Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

ER DRAINAGE ABSC,CYST DENTOALVEOLAR41800

Facility

$547.00

Service Code	CPT 41800
Hospital Charge Code	1041800
Hospital Revenue Code	450
Min. Negotiated Rate	$382.90
Max. Negotiated Rate	$547.00
Rate for Payer: Aetna Commercial	$519.65
Rate for Payer: Aetna Medicare	$492.30
Rate for Payer: BCBS MT CHIP	$492.30
Rate for Payer: BCBS MT Closed Plan Network	$519.65
Rate for Payer: BCBS MT HealthLink	$492.30
Rate for Payer: BCBS MT Medicare	$492.30
Rate for Payer: BCBS MT POS	$519.65
Rate for Payer: BCBS MT Traditional	$547.00
Rate for Payer: Cash Price	$492.30
Rate for Payer: Cigna Commercial	$519.65
Rate for Payer: Cigna Medicare	$492.30
Rate for Payer: Medicaid All Medicaid	$503.24
Rate for Payer: Medicare All Medicare	$382.90
Rate for Payer: Monida Allegiance	$519.65
Rate for Payer: Monida First Choice Health	$530.59
Rate for Payer: Monida Montana Health Co-op	$519.65
Rate for Payer: Monida PacificSource	$519.65

ER DRAINAGE ABSC,CYST DENTOALVEOLAR41800

Facility

$547.00

Service Code	CPT 41800
Hospital Charge Code	1041800
Hospital Revenue Code	450
Min. Negotiated Rate	$382.90
Max. Negotiated Rate	$547.00
Rate for Payer: Aetna Commercial	$519.65
Rate for Payer: Aetna Medicare	$492.30
Rate for Payer: BCBS MT CHIP	$492.30
Rate for Payer: BCBS MT Closed Plan Network	$519.65
Rate for Payer: BCBS MT HealthLink	$492.30
Rate for Payer: BCBS MT Medicare	$492.30
Rate for Payer: BCBS MT POS	$519.65
Rate for Payer: BCBS MT Traditional	$547.00
Rate for Payer: Cash Price	$492.30
Rate for Payer: Cigna Commercial	$519.65
Rate for Payer: Cigna Medicare	$492.30
Rate for Payer: Medicaid All Medicaid	$503.24
Rate for Payer: Medicare All Medicare	$382.90
Rate for Payer: Monida Allegiance	$519.65
Rate for Payer: Monida First Choice Health	$530.59
Rate for Payer: Monida Montana Health Co-op	$519.65
Rate for Payer: Monida PacificSource	$519.65

ER DRAINAGE OF BARTHOLINS GLAND ABSCESS

Facility

$441.00

Service Code	CPT 56420
Hospital Charge Code	1056420
Hospital Revenue Code	450
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

ER DRAINAGE OF BARTHOLINS GLAND ABSCESS

Facility

$441.00

Service Code	CPT 56420
Hospital Charge Code	1056420
Hospital Revenue Code	450
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

ER DRAIN BLOOD FROM UNDER NAIL

Facility

$175.00

Service Code	CPT 11740
Hospital Charge Code	1011740
Hospital Revenue Code	450
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$166.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS MT CHIP	$157.50
Rate for Payer: BCBS MT Closed Plan Network	$166.25
Rate for Payer: BCBS MT HealthLink	$157.50
Rate for Payer: BCBS MT Medicare	$157.50
Rate for Payer: BCBS MT POS	$166.25
Rate for Payer: BCBS MT Traditional	$175.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cigna Commercial	$166.25
Rate for Payer: Cigna Medicare	$157.50
Rate for Payer: Medicaid All Medicaid	$161.00
Rate for Payer: Medicare All Medicare	$122.50
Rate for Payer: Monida Allegiance	$166.25
Rate for Payer: Monida First Choice Health	$169.75
Rate for Payer: Monida Montana Health Co-op	$166.25
Rate for Payer: Monida PacificSource	$166.25

ER DRAIN BLOOD FROM UNDER NAIL

Facility

$175.00

Service Code	CPT 11740
Hospital Charge Code	1011740
Hospital Revenue Code	450
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$166.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS MT CHIP	$157.50
Rate for Payer: BCBS MT Closed Plan Network	$166.25
Rate for Payer: BCBS MT HealthLink	$157.50
Rate for Payer: BCBS MT Medicare	$157.50
Rate for Payer: BCBS MT POS	$166.25
Rate for Payer: BCBS MT Traditional	$175.00
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cigna Commercial	$166.25
Rate for Payer: Cigna Medicare	$157.50
Rate for Payer: Medicaid All Medicaid	$161.00
Rate for Payer: Medicare All Medicare	$122.50
Rate for Payer: Monida Allegiance	$166.25
Rate for Payer: Monida First Choice Health	$169.75
Rate for Payer: Monida Montana Health Co-op	$166.25
Rate for Payer: Monida PacificSource	$166.25

ER DRESS/DEBRIDE BURN >10%TOTAL LARGE

Facility

$525.00

Service Code	CPT 16030
Hospital Charge Code	1016030
Hospital Revenue Code	450
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$498.75
Rate for Payer: Aetna Medicare	$472.50
Rate for Payer: BCBS MT CHIP	$472.50
Rate for Payer: BCBS MT Closed Plan Network	$498.75
Rate for Payer: BCBS MT HealthLink	$472.50
Rate for Payer: BCBS MT Medicare	$472.50
Rate for Payer: BCBS MT POS	$498.75
Rate for Payer: BCBS MT Traditional	$525.00
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cigna Commercial	$498.75
Rate for Payer: Cigna Medicare	$472.50
Rate for Payer: Medicaid All Medicaid	$483.00
Rate for Payer: Medicare All Medicare	$367.50
Rate for Payer: Monida Allegiance	$498.75
Rate for Payer: Monida First Choice Health	$509.25
Rate for Payer: Monida Montana Health Co-op	$498.75
Rate for Payer: Monida PacificSource	$498.75

ER DRESS/DEBRIDE BURN >10%TOTAL LARGE

Facility

$525.00

Service Code	CPT 16030
Hospital Charge Code	1016030
Hospital Revenue Code	450
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$498.75
Rate for Payer: Aetna Medicare	$472.50
Rate for Payer: BCBS MT CHIP	$472.50
Rate for Payer: BCBS MT Closed Plan Network	$498.75
Rate for Payer: BCBS MT HealthLink	$472.50
Rate for Payer: BCBS MT Medicare	$472.50
Rate for Payer: BCBS MT POS	$498.75
Rate for Payer: BCBS MT Traditional	$525.00
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cigna Commercial	$498.75
Rate for Payer: Cigna Medicare	$472.50
Rate for Payer: Medicaid All Medicaid	$483.00
Rate for Payer: Medicare All Medicare	$367.50
Rate for Payer: Monida Allegiance	$498.75
Rate for Payer: Monida First Choice Health	$509.25
Rate for Payer: Monida Montana Health Co-op	$498.75
Rate for Payer: Monida PacificSource	$498.75

ER DRESS/DEBRIDE PART-THICK BURNS >5%

Facility

$387.00

Service Code	CPT 16020
Hospital Charge Code	1016020
Hospital Revenue Code	450
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$367.65
Rate for Payer: Aetna Medicare	$348.30
Rate for Payer: BCBS MT CHIP	$348.30
Rate for Payer: BCBS MT Closed Plan Network	$367.65
Rate for Payer: BCBS MT HealthLink	$348.30
Rate for Payer: BCBS MT Medicare	$348.30
Rate for Payer: BCBS MT POS	$367.65
Rate for Payer: BCBS MT Traditional	$387.00
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cigna Commercial	$367.65
Rate for Payer: Cigna Medicare	$348.30
Rate for Payer: Medicaid All Medicaid	$356.04
Rate for Payer: Medicare All Medicare	$270.90
Rate for Payer: Monida Allegiance	$367.65
Rate for Payer: Monida First Choice Health	$375.39
Rate for Payer: Monida Montana Health Co-op	$367.65
Rate for Payer: Monida PacificSource	$367.65

ER DRESS/DEBRIDE PART-THICK BURNS >5%

Facility

$387.00

Service Code	CPT 16020
Hospital Charge Code	1016020
Hospital Revenue Code	450
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$367.65
Rate for Payer: Aetna Medicare	$348.30
Rate for Payer: BCBS MT CHIP	$348.30
Rate for Payer: BCBS MT Closed Plan Network	$367.65
Rate for Payer: BCBS MT HealthLink	$348.30
Rate for Payer: BCBS MT Medicare	$348.30
Rate for Payer: BCBS MT POS	$367.65
Rate for Payer: BCBS MT Traditional	$387.00
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cigna Commercial	$367.65
Rate for Payer: Cigna Medicare	$348.30
Rate for Payer: Medicaid All Medicaid	$356.04
Rate for Payer: Medicare All Medicare	$270.90
Rate for Payer: Monida Allegiance	$367.65
Rate for Payer: Monida First Choice Health	$375.39
Rate for Payer: Monida Montana Health Co-op	$367.65
Rate for Payer: Monida PacificSource	$367.65

ER GASTRIC INTUBATION

Facility

$374.00

Service Code	CPT 43753
Hospital Charge Code	1043753
Hospital Revenue Code	450
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

ER GASTRIC INTUBATION

Facility

$374.00

Service Code	CPT 43753
Hospital Charge Code	1043753
Hospital Revenue Code	450
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

ER INCISION OF RECTAL ABSCESS

Facility

$1,042.00

Service Code	CPT 46040
Hospital Charge Code	1046040
Hospital Revenue Code	450
Min. Negotiated Rate	$729.40
Max. Negotiated Rate	$1,042.00
Rate for Payer: Aetna Commercial	$989.90
Rate for Payer: Aetna Medicare	$937.80
Rate for Payer: BCBS MT CHIP	$937.80
Rate for Payer: BCBS MT Closed Plan Network	$989.90
Rate for Payer: BCBS MT HealthLink	$937.80
Rate for Payer: BCBS MT Medicare	$937.80
Rate for Payer: BCBS MT POS	$989.90
Rate for Payer: BCBS MT Traditional	$1,042.00
Rate for Payer: Cash Price	$937.80
Rate for Payer: Cigna Commercial	$989.90
Rate for Payer: Cigna Medicare	$937.80
Rate for Payer: Medicaid All Medicaid	$958.64
Rate for Payer: Medicare All Medicare	$729.40
Rate for Payer: Monida Allegiance	$989.90
Rate for Payer: Monida First Choice Health	$1,010.74
Rate for Payer: Monida Montana Health Co-op	$989.90
Rate for Payer: Monida PacificSource	$989.90

ER INCISION OF RECTAL ABSCESS

Facility

$1,042.00

Service Code	CPT 46040
Hospital Charge Code	1046040
Hospital Revenue Code	450
Min. Negotiated Rate	$729.40
Max. Negotiated Rate	$1,042.00
Rate for Payer: Aetna Commercial	$989.90
Rate for Payer: Aetna Medicare	$937.80
Rate for Payer: BCBS MT CHIP	$937.80
Rate for Payer: BCBS MT Closed Plan Network	$989.90
Rate for Payer: BCBS MT HealthLink	$937.80
Rate for Payer: BCBS MT Medicare	$937.80
Rate for Payer: BCBS MT POS	$989.90
Rate for Payer: BCBS MT Traditional	$1,042.00
Rate for Payer: Cash Price	$937.80
Rate for Payer: Cigna Commercial	$989.90
Rate for Payer: Cigna Medicare	$937.80
Rate for Payer: Medicaid All Medicaid	$958.64
Rate for Payer: Medicare All Medicare	$729.40
Rate for Payer: Monida Allegiance	$989.90
Rate for Payer: Monida First Choice Health	$1,010.74
Rate for Payer: Monida Montana Health Co-op	$989.90
Rate for Payer: Monida PacificSource	$989.90

ER INFUSION ADD PUMP SET UP

Facility

$94.00

Service Code	CPT 96371
Hospital Charge Code	1030203
Hospital Revenue Code	450
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare	$84.60
Rate for Payer: BCBS MT CHIP	$84.60
Rate for Payer: BCBS MT Closed Plan Network	$89.30
Rate for Payer: BCBS MT HealthLink	$84.60
Rate for Payer: BCBS MT Medicare	$84.60
Rate for Payer: BCBS MT POS	$89.30
Rate for Payer: BCBS MT Traditional	$94.00
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cigna Commercial	$89.30
Rate for Payer: Cigna Medicare	$84.60
Rate for Payer: Medicaid All Medicaid	$86.48
Rate for Payer: Medicare All Medicare	$65.80
Rate for Payer: Monida Allegiance	$89.30
Rate for Payer: Monida First Choice Health	$91.18
Rate for Payer: Monida Montana Health Co-op	$89.30
Rate for Payer: Monida PacificSource	$89.30

ER INFUSION ADD PUMP SET UP

Facility

$94.00

Service Code	CPT 96371
Hospital Charge Code	1030203
Hospital Revenue Code	450
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare	$84.60
Rate for Payer: BCBS MT CHIP	$84.60
Rate for Payer: BCBS MT Closed Plan Network	$89.30
Rate for Payer: BCBS MT HealthLink	$84.60
Rate for Payer: BCBS MT Medicare	$84.60
Rate for Payer: BCBS MT POS	$89.30
Rate for Payer: BCBS MT Traditional	$94.00
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cigna Commercial	$89.30
Rate for Payer: Cigna Medicare	$84.60
Rate for Payer: Medicaid All Medicaid	$86.48
Rate for Payer: Medicare All Medicare	$65.80
Rate for Payer: Monida Allegiance	$89.30
Rate for Payer: Monida First Choice Health	$91.18
Rate for Payer: Monida Montana Health Co-op	$89.30
Rate for Payer: Monida PacificSource	$89.30

ER INJ AND/OR ASPIRATION JOINT INTERM

Facility

$672.00

Service Code	CPT 20605
Hospital Charge Code	1020605
Hospital Revenue Code	450
Min. Negotiated Rate	$470.40
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$638.40
Rate for Payer: Aetna Medicare	$604.80
Rate for Payer: BCBS MT CHIP	$604.80
Rate for Payer: BCBS MT Closed Plan Network	$638.40
Rate for Payer: BCBS MT HealthLink	$604.80
Rate for Payer: BCBS MT Medicare	$604.80
Rate for Payer: BCBS MT POS	$638.40
Rate for Payer: BCBS MT Traditional	$672.00
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cigna Commercial	$638.40
Rate for Payer: Cigna Medicare	$604.80
Rate for Payer: Medicaid All Medicaid	$618.24
Rate for Payer: Medicare All Medicare	$470.40
Rate for Payer: Monida Allegiance	$638.40
Rate for Payer: Monida First Choice Health	$651.84
Rate for Payer: Monida Montana Health Co-op	$638.40
Rate for Payer: Monida PacificSource	$638.40

ER INJ AND/OR ASPIRATION JOINT INTERM

Facility

$672.00

Service Code	CPT 20605
Hospital Charge Code	1020605
Hospital Revenue Code	450
Min. Negotiated Rate	$470.40
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$638.40
Rate for Payer: Aetna Medicare	$604.80
Rate for Payer: BCBS MT CHIP	$604.80
Rate for Payer: BCBS MT Closed Plan Network	$638.40
Rate for Payer: BCBS MT HealthLink	$604.80
Rate for Payer: BCBS MT Medicare	$604.80
Rate for Payer: BCBS MT POS	$638.40
Rate for Payer: BCBS MT Traditional	$672.00
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cigna Commercial	$638.40
Rate for Payer: Cigna Medicare	$604.80
Rate for Payer: Medicaid All Medicaid	$618.24
Rate for Payer: Medicare All Medicare	$470.40
Rate for Payer: Monida Allegiance	$638.40
Rate for Payer: Monida First Choice Health	$651.84
Rate for Payer: Monida Montana Health Co-op	$638.40
Rate for Payer: Monida PacificSource	$638.40

ER INJECT/ASPIR JOINT LG

Facility

$984.00

Service Code	CPT 20610
Hospital Charge Code	1020610
Hospital Revenue Code	450
Min. Negotiated Rate	$688.80
Max. Negotiated Rate	$984.00
Rate for Payer: Aetna Commercial	$934.80
Rate for Payer: Aetna Medicare	$885.60
Rate for Payer: BCBS MT CHIP	$885.60
Rate for Payer: BCBS MT Closed Plan Network	$934.80
Rate for Payer: BCBS MT HealthLink	$885.60
Rate for Payer: BCBS MT Medicare	$885.60
Rate for Payer: BCBS MT POS	$934.80
Rate for Payer: BCBS MT Traditional	$984.00
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cigna Commercial	$934.80
Rate for Payer: Cigna Medicare	$885.60
Rate for Payer: Medicaid All Medicaid	$905.28
Rate for Payer: Medicare All Medicare	$688.80
Rate for Payer: Monida Allegiance	$934.80
Rate for Payer: Monida First Choice Health	$954.48
Rate for Payer: Monida Montana Health Co-op	$934.80
Rate for Payer: Monida PacificSource	$934.80

ER INJECT/ASPIR JOINT LG

Facility

$984.00

Service Code	CPT 20610
Hospital Charge Code	1020610
Hospital Revenue Code	450
Min. Negotiated Rate	$688.80
Max. Negotiated Rate	$984.00
Rate for Payer: Aetna Commercial	$934.80
Rate for Payer: Aetna Medicare	$885.60
Rate for Payer: BCBS MT CHIP	$885.60
Rate for Payer: BCBS MT Closed Plan Network	$934.80
Rate for Payer: BCBS MT HealthLink	$885.60
Rate for Payer: BCBS MT Medicare	$885.60
Rate for Payer: BCBS MT POS	$934.80
Rate for Payer: BCBS MT Traditional	$984.00
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cigna Commercial	$934.80
Rate for Payer: Cigna Medicare	$885.60
Rate for Payer: Medicaid All Medicaid	$905.28
Rate for Payer: Medicare All Medicare	$688.80
Rate for Payer: Monida Allegiance	$934.80
Rate for Payer: Monida First Choice Health	$954.48
Rate for Payer: Monida Montana Health Co-op	$934.80
Rate for Payer: Monida PacificSource	$934.80

ER INJ SQ/IM

Facility

$98.00

Service Code	CPT 96372
Hospital Charge Code	1030202
Hospital Revenue Code	450
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

ER INJ SQ/IM

Facility

$98.00

Service Code	CPT 96372
Hospital Charge Code	1030202
Hospital Revenue Code	450
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

ER INSERTION OF CHEST TUBE

Facility

$1,253.00

Service Code	CPT 32551
Hospital Charge Code	1032551
Hospital Revenue Code	450
Min. Negotiated Rate	$877.10
Max. Negotiated Rate	$1,253.00
Rate for Payer: Aetna Commercial	$1,190.35
Rate for Payer: Aetna Medicare	$1,127.70
Rate for Payer: BCBS MT CHIP	$1,127.70
Rate for Payer: BCBS MT Closed Plan Network	$1,190.35
Rate for Payer: BCBS MT HealthLink	$1,127.70
Rate for Payer: BCBS MT Medicare	$1,127.70
Rate for Payer: BCBS MT POS	$1,190.35
Rate for Payer: BCBS MT Traditional	$1,253.00
Rate for Payer: Cash Price	$1,127.70
Rate for Payer: Cigna Commercial	$1,190.35
Rate for Payer: Cigna Medicare	$1,127.70
Rate for Payer: Medicaid All Medicaid	$1,152.76
Rate for Payer: Medicare All Medicare	$877.10
Rate for Payer: Monida Allegiance	$1,190.35
Rate for Payer: Monida First Choice Health	$1,215.41
Rate for Payer: Monida Montana Health Co-op	$1,190.35
Rate for Payer: Monida PacificSource	$1,190.35

ER INSERTION OF CHEST TUBE

Facility

$1,253.00

Service Code	CPT 32551
Hospital Charge Code	1032551
Hospital Revenue Code	450
Min. Negotiated Rate	$877.10
Max. Negotiated Rate	$1,253.00
Rate for Payer: Aetna Commercial	$1,190.35
Rate for Payer: Aetna Medicare	$1,127.70
Rate for Payer: BCBS MT CHIP	$1,127.70
Rate for Payer: BCBS MT Closed Plan Network	$1,190.35
Rate for Payer: BCBS MT HealthLink	$1,127.70
Rate for Payer: BCBS MT Medicare	$1,127.70
Rate for Payer: BCBS MT POS	$1,190.35
Rate for Payer: BCBS MT Traditional	$1,253.00
Rate for Payer: Cash Price	$1,127.70
Rate for Payer: Cigna Commercial	$1,190.35
Rate for Payer: Cigna Medicare	$1,127.70
Rate for Payer: Medicaid All Medicaid	$1,152.76
Rate for Payer: Medicare All Medicare	$877.10
Rate for Payer: Monida Allegiance	$1,190.35
Rate for Payer: Monida First Choice Health	$1,215.41
Rate for Payer: Monida Montana Health Co-op	$1,190.35
Rate for Payer: Monida PacificSource	$1,190.35

ER INTUBATION, ENDOTRACHEAL 31500

Facility

$641.00

Service Code	CPT 31500
Hospital Charge Code	1031500
Hospital Revenue Code	450
Min. Negotiated Rate	$448.70
Max. Negotiated Rate	$641.00
Rate for Payer: Aetna Commercial	$608.95
Rate for Payer: Aetna Medicare	$576.90
Rate for Payer: BCBS MT CHIP	$576.90
Rate for Payer: BCBS MT Closed Plan Network	$608.95
Rate for Payer: BCBS MT HealthLink	$576.90
Rate for Payer: BCBS MT Medicare	$576.90
Rate for Payer: BCBS MT POS	$608.95
Rate for Payer: BCBS MT Traditional	$641.00
Rate for Payer: Cash Price	$576.90
Rate for Payer: Cigna Commercial	$608.95
Rate for Payer: Cigna Medicare	$576.90
Rate for Payer: Medicaid All Medicaid	$589.72
Rate for Payer: Medicare All Medicare	$448.70
Rate for Payer: Monida Allegiance	$608.95
Rate for Payer: Monida First Choice Health	$621.77
Rate for Payer: Monida Montana Health Co-op	$608.95
Rate for Payer: Monida PacificSource	$608.95

Know your out-of-pocket cost for care.

All Charges