Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

IBUPROFEN TAB [200 MG]

Facility

$5.00

Service Code	HCPCS A9150
Hospital Charge Code	3000228
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS MT CHIP	$4.50
Rate for Payer: BCBS MT Closed Plan Network	$4.75
Rate for Payer: BCBS MT HealthLink	$4.50
Rate for Payer: BCBS MT Medicare	$4.50
Rate for Payer: BCBS MT POS	$4.75
Rate for Payer: BCBS MT Traditional	$5.00
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: Cigna Medicare	$4.50
Rate for Payer: Medicaid All Medicaid	$4.60
Rate for Payer: Medicare All Medicare	$3.50
Rate for Payer: Monida Allegiance	$4.75
Rate for Payer: Monida First Choice Health	$4.85
Rate for Payer: Monida Montana Health Co-op	$4.75
Rate for Payer: Monida PacificSource	$4.75

ICE PACK SECURE-ALL LG

Facility

$13.00

Hospital Charge Code	2830192
Hospital Revenue Code	270
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$12.35
Rate for Payer: Aetna Medicare	$11.70
Rate for Payer: BCBS MT CHIP	$11.70
Rate for Payer: BCBS MT Closed Plan Network	$12.35
Rate for Payer: BCBS MT HealthLink	$11.70
Rate for Payer: BCBS MT Medicare	$11.70
Rate for Payer: BCBS MT POS	$12.35
Rate for Payer: BCBS MT Traditional	$13.00
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cigna Commercial	$12.35
Rate for Payer: Cigna Medicare	$11.70
Rate for Payer: Medicaid All Medicaid	$11.96
Rate for Payer: Medicare All Medicare	$9.10
Rate for Payer: Monida Allegiance	$12.35
Rate for Payer: Monida First Choice Health	$12.61
Rate for Payer: Monida Montana Health Co-op	$12.35
Rate for Payer: Monida PacificSource	$12.35

ICE PACK SECURE-ALL LG

Facility

$13.00

Hospital Charge Code	2830192
Hospital Revenue Code	270
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$12.35
Rate for Payer: Aetna Medicare	$11.70
Rate for Payer: BCBS MT CHIP	$11.70
Rate for Payer: BCBS MT Closed Plan Network	$12.35
Rate for Payer: BCBS MT HealthLink	$11.70
Rate for Payer: BCBS MT Medicare	$11.70
Rate for Payer: BCBS MT POS	$12.35
Rate for Payer: BCBS MT Traditional	$13.00
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cigna Commercial	$12.35
Rate for Payer: Cigna Medicare	$11.70
Rate for Payer: Medicaid All Medicaid	$11.96
Rate for Payer: Medicare All Medicare	$9.10
Rate for Payer: Monida Allegiance	$12.35
Rate for Payer: Monida First Choice Health	$12.61
Rate for Payer: Monida Montana Health Co-op	$12.35
Rate for Payer: Monida PacificSource	$12.35

I D ABSCESS/CYST COMPLICATED (10061)

Facility

$557.00

Service Code	CPT 10061
Hospital Charge Code	8010061
Hospital Revenue Code	521
Min. Negotiated Rate	$389.90
Max. Negotiated Rate	$557.00
Rate for Payer: Aetna Commercial	$529.15
Rate for Payer: Aetna Medicare	$501.30
Rate for Payer: BCBS MT CHIP	$501.30
Rate for Payer: BCBS MT Closed Plan Network	$529.15
Rate for Payer: BCBS MT HealthLink	$501.30
Rate for Payer: BCBS MT Medicare	$501.30
Rate for Payer: BCBS MT POS	$529.15
Rate for Payer: BCBS MT Traditional	$557.00
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cigna Commercial	$529.15
Rate for Payer: Cigna Medicare	$501.30
Rate for Payer: Medicaid All Medicaid	$512.44
Rate for Payer: Medicare All Medicare	$389.90
Rate for Payer: Monida Allegiance	$529.15
Rate for Payer: Monida First Choice Health	$540.29
Rate for Payer: Monida Montana Health Co-op	$529.15
Rate for Payer: Monida PacificSource	$529.15

I D ABSCESS/CYST COMPLICATED (10061)

Facility

$557.00

Service Code	CPT 10061
Hospital Charge Code	8010061
Hospital Revenue Code	521
Min. Negotiated Rate	$389.90
Max. Negotiated Rate	$557.00
Rate for Payer: Aetna Commercial	$529.15
Rate for Payer: Aetna Medicare	$501.30
Rate for Payer: BCBS MT CHIP	$501.30
Rate for Payer: BCBS MT Closed Plan Network	$529.15
Rate for Payer: BCBS MT HealthLink	$501.30
Rate for Payer: BCBS MT Medicare	$501.30
Rate for Payer: BCBS MT POS	$529.15
Rate for Payer: BCBS MT Traditional	$557.00
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cigna Commercial	$529.15
Rate for Payer: Cigna Medicare	$501.30
Rate for Payer: Medicaid All Medicaid	$512.44
Rate for Payer: Medicare All Medicare	$389.90
Rate for Payer: Monida Allegiance	$529.15
Rate for Payer: Monida First Choice Health	$540.29
Rate for Payer: Monida Montana Health Co-op	$529.15
Rate for Payer: Monida PacificSource	$529.15

I D ABSCESS/CYST SIMPLE (10060)

Facility

$441.00

Service Code	CPT 10060
Hospital Charge Code	8010060
Hospital Revenue Code	521
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

I D ABSCESS/CYST SIMPLE (10060)

Facility

$441.00

Service Code	CPT 10060
Hospital Charge Code	8010060
Hospital Revenue Code	521
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

I&D ARM BURSA

Facility

$690.00

Service Code	CPT 23931
Hospital Charge Code	8023931
Hospital Revenue Code	521
Min. Negotiated Rate	$483.00
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$655.50
Rate for Payer: Aetna Medicare	$621.00
Rate for Payer: BCBS MT CHIP	$621.00
Rate for Payer: BCBS MT Closed Plan Network	$655.50
Rate for Payer: BCBS MT HealthLink	$621.00
Rate for Payer: BCBS MT Medicare	$621.00
Rate for Payer: BCBS MT POS	$655.50
Rate for Payer: BCBS MT Traditional	$690.00
Rate for Payer: Cash Price	$621.00
Rate for Payer: Cigna Commercial	$655.50
Rate for Payer: Cigna Medicare	$621.00
Rate for Payer: Medicaid All Medicaid	$634.80
Rate for Payer: Medicare All Medicare	$483.00
Rate for Payer: Monida Allegiance	$655.50
Rate for Payer: Monida First Choice Health	$669.30
Rate for Payer: Monida Montana Health Co-op	$655.50
Rate for Payer: Monida PacificSource	$655.50

I&D ARM BURSA

Facility

$690.00

Service Code	CPT 23931
Hospital Charge Code	8023931
Hospital Revenue Code	521
Min. Negotiated Rate	$483.00
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$655.50
Rate for Payer: Aetna Medicare	$621.00
Rate for Payer: BCBS MT CHIP	$621.00
Rate for Payer: BCBS MT Closed Plan Network	$655.50
Rate for Payer: BCBS MT HealthLink	$621.00
Rate for Payer: BCBS MT Medicare	$621.00
Rate for Payer: BCBS MT POS	$655.50
Rate for Payer: BCBS MT Traditional	$690.00
Rate for Payer: Cash Price	$621.00
Rate for Payer: Cigna Commercial	$655.50
Rate for Payer: Cigna Medicare	$621.00
Rate for Payer: Medicaid All Medicaid	$634.80
Rate for Payer: Medicare All Medicare	$483.00
Rate for Payer: Monida Allegiance	$655.50
Rate for Payer: Monida First Choice Health	$669.30
Rate for Payer: Monida Montana Health Co-op	$655.50
Rate for Payer: Monida PacificSource	$655.50

I D HEMATOMA SEROMA OR FLUID COLLEC

Facility

$495.00

Service Code	CPT 10140
Hospital Charge Code	8010140
Hospital Revenue Code	521
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$470.25
Rate for Payer: Aetna Medicare	$445.50
Rate for Payer: BCBS MT CHIP	$445.50
Rate for Payer: BCBS MT Closed Plan Network	$470.25
Rate for Payer: BCBS MT HealthLink	$445.50
Rate for Payer: BCBS MT Medicare	$445.50
Rate for Payer: BCBS MT POS	$470.25
Rate for Payer: BCBS MT Traditional	$495.00
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cigna Commercial	$470.25
Rate for Payer: Cigna Medicare	$445.50
Rate for Payer: Medicaid All Medicaid	$455.40
Rate for Payer: Medicare All Medicare	$346.50
Rate for Payer: Monida Allegiance	$470.25
Rate for Payer: Monida First Choice Health	$480.15
Rate for Payer: Monida Montana Health Co-op	$470.25
Rate for Payer: Monida PacificSource	$470.25

I D HEMATOMA SEROMA OR FLUID COLLEC

Facility

$495.00

Service Code	CPT 10140
Hospital Charge Code	8010140
Hospital Revenue Code	521
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$470.25
Rate for Payer: Aetna Medicare	$445.50
Rate for Payer: BCBS MT CHIP	$445.50
Rate for Payer: BCBS MT Closed Plan Network	$470.25
Rate for Payer: BCBS MT HealthLink	$445.50
Rate for Payer: BCBS MT Medicare	$445.50
Rate for Payer: BCBS MT POS	$470.25
Rate for Payer: BCBS MT Traditional	$495.00
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cigna Commercial	$470.25
Rate for Payer: Cigna Medicare	$445.50
Rate for Payer: Medicaid All Medicaid	$455.40
Rate for Payer: Medicare All Medicare	$346.50
Rate for Payer: Monida Allegiance	$470.25
Rate for Payer: Monida First Choice Health	$480.15
Rate for Payer: Monida Montana Health Co-op	$470.25
Rate for Payer: Monida PacificSource	$470.25

ID NOW INFLUENZA BUNDLE

Facility

$7,991.45

Hospital Charge Code	90197134
Hospital Revenue Code	270
Min. Negotiated Rate	$5,594.02
Max. Negotiated Rate	$7,991.45
Rate for Payer: Aetna Commercial	$7,591.88
Rate for Payer: Aetna Medicare	$7,192.31
Rate for Payer: BCBS MT CHIP	$7,192.31
Rate for Payer: BCBS MT Closed Plan Network	$7,591.88
Rate for Payer: BCBS MT HealthLink	$7,192.31
Rate for Payer: BCBS MT Medicare	$7,192.31
Rate for Payer: BCBS MT POS	$7,591.88
Rate for Payer: BCBS MT Traditional	$7,991.45
Rate for Payer: Cash Price	$7,192.31
Rate for Payer: Cigna Commercial	$7,591.88
Rate for Payer: Cigna Medicare	$7,192.31
Rate for Payer: Medicaid All Medicaid	$7,352.13
Rate for Payer: Medicare All Medicare	$5,594.02
Rate for Payer: Monida Allegiance	$7,591.88
Rate for Payer: Monida First Choice Health	$7,751.71
Rate for Payer: Monida Montana Health Co-op	$7,591.88
Rate for Payer: Monida PacificSource	$7,591.88

ID NOW INFLUENZA BUNDLE

Facility

$7,991.45

Hospital Charge Code	90197134
Hospital Revenue Code	270
Min. Negotiated Rate	$5,594.02
Max. Negotiated Rate	$7,991.45
Rate for Payer: Aetna Commercial	$7,591.88
Rate for Payer: Aetna Medicare	$7,192.31
Rate for Payer: BCBS MT CHIP	$7,192.31
Rate for Payer: BCBS MT Closed Plan Network	$7,591.88
Rate for Payer: BCBS MT HealthLink	$7,192.31
Rate for Payer: BCBS MT Medicare	$7,192.31
Rate for Payer: BCBS MT POS	$7,591.88
Rate for Payer: BCBS MT Traditional	$7,991.45
Rate for Payer: Cash Price	$7,192.31
Rate for Payer: Cigna Commercial	$7,591.88
Rate for Payer: Cigna Medicare	$7,192.31
Rate for Payer: Medicaid All Medicaid	$7,352.13
Rate for Payer: Medicare All Medicare	$5,594.02
Rate for Payer: Monida Allegiance	$7,591.88
Rate for Payer: Monida First Choice Health	$7,751.71
Rate for Payer: Monida Montana Health Co-op	$7,591.88
Rate for Payer: Monida PacificSource	$7,591.88

ID NOW INFLUENZA - RVMC

Facility

$250.00

Service Code	CPT 87502
Hospital Charge Code	4087927
Hospital Revenue Code	521
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare	$225.00
Rate for Payer: BCBS MT CHIP	$225.00
Rate for Payer: BCBS MT Closed Plan Network	$237.50
Rate for Payer: BCBS MT HealthLink	$225.00
Rate for Payer: BCBS MT Medicare	$225.00
Rate for Payer: BCBS MT POS	$237.50
Rate for Payer: BCBS MT Traditional	$250.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: Cigna Medicare	$225.00
Rate for Payer: Medicaid All Medicaid	$230.00
Rate for Payer: Medicare All Medicare	$175.00
Rate for Payer: Monida Allegiance	$237.50
Rate for Payer: Monida First Choice Health	$242.50
Rate for Payer: Monida Montana Health Co-op	$237.50
Rate for Payer: Monida PacificSource	$237.50

ID NOW INFLUENZA - RVMC

Facility

$250.00

Service Code	CPT 87502
Hospital Charge Code	4087927
Hospital Revenue Code	521
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare	$225.00
Rate for Payer: BCBS MT CHIP	$225.00
Rate for Payer: BCBS MT Closed Plan Network	$237.50
Rate for Payer: BCBS MT HealthLink	$225.00
Rate for Payer: BCBS MT Medicare	$225.00
Rate for Payer: BCBS MT POS	$237.50
Rate for Payer: BCBS MT Traditional	$250.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: Cigna Medicare	$225.00
Rate for Payer: Medicaid All Medicaid	$230.00
Rate for Payer: Medicare All Medicare	$175.00
Rate for Payer: Monida Allegiance	$237.50
Rate for Payer: Monida First Choice Health	$242.50
Rate for Payer: Monida Montana Health Co-op	$237.50
Rate for Payer: Monida PacificSource	$237.50

ID NOW INFLUENZA - TWIN BRIDGES

Facility

$250.00

Service Code	CPT 87502
Hospital Charge Code	8198945
Hospital Revenue Code	521
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare	$225.00
Rate for Payer: BCBS MT CHIP	$225.00
Rate for Payer: BCBS MT Closed Plan Network	$237.50
Rate for Payer: BCBS MT HealthLink	$225.00
Rate for Payer: BCBS MT Medicare	$225.00
Rate for Payer: BCBS MT POS	$237.50
Rate for Payer: BCBS MT Traditional	$250.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: Cigna Medicare	$225.00
Rate for Payer: Medicaid All Medicaid	$230.00
Rate for Payer: Medicare All Medicare	$175.00
Rate for Payer: Monida Allegiance	$237.50
Rate for Payer: Monida First Choice Health	$242.50
Rate for Payer: Monida Montana Health Co-op	$237.50
Rate for Payer: Monida PacificSource	$237.50

ID NOW INFLUENZA - TWIN BRIDGES

Facility

$250.00

Service Code	CPT 87502
Hospital Charge Code	8198945
Hospital Revenue Code	521
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare	$225.00
Rate for Payer: BCBS MT CHIP	$225.00
Rate for Payer: BCBS MT Closed Plan Network	$237.50
Rate for Payer: BCBS MT HealthLink	$225.00
Rate for Payer: BCBS MT Medicare	$225.00
Rate for Payer: BCBS MT POS	$237.50
Rate for Payer: BCBS MT Traditional	$250.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: Cigna Medicare	$225.00
Rate for Payer: Medicaid All Medicaid	$230.00
Rate for Payer: Medicare All Medicare	$175.00
Rate for Payer: Monida Allegiance	$237.50
Rate for Payer: Monida First Choice Health	$242.50
Rate for Payer: Monida Montana Health Co-op	$237.50
Rate for Payer: Monida PacificSource	$237.50

ID NOW RSV BUNDLE

Facility

$5,524.63

Hospital Charge Code	90197142
Hospital Revenue Code	270
Min. Negotiated Rate	$3,867.24
Max. Negotiated Rate	$5,524.63
Rate for Payer: Aetna Commercial	$5,248.40
Rate for Payer: Aetna Medicare	$4,972.17
Rate for Payer: BCBS MT CHIP	$4,972.17
Rate for Payer: BCBS MT Closed Plan Network	$5,248.40
Rate for Payer: BCBS MT HealthLink	$4,972.17
Rate for Payer: BCBS MT Medicare	$4,972.17
Rate for Payer: BCBS MT POS	$5,248.40
Rate for Payer: BCBS MT Traditional	$5,524.63
Rate for Payer: Cash Price	$4,972.17
Rate for Payer: Cigna Commercial	$5,248.40
Rate for Payer: Cigna Medicare	$4,972.17
Rate for Payer: Medicaid All Medicaid	$5,082.66
Rate for Payer: Medicare All Medicare	$3,867.24
Rate for Payer: Monida Allegiance	$5,248.40
Rate for Payer: Monida First Choice Health	$5,358.89
Rate for Payer: Monida Montana Health Co-op	$5,248.40
Rate for Payer: Monida PacificSource	$5,248.40

ID NOW RSV BUNDLE

Facility

$5,524.63

Hospital Charge Code	90197142
Hospital Revenue Code	270
Min. Negotiated Rate	$3,867.24
Max. Negotiated Rate	$5,524.63
Rate for Payer: Aetna Commercial	$5,248.40
Rate for Payer: Aetna Medicare	$4,972.17
Rate for Payer: BCBS MT CHIP	$4,972.17
Rate for Payer: BCBS MT Closed Plan Network	$5,248.40
Rate for Payer: BCBS MT HealthLink	$4,972.17
Rate for Payer: BCBS MT Medicare	$4,972.17
Rate for Payer: BCBS MT POS	$5,248.40
Rate for Payer: BCBS MT Traditional	$5,524.63
Rate for Payer: Cash Price	$4,972.17
Rate for Payer: Cigna Commercial	$5,248.40
Rate for Payer: Cigna Medicare	$4,972.17
Rate for Payer: Medicaid All Medicaid	$5,082.66
Rate for Payer: Medicare All Medicare	$3,867.24
Rate for Payer: Monida Allegiance	$5,248.40
Rate for Payer: Monida First Choice Health	$5,358.89
Rate for Payer: Monida Montana Health Co-op	$5,248.40
Rate for Payer: Monida PacificSource	$5,248.40

ID NOW RSV - RVMC

Facility

$125.00

Service Code	CPT 87807
Hospital Charge Code	4087807
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: BCBS MT CHIP	$112.50
Rate for Payer: BCBS MT Closed Plan Network	$118.75
Rate for Payer: BCBS MT HealthLink	$112.50
Rate for Payer: BCBS MT Medicare	$112.50
Rate for Payer: BCBS MT POS	$118.75
Rate for Payer: BCBS MT Traditional	$125.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: Cigna Medicare	$112.50
Rate for Payer: Medicaid All Medicaid	$115.00
Rate for Payer: Medicare All Medicare	$87.50
Rate for Payer: Monida Allegiance	$118.75
Rate for Payer: Monida First Choice Health	$121.25
Rate for Payer: Monida Montana Health Co-op	$118.75
Rate for Payer: Monida PacificSource	$118.75

ID NOW RSV - RVMC

Facility

$125.00

Service Code	CPT 87807
Hospital Charge Code	4087807
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: BCBS MT CHIP	$112.50
Rate for Payer: BCBS MT Closed Plan Network	$118.75
Rate for Payer: BCBS MT HealthLink	$112.50
Rate for Payer: BCBS MT Medicare	$112.50
Rate for Payer: BCBS MT POS	$118.75
Rate for Payer: BCBS MT Traditional	$125.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: Cigna Medicare	$112.50
Rate for Payer: Medicaid All Medicaid	$115.00
Rate for Payer: Medicare All Medicare	$87.50
Rate for Payer: Monida Allegiance	$118.75
Rate for Payer: Monida First Choice Health	$121.25
Rate for Payer: Monida Montana Health Co-op	$118.75
Rate for Payer: Monida PacificSource	$118.75

ID NOW RSV - TWIN BRIDGES

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	8198947
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW RSV - TWIN BRIDGES

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	8198947
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW SARS COV - RVMC

Facility

$215.00

Service Code	CPT 87635
Hospital Charge Code	4086351
Hospital Revenue Code	300
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$204.25
Rate for Payer: Aetna Medicare	$193.50
Rate for Payer: BCBS MT CHIP	$193.50
Rate for Payer: BCBS MT Closed Plan Network	$204.25
Rate for Payer: BCBS MT HealthLink	$193.50
Rate for Payer: BCBS MT Medicare	$193.50
Rate for Payer: BCBS MT POS	$204.25
Rate for Payer: BCBS MT Traditional	$215.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cigna Commercial	$204.25
Rate for Payer: Cigna Medicare	$193.50
Rate for Payer: Medicaid All Medicaid	$197.80
Rate for Payer: Medicare All Medicare	$150.50
Rate for Payer: Monida Allegiance	$204.25
Rate for Payer: Monida First Choice Health	$208.55
Rate for Payer: Monida Montana Health Co-op	$204.25
Rate for Payer: Monida PacificSource	$204.25

ID NOW SARS COV - RVMC

Facility

$215.00

Service Code	CPT 87635
Hospital Charge Code	4086351
Hospital Revenue Code	300
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$204.25
Rate for Payer: Aetna Medicare	$193.50
Rate for Payer: BCBS MT CHIP	$193.50
Rate for Payer: BCBS MT Closed Plan Network	$204.25
Rate for Payer: BCBS MT HealthLink	$193.50
Rate for Payer: BCBS MT Medicare	$193.50
Rate for Payer: BCBS MT POS	$204.25
Rate for Payer: BCBS MT Traditional	$215.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cigna Commercial	$204.25
Rate for Payer: Cigna Medicare	$193.50
Rate for Payer: Medicaid All Medicaid	$197.80
Rate for Payer: Medicare All Medicare	$150.50
Rate for Payer: Monida Allegiance	$204.25
Rate for Payer: Monida First Choice Health	$208.55
Rate for Payer: Monida Montana Health Co-op	$204.25
Rate for Payer: Monida PacificSource	$204.25

Know your out-of-pocket cost for care.

All Charges