Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

EXCISION BENIGN LESION 0.5CM LESS(11440)

Facility

$401.00

Service Code	CPT 11440
Hospital Charge Code	8011440
Hospital Revenue Code	521
Min. Negotiated Rate	$280.70
Max. Negotiated Rate	$401.00
Rate for Payer: Aetna Commercial	$380.95
Rate for Payer: Aetna Medicare	$360.90
Rate for Payer: BCBS MT CHIP	$360.90
Rate for Payer: BCBS MT Closed Plan Network	$380.95
Rate for Payer: BCBS MT HealthLink	$360.90
Rate for Payer: BCBS MT Medicare	$360.90
Rate for Payer: BCBS MT POS	$380.95
Rate for Payer: BCBS MT Traditional	$401.00
Rate for Payer: Cash Price	$360.90
Rate for Payer: Cigna Commercial	$380.95
Rate for Payer: Cigna Medicare	$360.90
Rate for Payer: Medicaid All Medicaid	$368.92
Rate for Payer: Medicare All Medicare	$280.70
Rate for Payer: Monida Allegiance	$380.95
Rate for Payer: Monida First Choice Health	$388.97
Rate for Payer: Monida Montana Health Co-op	$380.95
Rate for Payer: Monida PacificSource	$380.95

EXCISION BENIGN LESION 0.5CM LESS(11440)

Facility

$401.00

Service Code	CPT 11440
Hospital Charge Code	8011440
Hospital Revenue Code	521
Min. Negotiated Rate	$280.70
Max. Negotiated Rate	$401.00
Rate for Payer: Aetna Commercial	$380.95
Rate for Payer: Aetna Medicare	$360.90
Rate for Payer: BCBS MT CHIP	$360.90
Rate for Payer: BCBS MT Closed Plan Network	$380.95
Rate for Payer: BCBS MT HealthLink	$360.90
Rate for Payer: BCBS MT Medicare	$360.90
Rate for Payer: BCBS MT POS	$380.95
Rate for Payer: BCBS MT Traditional	$401.00
Rate for Payer: Cash Price	$360.90
Rate for Payer: Cigna Commercial	$380.95
Rate for Payer: Cigna Medicare	$360.90
Rate for Payer: Medicaid All Medicaid	$368.92
Rate for Payer: Medicare All Medicare	$280.70
Rate for Payer: Monida Allegiance	$380.95
Rate for Payer: Monida First Choice Health	$388.97
Rate for Payer: Monida Montana Health Co-op	$380.95
Rate for Payer: Monida PacificSource	$380.95

EXCISION BENIGN LESION 0.6-1.0CM(11401)

Facility

$431.00

Service Code	CPT 11401
Hospital Charge Code	8011401
Hospital Revenue Code	521
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$431.00
Rate for Payer: Aetna Commercial	$409.45
Rate for Payer: Aetna Medicare	$387.90
Rate for Payer: BCBS MT CHIP	$387.90
Rate for Payer: BCBS MT Closed Plan Network	$409.45
Rate for Payer: BCBS MT HealthLink	$387.90
Rate for Payer: BCBS MT Medicare	$387.90
Rate for Payer: BCBS MT POS	$409.45
Rate for Payer: BCBS MT Traditional	$431.00
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cigna Commercial	$409.45
Rate for Payer: Cigna Medicare	$387.90
Rate for Payer: Medicaid All Medicaid	$396.52
Rate for Payer: Medicare All Medicare	$301.70
Rate for Payer: Monida Allegiance	$409.45
Rate for Payer: Monida First Choice Health	$418.07
Rate for Payer: Monida Montana Health Co-op	$409.45
Rate for Payer: Monida PacificSource	$409.45

EXCISION BENIGN LESION 0.6-1.0CM(11401)

Facility

$431.00

Service Code	CPT 11401
Hospital Charge Code	8011401
Hospital Revenue Code	521
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$431.00
Rate for Payer: Aetna Commercial	$409.45
Rate for Payer: Aetna Medicare	$387.90
Rate for Payer: BCBS MT CHIP	$387.90
Rate for Payer: BCBS MT Closed Plan Network	$409.45
Rate for Payer: BCBS MT HealthLink	$387.90
Rate for Payer: BCBS MT Medicare	$387.90
Rate for Payer: BCBS MT POS	$409.45
Rate for Payer: BCBS MT Traditional	$431.00
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cigna Commercial	$409.45
Rate for Payer: Cigna Medicare	$387.90
Rate for Payer: Medicaid All Medicaid	$396.52
Rate for Payer: Medicare All Medicare	$301.70
Rate for Payer: Monida Allegiance	$409.45
Rate for Payer: Monida First Choice Health	$418.07
Rate for Payer: Monida Montana Health Co-op	$409.45
Rate for Payer: Monida PacificSource	$409.45

EXCISION BENIGN LESION 0.6-1.0CM (11441)

Facility

$712.00

Service Code	CPT 11441
Hospital Charge Code	8011441
Hospital Revenue Code	521
Min. Negotiated Rate	$498.40
Max. Negotiated Rate	$712.00
Rate for Payer: Aetna Commercial	$676.40
Rate for Payer: Aetna Medicare	$640.80
Rate for Payer: BCBS MT CHIP	$640.80
Rate for Payer: BCBS MT Closed Plan Network	$676.40
Rate for Payer: BCBS MT HealthLink	$640.80
Rate for Payer: BCBS MT Medicare	$640.80
Rate for Payer: BCBS MT POS	$676.40
Rate for Payer: BCBS MT Traditional	$712.00
Rate for Payer: Cash Price	$640.80
Rate for Payer: Cigna Commercial	$676.40
Rate for Payer: Cigna Medicare	$640.80
Rate for Payer: Medicaid All Medicaid	$655.04
Rate for Payer: Medicare All Medicare	$498.40
Rate for Payer: Monida Allegiance	$676.40
Rate for Payer: Monida First Choice Health	$690.64
Rate for Payer: Monida Montana Health Co-op	$676.40
Rate for Payer: Monida PacificSource	$676.40

EXCISION BENIGN LESION 0.6-1.0CM (11441)

Facility

$712.00

Service Code	CPT 11441
Hospital Charge Code	8011441
Hospital Revenue Code	521
Min. Negotiated Rate	$498.40
Max. Negotiated Rate	$712.00
Rate for Payer: Aetna Commercial	$676.40
Rate for Payer: Aetna Medicare	$640.80
Rate for Payer: BCBS MT CHIP	$640.80
Rate for Payer: BCBS MT Closed Plan Network	$676.40
Rate for Payer: BCBS MT HealthLink	$640.80
Rate for Payer: BCBS MT Medicare	$640.80
Rate for Payer: BCBS MT POS	$676.40
Rate for Payer: BCBS MT Traditional	$712.00
Rate for Payer: Cash Price	$640.80
Rate for Payer: Cigna Commercial	$676.40
Rate for Payer: Cigna Medicare	$640.80
Rate for Payer: Medicaid All Medicaid	$655.04
Rate for Payer: Medicare All Medicare	$498.40
Rate for Payer: Monida Allegiance	$676.40
Rate for Payer: Monida First Choice Health	$690.64
Rate for Payer: Monida Montana Health Co-op	$676.40
Rate for Payer: Monida PacificSource	$676.40

EXCISION BENIGN LESION 1.1-2.0CM(11402)

Facility

$469.00

Service Code	CPT 11402
Hospital Charge Code	8011402
Hospital Revenue Code	521
Min. Negotiated Rate	$328.30
Max. Negotiated Rate	$469.00
Rate for Payer: Aetna Commercial	$445.55
Rate for Payer: Aetna Medicare	$422.10
Rate for Payer: BCBS MT CHIP	$422.10
Rate for Payer: BCBS MT Closed Plan Network	$445.55
Rate for Payer: BCBS MT HealthLink	$422.10
Rate for Payer: BCBS MT Medicare	$422.10
Rate for Payer: BCBS MT POS	$445.55
Rate for Payer: BCBS MT Traditional	$469.00
Rate for Payer: Cash Price	$422.10
Rate for Payer: Cigna Commercial	$445.55
Rate for Payer: Cigna Medicare	$422.10
Rate for Payer: Medicaid All Medicaid	$431.48
Rate for Payer: Medicare All Medicare	$328.30
Rate for Payer: Monida Allegiance	$445.55
Rate for Payer: Monida First Choice Health	$454.93
Rate for Payer: Monida Montana Health Co-op	$445.55
Rate for Payer: Monida PacificSource	$445.55

EXCISION BENIGN LESION 1.1-2.0CM(11402)

Facility

$469.00

Service Code	CPT 11402
Hospital Charge Code	8011402
Hospital Revenue Code	521
Min. Negotiated Rate	$328.30
Max. Negotiated Rate	$469.00
Rate for Payer: Aetna Commercial	$445.55
Rate for Payer: Aetna Medicare	$422.10
Rate for Payer: BCBS MT CHIP	$422.10
Rate for Payer: BCBS MT Closed Plan Network	$445.55
Rate for Payer: BCBS MT HealthLink	$422.10
Rate for Payer: BCBS MT Medicare	$422.10
Rate for Payer: BCBS MT POS	$445.55
Rate for Payer: BCBS MT Traditional	$469.00
Rate for Payer: Cash Price	$422.10
Rate for Payer: Cigna Commercial	$445.55
Rate for Payer: Cigna Medicare	$422.10
Rate for Payer: Medicaid All Medicaid	$431.48
Rate for Payer: Medicare All Medicare	$328.30
Rate for Payer: Monida Allegiance	$445.55
Rate for Payer: Monida First Choice Health	$454.93
Rate for Payer: Monida Montana Health Co-op	$445.55
Rate for Payer: Monida PacificSource	$445.55

EXCISION BENIGN LESION 2.1-3.0CM(11403)

Facility

$497.00

Service Code	CPT 11403
Hospital Charge Code	8011403
Hospital Revenue Code	521
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$497.00
Rate for Payer: Aetna Commercial	$472.15
Rate for Payer: Aetna Medicare	$447.30
Rate for Payer: BCBS MT CHIP	$447.30
Rate for Payer: BCBS MT Closed Plan Network	$472.15
Rate for Payer: BCBS MT HealthLink	$447.30
Rate for Payer: BCBS MT Medicare	$447.30
Rate for Payer: BCBS MT POS	$472.15
Rate for Payer: BCBS MT Traditional	$497.00
Rate for Payer: Cash Price	$447.30
Rate for Payer: Cigna Commercial	$472.15
Rate for Payer: Cigna Medicare	$447.30
Rate for Payer: Medicaid All Medicaid	$457.24
Rate for Payer: Medicare All Medicare	$347.90
Rate for Payer: Monida Allegiance	$472.15
Rate for Payer: Monida First Choice Health	$482.09
Rate for Payer: Monida Montana Health Co-op	$472.15
Rate for Payer: Monida PacificSource	$472.15

EXCISION BENIGN LESION 2.1-3.0CM(11403)

Facility

$497.00

Service Code	CPT 11403
Hospital Charge Code	8011403
Hospital Revenue Code	521
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$497.00
Rate for Payer: Aetna Commercial	$472.15
Rate for Payer: Aetna Medicare	$447.30
Rate for Payer: BCBS MT CHIP	$447.30
Rate for Payer: BCBS MT Closed Plan Network	$472.15
Rate for Payer: BCBS MT HealthLink	$447.30
Rate for Payer: BCBS MT Medicare	$447.30
Rate for Payer: BCBS MT POS	$472.15
Rate for Payer: BCBS MT Traditional	$497.00
Rate for Payer: Cash Price	$447.30
Rate for Payer: Cigna Commercial	$472.15
Rate for Payer: Cigna Medicare	$447.30
Rate for Payer: Medicaid All Medicaid	$457.24
Rate for Payer: Medicare All Medicare	$347.90
Rate for Payer: Monida Allegiance	$472.15
Rate for Payer: Monida First Choice Health	$482.09
Rate for Payer: Monida Montana Health Co-op	$472.15
Rate for Payer: Monida PacificSource	$472.15

EXCISION BENIGN LESION 3.1-4.0 CM(11404)

Facility

$549.00

Service Code	CPT 11404
Hospital Charge Code	8011404
Hospital Revenue Code	521
Min. Negotiated Rate	$384.30
Max. Negotiated Rate	$549.00
Rate for Payer: Aetna Commercial	$521.55
Rate for Payer: Aetna Medicare	$494.10
Rate for Payer: BCBS MT CHIP	$494.10
Rate for Payer: BCBS MT Closed Plan Network	$521.55
Rate for Payer: BCBS MT HealthLink	$494.10
Rate for Payer: BCBS MT Medicare	$494.10
Rate for Payer: BCBS MT POS	$521.55
Rate for Payer: BCBS MT Traditional	$549.00
Rate for Payer: Cash Price	$494.10
Rate for Payer: Cigna Commercial	$521.55
Rate for Payer: Cigna Medicare	$494.10
Rate for Payer: Medicaid All Medicaid	$505.08
Rate for Payer: Medicare All Medicare	$384.30
Rate for Payer: Monida Allegiance	$521.55
Rate for Payer: Monida First Choice Health	$532.53
Rate for Payer: Monida Montana Health Co-op	$521.55
Rate for Payer: Monida PacificSource	$521.55

EXCISION BENIGN LESION 3.1-4.0 CM(11404)

Facility

$549.00

Service Code	CPT 11404
Hospital Charge Code	8011404
Hospital Revenue Code	521
Min. Negotiated Rate	$384.30
Max. Negotiated Rate	$549.00
Rate for Payer: Aetna Commercial	$521.55
Rate for Payer: Aetna Medicare	$494.10
Rate for Payer: BCBS MT CHIP	$494.10
Rate for Payer: BCBS MT Closed Plan Network	$521.55
Rate for Payer: BCBS MT HealthLink	$494.10
Rate for Payer: BCBS MT Medicare	$494.10
Rate for Payer: BCBS MT POS	$521.55
Rate for Payer: BCBS MT Traditional	$549.00
Rate for Payer: Cash Price	$494.10
Rate for Payer: Cigna Commercial	$521.55
Rate for Payer: Cigna Medicare	$494.10
Rate for Payer: Medicaid All Medicaid	$505.08
Rate for Payer: Medicare All Medicare	$384.30
Rate for Payer: Monida Allegiance	$521.55
Rate for Payer: Monida First Choice Health	$532.53
Rate for Payer: Monida Montana Health Co-op	$521.55
Rate for Payer: Monida PacificSource	$521.55

EXCISION BNIGN LSION + MARG >0.5CM(11420

Facility

$586.00

Service Code	CPT 11420
Hospital Charge Code	8011420
Hospital Revenue Code	521
Min. Negotiated Rate	$410.20
Max. Negotiated Rate	$586.00
Rate for Payer: Aetna Commercial	$556.70
Rate for Payer: Aetna Medicare	$527.40
Rate for Payer: BCBS MT CHIP	$527.40
Rate for Payer: BCBS MT Closed Plan Network	$556.70
Rate for Payer: BCBS MT HealthLink	$527.40
Rate for Payer: BCBS MT Medicare	$527.40
Rate for Payer: BCBS MT POS	$556.70
Rate for Payer: BCBS MT Traditional	$586.00
Rate for Payer: Cash Price	$527.40
Rate for Payer: Cigna Commercial	$556.70
Rate for Payer: Cigna Medicare	$527.40
Rate for Payer: Medicaid All Medicaid	$539.12
Rate for Payer: Medicare All Medicare	$410.20
Rate for Payer: Monida Allegiance	$556.70
Rate for Payer: Monida First Choice Health	$568.42
Rate for Payer: Monida Montana Health Co-op	$556.70
Rate for Payer: Monida PacificSource	$556.70

EXCISION BNIGN LSION + MARG >0.5CM(11420

Facility

$586.00

Service Code	CPT 11420
Hospital Charge Code	8011420
Hospital Revenue Code	521
Min. Negotiated Rate	$410.20
Max. Negotiated Rate	$586.00
Rate for Payer: Aetna Commercial	$556.70
Rate for Payer: Aetna Medicare	$527.40
Rate for Payer: BCBS MT CHIP	$527.40
Rate for Payer: BCBS MT Closed Plan Network	$556.70
Rate for Payer: BCBS MT HealthLink	$527.40
Rate for Payer: BCBS MT Medicare	$527.40
Rate for Payer: BCBS MT POS	$556.70
Rate for Payer: BCBS MT Traditional	$586.00
Rate for Payer: Cash Price	$527.40
Rate for Payer: Cigna Commercial	$556.70
Rate for Payer: Cigna Medicare	$527.40
Rate for Payer: Medicaid All Medicaid	$539.12
Rate for Payer: Medicare All Medicare	$410.20
Rate for Payer: Monida Allegiance	$556.70
Rate for Payer: Monida First Choice Health	$568.42
Rate for Payer: Monida Montana Health Co-op	$556.70
Rate for Payer: Monida PacificSource	$556.70

EXCISION BNIGN LSION-SCALP-1.1-2.0(11422

Facility

$469.00

Service Code	CPT 11422
Hospital Charge Code	8011422
Hospital Revenue Code	521
Min. Negotiated Rate	$328.30
Max. Negotiated Rate	$469.00
Rate for Payer: Aetna Commercial	$445.55
Rate for Payer: Aetna Medicare	$422.10
Rate for Payer: BCBS MT CHIP	$422.10
Rate for Payer: BCBS MT Closed Plan Network	$445.55
Rate for Payer: BCBS MT HealthLink	$422.10
Rate for Payer: BCBS MT Medicare	$422.10
Rate for Payer: BCBS MT POS	$445.55
Rate for Payer: BCBS MT Traditional	$469.00
Rate for Payer: Cash Price	$422.10
Rate for Payer: Cigna Commercial	$445.55
Rate for Payer: Cigna Medicare	$422.10
Rate for Payer: Medicaid All Medicaid	$431.48
Rate for Payer: Medicare All Medicare	$328.30
Rate for Payer: Monida Allegiance	$445.55
Rate for Payer: Monida First Choice Health	$454.93
Rate for Payer: Monida Montana Health Co-op	$445.55
Rate for Payer: Monida PacificSource	$445.55

EXCISION BNIGN LSION-SCALP-1.1-2.0(11422

Facility

$469.00

Service Code	CPT 11422
Hospital Charge Code	8011422
Hospital Revenue Code	521
Min. Negotiated Rate	$328.30
Max. Negotiated Rate	$469.00
Rate for Payer: Aetna Commercial	$445.55
Rate for Payer: Aetna Medicare	$422.10
Rate for Payer: BCBS MT CHIP	$422.10
Rate for Payer: BCBS MT Closed Plan Network	$445.55
Rate for Payer: BCBS MT HealthLink	$422.10
Rate for Payer: BCBS MT Medicare	$422.10
Rate for Payer: BCBS MT POS	$445.55
Rate for Payer: BCBS MT Traditional	$469.00
Rate for Payer: Cash Price	$422.10
Rate for Payer: Cigna Commercial	$445.55
Rate for Payer: Cigna Medicare	$422.10
Rate for Payer: Medicaid All Medicaid	$431.48
Rate for Payer: Medicare All Medicare	$328.30
Rate for Payer: Monida Allegiance	$445.55
Rate for Payer: Monida First Choice Health	$454.93
Rate for Payer: Monida Montana Health Co-op	$445.55
Rate for Payer: Monida PacificSource	$445.55

EXCISION MALIG LESION 0.6-1.0CM (11601)

Facility

$431.00

Service Code	CPT 11601
Hospital Charge Code	8011601
Hospital Revenue Code	521
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$431.00
Rate for Payer: Aetna Commercial	$409.45
Rate for Payer: Aetna Medicare	$387.90
Rate for Payer: BCBS MT CHIP	$387.90
Rate for Payer: BCBS MT Closed Plan Network	$409.45
Rate for Payer: BCBS MT HealthLink	$387.90
Rate for Payer: BCBS MT Medicare	$387.90
Rate for Payer: BCBS MT POS	$409.45
Rate for Payer: BCBS MT Traditional	$431.00
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cigna Commercial	$409.45
Rate for Payer: Cigna Medicare	$387.90
Rate for Payer: Medicaid All Medicaid	$396.52
Rate for Payer: Medicare All Medicare	$301.70
Rate for Payer: Monida Allegiance	$409.45
Rate for Payer: Monida First Choice Health	$418.07
Rate for Payer: Monida Montana Health Co-op	$409.45
Rate for Payer: Monida PacificSource	$409.45

EXCISION MALIG LESION 0.6-1.0CM (11601)

Facility

$431.00

Service Code	CPT 11601
Hospital Charge Code	8011601
Hospital Revenue Code	521
Min. Negotiated Rate	$301.70
Max. Negotiated Rate	$431.00
Rate for Payer: Aetna Commercial	$409.45
Rate for Payer: Aetna Medicare	$387.90
Rate for Payer: BCBS MT CHIP	$387.90
Rate for Payer: BCBS MT Closed Plan Network	$409.45
Rate for Payer: BCBS MT HealthLink	$387.90
Rate for Payer: BCBS MT Medicare	$387.90
Rate for Payer: BCBS MT POS	$409.45
Rate for Payer: BCBS MT Traditional	$431.00
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cigna Commercial	$409.45
Rate for Payer: Cigna Medicare	$387.90
Rate for Payer: Medicaid All Medicaid	$396.52
Rate for Payer: Medicare All Medicare	$301.70
Rate for Payer: Monida Allegiance	$409.45
Rate for Payer: Monida First Choice Health	$418.07
Rate for Payer: Monida Montana Health Co-op	$409.45
Rate for Payer: Monida PacificSource	$409.45

EXCISION MALIG LESION 1.1-2.0CM (11602)

Facility

$470.00

Service Code	CPT 11602
Hospital Charge Code	8011602
Hospital Revenue Code	521
Min. Negotiated Rate	$329.00
Max. Negotiated Rate	$470.00
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare	$423.00
Rate for Payer: BCBS MT CHIP	$423.00
Rate for Payer: BCBS MT Closed Plan Network	$446.50
Rate for Payer: BCBS MT HealthLink	$423.00
Rate for Payer: BCBS MT Medicare	$423.00
Rate for Payer: BCBS MT POS	$446.50
Rate for Payer: BCBS MT Traditional	$470.00
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: Cigna Medicare	$423.00
Rate for Payer: Medicaid All Medicaid	$432.40
Rate for Payer: Medicare All Medicare	$329.00
Rate for Payer: Monida Allegiance	$446.50
Rate for Payer: Monida First Choice Health	$455.90
Rate for Payer: Monida Montana Health Co-op	$446.50
Rate for Payer: Monida PacificSource	$446.50

EXCISION MALIG LESION 1.1-2.0CM (11602)

Facility

$470.00

Service Code	CPT 11602
Hospital Charge Code	8011602
Hospital Revenue Code	521
Min. Negotiated Rate	$329.00
Max. Negotiated Rate	$470.00
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare	$423.00
Rate for Payer: BCBS MT CHIP	$423.00
Rate for Payer: BCBS MT Closed Plan Network	$446.50
Rate for Payer: BCBS MT HealthLink	$423.00
Rate for Payer: BCBS MT Medicare	$423.00
Rate for Payer: BCBS MT POS	$446.50
Rate for Payer: BCBS MT Traditional	$470.00
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: Cigna Medicare	$423.00
Rate for Payer: Medicaid All Medicaid	$432.40
Rate for Payer: Medicare All Medicare	$329.00
Rate for Payer: Monida Allegiance	$446.50
Rate for Payer: Monida First Choice Health	$455.90
Rate for Payer: Monida Montana Health Co-op	$446.50
Rate for Payer: Monida PacificSource	$446.50

EXCISION NAIL INGROWN PART/COMPLT(11750)

Facility

$520.00

Service Code	CPT 11750
Hospital Charge Code	8011750
Hospital Revenue Code	521
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare	$468.00
Rate for Payer: BCBS MT CHIP	$468.00
Rate for Payer: BCBS MT Closed Plan Network	$494.00
Rate for Payer: BCBS MT HealthLink	$468.00
Rate for Payer: BCBS MT Medicare	$468.00
Rate for Payer: BCBS MT POS	$494.00
Rate for Payer: BCBS MT Traditional	$520.00
Rate for Payer: Cash Price	$468.00
Rate for Payer: Cigna Commercial	$494.00
Rate for Payer: Cigna Medicare	$468.00
Rate for Payer: Medicaid All Medicaid	$478.40
Rate for Payer: Medicare All Medicare	$364.00
Rate for Payer: Monida Allegiance	$494.00
Rate for Payer: Monida First Choice Health	$504.40
Rate for Payer: Monida Montana Health Co-op	$494.00
Rate for Payer: Monida PacificSource	$494.00

EXCISION NAIL INGROWN PART/COMPLT(11750)

Facility

$520.00

Service Code	CPT 11750
Hospital Charge Code	8011750
Hospital Revenue Code	521
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$520.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare	$468.00
Rate for Payer: BCBS MT CHIP	$468.00
Rate for Payer: BCBS MT Closed Plan Network	$494.00
Rate for Payer: BCBS MT HealthLink	$468.00
Rate for Payer: BCBS MT Medicare	$468.00
Rate for Payer: BCBS MT POS	$494.00
Rate for Payer: BCBS MT Traditional	$520.00
Rate for Payer: Cash Price	$468.00
Rate for Payer: Cigna Commercial	$494.00
Rate for Payer: Cigna Medicare	$468.00
Rate for Payer: Medicaid All Medicaid	$478.40
Rate for Payer: Medicare All Medicare	$364.00
Rate for Payer: Monida Allegiance	$494.00
Rate for Payer: Monida First Choice Health	$504.40
Rate for Payer: Monida Montana Health Co-op	$494.00
Rate for Payer: Monida PacificSource	$494.00

EXCISION OF NAIL FOLD SKIN (11765)

Facility

$303.00

Service Code	CPT 11765
Hospital Charge Code	8011765
Hospital Revenue Code	521
Min. Negotiated Rate	$212.10
Max. Negotiated Rate	$303.00
Rate for Payer: Aetna Commercial	$287.85
Rate for Payer: Aetna Medicare	$272.70
Rate for Payer: BCBS MT CHIP	$272.70
Rate for Payer: BCBS MT Closed Plan Network	$287.85
Rate for Payer: BCBS MT HealthLink	$272.70
Rate for Payer: BCBS MT Medicare	$272.70
Rate for Payer: BCBS MT POS	$287.85
Rate for Payer: BCBS MT Traditional	$303.00
Rate for Payer: Cash Price	$272.70
Rate for Payer: Cigna Commercial	$287.85
Rate for Payer: Cigna Medicare	$272.70
Rate for Payer: Medicaid All Medicaid	$278.76
Rate for Payer: Medicare All Medicare	$212.10
Rate for Payer: Monida Allegiance	$287.85
Rate for Payer: Monida First Choice Health	$293.91
Rate for Payer: Monida Montana Health Co-op	$287.85
Rate for Payer: Monida PacificSource	$287.85

EXCISION OF NAIL FOLD SKIN (11765)

Facility

$303.00

Service Code	CPT 11765
Hospital Charge Code	8011765
Hospital Revenue Code	521
Min. Negotiated Rate	$212.10
Max. Negotiated Rate	$303.00
Rate for Payer: Aetna Commercial	$287.85
Rate for Payer: Aetna Medicare	$272.70
Rate for Payer: BCBS MT CHIP	$272.70
Rate for Payer: BCBS MT Closed Plan Network	$287.85
Rate for Payer: BCBS MT HealthLink	$272.70
Rate for Payer: BCBS MT Medicare	$272.70
Rate for Payer: BCBS MT POS	$287.85
Rate for Payer: BCBS MT Traditional	$303.00
Rate for Payer: Cash Price	$272.70
Rate for Payer: Cigna Commercial	$287.85
Rate for Payer: Cigna Medicare	$272.70
Rate for Payer: Medicaid All Medicaid	$278.76
Rate for Payer: Medicare All Medicare	$212.10
Rate for Payer: Monida Allegiance	$287.85
Rate for Payer: Monida First Choice Health	$293.91
Rate for Payer: Monida Montana Health Co-op	$287.85
Rate for Payer: Monida PacificSource	$287.85

EXCSION BNIGN LSION + MARG 0.6-1CM(11421

Facility

$586.00

Service Code	CPT 11421
Hospital Charge Code	8011421
Hospital Revenue Code	521
Min. Negotiated Rate	$410.20
Max. Negotiated Rate	$586.00
Rate for Payer: Aetna Commercial	$556.70
Rate for Payer: Aetna Medicare	$527.40
Rate for Payer: BCBS MT CHIP	$527.40
Rate for Payer: BCBS MT Closed Plan Network	$556.70
Rate for Payer: BCBS MT HealthLink	$527.40
Rate for Payer: BCBS MT Medicare	$527.40
Rate for Payer: BCBS MT POS	$556.70
Rate for Payer: BCBS MT Traditional	$586.00
Rate for Payer: Cash Price	$527.40
Rate for Payer: Cigna Commercial	$556.70
Rate for Payer: Cigna Medicare	$527.40
Rate for Payer: Medicaid All Medicaid	$539.12
Rate for Payer: Medicare All Medicare	$410.20
Rate for Payer: Monida Allegiance	$556.70
Rate for Payer: Monida First Choice Health	$568.42
Rate for Payer: Monida Montana Health Co-op	$556.70
Rate for Payer: Monida PacificSource	$556.70

Know your out-of-pocket cost for care.

All Charges