Rate for Payer: BCBS MT Traditional	$249.00
Rate for Payer: Cash Price	$224.10
Rate for Payer: Cigna Commercial	$236.55
Rate for Payer: Cigna Medicare	$224.10
Rate for Payer: Medicaid All Medicaid	$229.08
Rate for Payer: Medicare All Medicare	$174.30
Rate for Payer: Monida Allegiance	$236.55
Rate for Payer: Monida First Choice Health	$241.53
Rate for Payer: Monida Montana Health Co-op	$236.55
Rate for Payer: Monida PacificSource	$236.55

ER APPLICATION SPLINT HAND OR FINGER

Facility

$192.00

Service Code	CPT 29280
Hospital Charge Code	1029280
Hospital Revenue Code	450
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare	$172.80
Rate for Payer: BCBS MT CHIP	$172.80
Rate for Payer: BCBS MT Closed Plan Network	$182.40
Rate for Payer: BCBS MT HealthLink	$172.80
Rate for Payer: BCBS MT Medicare	$172.80
Rate for Payer: BCBS MT POS	$182.40
Rate for Payer: BCBS MT Traditional	$192.00
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna Commercial	$182.40
Rate for Payer: Cigna Medicare	$172.80
Rate for Payer: Medicaid All Medicaid	$176.64
Rate for Payer: Medicare All Medicare	$134.40
Rate for Payer: Monida Allegiance	$182.40
Rate for Payer: Monida First Choice Health	$186.24
Rate for Payer: Monida Montana Health Co-op	$182.40
Rate for Payer: Monida PacificSource	$182.40

ER APPLICATION SPLINT HAND OR FINGER

Facility

$192.00

Service Code	CPT 29280
Hospital Charge Code	1029280
Hospital Revenue Code	450
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare	$172.80
Rate for Payer: BCBS MT CHIP	$172.80
Rate for Payer: BCBS MT Closed Plan Network	$182.40
Rate for Payer: BCBS MT HealthLink	$172.80
Rate for Payer: BCBS MT Medicare	$172.80
Rate for Payer: BCBS MT POS	$182.40
Rate for Payer: BCBS MT Traditional	$192.00
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna Commercial	$182.40
Rate for Payer: Cigna Medicare	$172.80
Rate for Payer: Medicaid All Medicaid	$176.64
Rate for Payer: Medicare All Medicare	$134.40
Rate for Payer: Monida Allegiance	$182.40
Rate for Payer: Monida First Choice Health	$186.24
Rate for Payer: Monida Montana Health Co-op	$182.40
Rate for Payer: Monida PacificSource	$182.40

ER APPLICATION SPLINT LEG LONG

Facility

$348.00

Service Code	CPT 29505
Hospital Charge Code	1029505
Hospital Revenue Code	450
Min. Negotiated Rate	$243.60
Max. Negotiated Rate	$348.00
Rate for Payer: Aetna Commercial	$330.60
Rate for Payer: Aetna Medicare	$313.20
Rate for Payer: BCBS MT CHIP	$313.20
Rate for Payer: BCBS MT Closed Plan Network	$330.60
Rate for Payer: BCBS MT HealthLink	$313.20
Rate for Payer: BCBS MT Medicare	$313.20
Rate for Payer: BCBS MT POS	$330.60
Rate for Payer: BCBS MT Traditional	$348.00
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cigna Commercial	$330.60
Rate for Payer: Cigna Medicare	$313.20
Rate for Payer: Medicaid All Medicaid	$320.16
Rate for Payer: Medicare All Medicare	$243.60
Rate for Payer: Monida Allegiance	$330.60
Rate for Payer: Monida First Choice Health	$337.56
Rate for Payer: Monida Montana Health Co-op	$330.60
Rate for Payer: Monida PacificSource	$330.60

ER APPLICATION SPLINT LEG LONG

Facility

$348.00

Service Code	CPT 29505
Hospital Charge Code	1029505
Hospital Revenue Code	450
Min. Negotiated Rate	$243.60
Max. Negotiated Rate	$348.00
Rate for Payer: Aetna Commercial	$330.60
Rate for Payer: Aetna Medicare	$313.20
Rate for Payer: BCBS MT CHIP	$313.20
Rate for Payer: BCBS MT Closed Plan Network	$330.60
Rate for Payer: BCBS MT HealthLink	$313.20
Rate for Payer: BCBS MT Medicare	$313.20
Rate for Payer: BCBS MT POS	$330.60
Rate for Payer: BCBS MT Traditional	$348.00
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cigna Commercial	$330.60
Rate for Payer: Cigna Medicare	$313.20
Rate for Payer: Medicaid All Medicaid	$320.16
Rate for Payer: Medicare All Medicare	$243.60
Rate for Payer: Monida Allegiance	$330.60
Rate for Payer: Monida First Choice Health	$337.56
Rate for Payer: Monida Montana Health Co-op	$330.60
Rate for Payer: Monida PacificSource	$330.60

ER APPLICATION SPLINT LONG

Facility

$366.00

Service Code	CPT 29105
Hospital Charge Code	1029105
Hospital Revenue Code	450
Min. Negotiated Rate	$256.20
Max. Negotiated Rate	$366.00
Rate for Payer: Aetna Commercial	$347.70
Rate for Payer: Aetna Medicare	$329.40
Rate for Payer: BCBS MT CHIP	$329.40
Rate for Payer: BCBS MT Closed Plan Network	$347.70
Rate for Payer: BCBS MT HealthLink	$329.40
Rate for Payer: BCBS MT Medicare	$329.40
Rate for Payer: BCBS MT POS	$347.70
Rate for Payer: BCBS MT Traditional	$366.00
Rate for Payer: Cash Price	$329.40
Rate for Payer: Cigna Commercial	$347.70
Rate for Payer: Cigna Medicare	$329.40
Rate for Payer: Medicaid All Medicaid	$336.72
Rate for Payer: Medicare All Medicare	$256.20
Rate for Payer: Monida Allegiance	$347.70
Rate for Payer: Monida First Choice Health	$355.02
Rate for Payer: Monida Montana Health Co-op	$347.70
Rate for Payer: Monida PacificSource	$347.70

ER APPLICATION SPLINT LONG

Facility

$366.00

Service Code	CPT 29105
Hospital Charge Code	1029105
Hospital Revenue Code	450
Min. Negotiated Rate	$256.20
Max. Negotiated Rate	$366.00
Rate for Payer: Aetna Commercial	$347.70
Rate for Payer: Aetna Medicare	$329.40
Rate for Payer: BCBS MT CHIP	$329.40
Rate for Payer: BCBS MT Closed Plan Network	$347.70
Rate for Payer: BCBS MT HealthLink	$329.40
Rate for Payer: BCBS MT Medicare	$329.40
Rate for Payer: BCBS MT POS	$347.70
Rate for Payer: BCBS MT Traditional	$366.00
Rate for Payer: Cash Price	$329.40
Rate for Payer: Cigna Commercial	$347.70
Rate for Payer: Cigna Medicare	$329.40
Rate for Payer: Medicaid All Medicaid	$336.72
Rate for Payer: Medicare All Medicare	$256.20
Rate for Payer: Monida Allegiance	$347.70
Rate for Payer: Monida First Choice Health	$355.02
Rate for Payer: Monida Montana Health Co-op	$347.70
Rate for Payer: Monida PacificSource	$347.70

ER APPLICATION STRAPPING ELBOW OR WRIST

Facility

$202.00

Service Code	CPT 29260
Hospital Charge Code	1029260
Hospital Revenue Code	450
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$202.00
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare	$181.80
Rate for Payer: BCBS MT CHIP	$181.80
Rate for Payer: BCBS MT Closed Plan Network	$191.90
Rate for Payer: BCBS MT HealthLink	$181.80
Rate for Payer: BCBS MT Medicare	$181.80
Rate for Payer: BCBS MT POS	$191.90
Rate for Payer: BCBS MT Traditional	$202.00
Rate for Payer: Cash Price	$181.80
Rate for Payer: Cigna Commercial	$191.90
Rate for Payer: Cigna Medicare	$181.80
Rate for Payer: Medicaid All Medicaid	$185.84
Rate for Payer: Medicare All Medicare	$141.40
Rate for Payer: Monida Allegiance	$191.90
Rate for Payer: Monida First Choice Health	$195.94
Rate for Payer: Monida Montana Health Co-op	$191.90
Rate for Payer: Monida PacificSource	$191.90

ER APPLICATION STRAPPING ELBOW OR WRIST

Facility

$202.00

Service Code	CPT 29260
Hospital Charge Code	1029260
Hospital Revenue Code	450
Min. Negotiated Rate	$141.40
Max. Negotiated Rate	$202.00
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare	$181.80
Rate for Payer: BCBS MT CHIP	$181.80
Rate for Payer: BCBS MT Closed Plan Network	$191.90
Rate for Payer: BCBS MT HealthLink	$181.80
Rate for Payer: BCBS MT Medicare	$181.80
Rate for Payer: BCBS MT POS	$191.90
Rate for Payer: BCBS MT Traditional	$202.00
Rate for Payer: Cash Price	$181.80
Rate for Payer: Cigna Commercial	$191.90
Rate for Payer: Cigna Medicare	$181.80
Rate for Payer: Medicaid All Medicaid	$185.84
Rate for Payer: Medicare All Medicare	$141.40
Rate for Payer: Monida Allegiance	$191.90
Rate for Payer: Monida First Choice Health	$195.94
Rate for Payer: Monida Montana Health Co-op	$191.90
Rate for Payer: Monida PacificSource	$191.90

ER APPLICATION STRAPPING SHOULDER

Facility

$325.00

Service Code	CPT 29240
Hospital Charge Code	1029240
Hospital Revenue Code	450
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$308.75
Rate for Payer: Aetna Medicare	$292.50
Rate for Payer: BCBS MT CHIP	$292.50
Rate for Payer: BCBS MT Closed Plan Network	$308.75
Rate for Payer: BCBS MT HealthLink	$292.50
Rate for Payer: BCBS MT Medicare	$292.50
Rate for Payer: BCBS MT POS	$308.75
Rate for Payer: BCBS MT Traditional	$325.00
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cigna Commercial	$308.75
Rate for Payer: Cigna Medicare	$292.50
Rate for Payer: Medicaid All Medicaid	$299.00
Rate for Payer: Medicare All Medicare	$227.50
Rate for Payer: Monida Allegiance	$308.75
Rate for Payer: Monida First Choice Health	$315.25
Rate for Payer: Monida Montana Health Co-op	$308.75
Rate for Payer: Monida PacificSource	$308.75

ER APPLICATION STRAPPING SHOULDER

Facility

$325.00

Service Code	CPT 29240
Hospital Charge Code	1029240
Hospital Revenue Code	450
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$308.75
Rate for Payer: Aetna Medicare	$292.50
Rate for Payer: BCBS MT CHIP	$292.50
Rate for Payer: BCBS MT Closed Plan Network	$308.75
Rate for Payer: BCBS MT HealthLink	$292.50
Rate for Payer: BCBS MT Medicare	$292.50
Rate for Payer: BCBS MT POS	$308.75
Rate for Payer: BCBS MT Traditional	$325.00
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cigna Commercial	$308.75
Rate for Payer: Cigna Medicare	$292.50
Rate for Payer: Medicaid All Medicaid	$299.00
Rate for Payer: Medicare All Medicare	$227.50
Rate for Payer: Monida Allegiance	$308.75
Rate for Payer: Monida First Choice Health	$315.25
Rate for Payer: Monida Montana Health Co-op	$308.75
Rate for Payer: Monida PacificSource	$308.75

ER APPLY LONG LEG CAST

Facility

$348.00

Service Code	CPT 29345
Hospital Charge Code	1029345
Hospital Revenue Code	450
Min. Negotiated Rate	$243.60
Max. Negotiated Rate	$348.00
Rate for Payer: Aetna Commercial	$330.60
Rate for Payer: Aetna Medicare	$313.20
Rate for Payer: BCBS MT CHIP	$313.20
Rate for Payer: BCBS MT Closed Plan Network	$330.60
Rate for Payer: BCBS MT HealthLink	$313.20
Rate for Payer: BCBS MT Medicare	$313.20
Rate for Payer: BCBS MT POS	$330.60
Rate for Payer: BCBS MT Traditional	$348.00
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cigna Commercial	$330.60
Rate for Payer: Cigna Medicare	$313.20
Rate for Payer: Medicaid All Medicaid	$320.16
Rate for Payer: Medicare All Medicare	$243.60
Rate for Payer: Monida Allegiance	$330.60
Rate for Payer: Monida First Choice Health	$337.56
Rate for Payer: Monida Montana Health Co-op	$330.60
Rate for Payer: Monida PacificSource	$330.60

ER APPLY LONG LEG CAST

Facility

$348.00

Service Code	CPT 29345
Hospital Charge Code	1029345
Hospital Revenue Code	450
Min. Negotiated Rate	$243.60
Max. Negotiated Rate	$348.00
Rate for Payer: Aetna Commercial	$330.60
Rate for Payer: Aetna Medicare	$313.20
Rate for Payer: BCBS MT CHIP	$313.20
Rate for Payer: BCBS MT Closed Plan Network	$330.60
Rate for Payer: BCBS MT HealthLink	$313.20
Rate for Payer: BCBS MT Medicare	$313.20
Rate for Payer: BCBS MT POS	$330.60
Rate for Payer: BCBS MT Traditional	$348.00
Rate for Payer: Cash Price	$313.20
Rate for Payer: Cigna Commercial	$330.60
Rate for Payer: Cigna Medicare	$313.20
Rate for Payer: Medicaid All Medicaid	$320.16
Rate for Payer: Medicare All Medicare	$243.60
Rate for Payer: Monida Allegiance	$330.60
Rate for Payer: Monida First Choice Health	$337.56
Rate for Payer: Monida Montana Health Co-op	$330.60
Rate for Payer: Monida PacificSource	$330.60

ER APPLY SHORT LEG CAST

Facility

$295.00

Service Code	CPT 29405
Hospital Charge Code	1029405
Hospital Revenue Code	450
Min. Negotiated Rate	$206.50
Max. Negotiated Rate	$295.00
Rate for Payer: Aetna Commercial	$280.25
Rate for Payer: Aetna Medicare	$265.50
Rate for Payer: BCBS MT CHIP	$265.50
Rate for Payer: BCBS MT Closed Plan Network	$280.25
Rate for Payer: BCBS MT HealthLink	$265.50
Rate for Payer: BCBS MT Medicare	$265.50
Rate for Payer: BCBS MT POS	$280.25
Rate for Payer: BCBS MT Traditional	$295.00
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cigna Commercial	$280.25
Rate for Payer: Cigna Medicare	$265.50
Rate for Payer: Medicaid All Medicaid	$271.40
Rate for Payer: Medicare All Medicare	$206.50
Rate for Payer: Monida Allegiance	$280.25
Rate for Payer: Monida First Choice Health	$286.15
Rate for Payer: Monida Montana Health Co-op	$280.25
Rate for Payer: Monida PacificSource	$280.25

Know your out-of-pocket cost for care.

All Charges