Mt. San Rafael Hospital
Hospital Overview
Facility Details
CCN
061321
NPI
1184616740
Type
Critical Access Hospital
Ownership
Voluntary Non-Profit - Private
Beds
25
Contact Information
Address
410 Benedicta Avenue
Trinidad, CO 81082
Phone
(719) 846-9213
Insurance Accepted
Ameri Health
💡
Important Notice
Insurance acceptance may vary by specific plan, network status, and services required. Contact your insurance provider or the hospital's billing department to confirm coverage details.
Price Transparency Contract Information
💡 The data below comes from CMS-mandated price transparency data. Learn more.
💡 Tip: Rates shown are negotiated amounts between this hospital and insurance providers. Actual patient costs depend on your insurance plan and coverage details.
| Payer | Category | Code Type & Group | Contract Type | Rate Compared to State Average |
|---|---|---|---|---|
Aetna | Outpatient | HCPCS Coronavirus Diagnostic Panel Range: U0001 - U0005 | Percentage of Bill Charged | |
Aetna | Facility | RC Leave of Absence Range: 0180 - 0189 | Percentage of Bill Charged | |
Aetna | Facility | RC Subacute Care Range: 0190 - 0199 | Percentage of Bill Charged | |
Aetna | Facility | RC Room and Board Semi-private (two beds) Range: 0120 - 0129 | Percentage of Bill Charged | |
Aetna | Facility | RC Coronary Care Unit Range: 0210 - 0219 | Percentage of Bill Charged | |
Aetna | Outpatient | HCPCS Administrative, Miscellaneous and Investigational Range: A9150 - A9999 | Percentage of Bill Charged | |
Aetna | Facility | RC Nursery Range: 0170 - 0179 | Percentage of Bill Charged | |
Aetna | Facility | RC Behavioral Health Accommodations Range: 1000 - 1009 | Percentage of Bill Charged | |
Aetna | Facility | RC Room and Board Deluxe Private Range: 0140 - 0149 | Percentage of Bill Charged | |
Aetna | Outpatient | HCPCS Drugs Administered Other than Oral Method Range: J0120 - J8999 | Percentage of Bill Charged |
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