Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

MELATONIN TAB [3 MG]

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000306
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

MELOXICAM TAB [7.5 MG]

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	3007206
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS MT CHIP	$9.00
Rate for Payer: BCBS MT Closed Plan Network	$9.50
Rate for Payer: BCBS MT HealthLink	$9.00
Rate for Payer: BCBS MT Medicare	$9.00
Rate for Payer: BCBS MT POS	$9.50
Rate for Payer: BCBS MT Traditional	$10.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: Cigna Medicare	$9.00
Rate for Payer: Medicaid All Medicaid	$9.20
Rate for Payer: Medicare All Medicare	$7.00
Rate for Payer: Monida Allegiance	$9.50
Rate for Payer: Monida First Choice Health	$9.70
Rate for Payer: Monida Montana Health Co-op	$9.50
Rate for Payer: Monida PacificSource	$9.50

MELOXICAM TAB [7.5 MG]

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	3007206
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS MT CHIP	$9.00
Rate for Payer: BCBS MT Closed Plan Network	$9.50
Rate for Payer: BCBS MT HealthLink	$9.00
Rate for Payer: BCBS MT Medicare	$9.00
Rate for Payer: BCBS MT POS	$9.50
Rate for Payer: BCBS MT Traditional	$10.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: Cigna Medicare	$9.00
Rate for Payer: Medicaid All Medicaid	$9.20
Rate for Payer: Medicare All Medicare	$7.00
Rate for Payer: Monida Allegiance	$9.50
Rate for Payer: Monida First Choice Health	$9.70
Rate for Payer: Monida Montana Health Co-op	$9.50
Rate for Payer: Monida PacificSource	$9.50

MEMANTINE TAB [10 MG] NF

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000307
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

MEMANTINE TAB [10 MG] NF

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000307
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

MEROPENEM 1 GM INJECTION

Facility

$76.80

Service Code	NDC 63323050830
Hospital Charge Code	3007273
Hospital Revenue Code	250
Min. Negotiated Rate	$53.76
Max. Negotiated Rate	$76.80
Rate for Payer: Aetna Commercial	$72.96
Rate for Payer: Aetna Medicare	$69.12
Rate for Payer: BCBS MT CHIP	$69.12
Rate for Payer: BCBS MT Closed Plan Network	$72.96
Rate for Payer: BCBS MT HealthLink	$69.12
Rate for Payer: BCBS MT Medicare	$69.12
Rate for Payer: BCBS MT POS	$72.96
Rate for Payer: BCBS MT Traditional	$76.80
Rate for Payer: Cash Price	$69.12
Rate for Payer: Cigna Commercial	$72.96
Rate for Payer: Cigna Medicare	$69.12
Rate for Payer: Medicaid All Medicaid	$70.66
Rate for Payer: Medicare All Medicare	$53.76
Rate for Payer: Monida Allegiance	$72.96
Rate for Payer: Monida First Choice Health	$74.50
Rate for Payer: Monida Montana Health Co-op	$72.96
Rate for Payer: Monida PacificSource	$72.96

MEROPENEM 1 GM INJECTION

Facility

$76.80

Service Code	NDC 63323050830
Hospital Charge Code	3007273
Hospital Revenue Code	250
Min. Negotiated Rate	$53.76
Max. Negotiated Rate	$76.80
Rate for Payer: Aetna Commercial	$72.96
Rate for Payer: Aetna Medicare	$69.12
Rate for Payer: BCBS MT CHIP	$69.12
Rate for Payer: BCBS MT Closed Plan Network	$72.96
Rate for Payer: BCBS MT HealthLink	$69.12
Rate for Payer: BCBS MT Medicare	$69.12
Rate for Payer: BCBS MT POS	$72.96
Rate for Payer: BCBS MT Traditional	$76.80
Rate for Payer: Cash Price	$69.12
Rate for Payer: Cigna Commercial	$72.96
Rate for Payer: Cigna Medicare	$69.12
Rate for Payer: Medicaid All Medicaid	$70.66
Rate for Payer: Medicare All Medicare	$53.76
Rate for Payer: Monida Allegiance	$72.96
Rate for Payer: Monida First Choice Health	$74.50
Rate for Payer: Monida Montana Health Co-op	$72.96
Rate for Payer: Monida PacificSource	$72.96

MEROPENEM 500MG INJ

Facility

$72.00

Service Code	HCPCS J3490
Hospital Charge Code	3000308
Hospital Revenue Code	258
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare	$64.80
Rate for Payer: BCBS MT CHIP	$64.80
Rate for Payer: BCBS MT Closed Plan Network	$68.40
Rate for Payer: BCBS MT HealthLink	$64.80
Rate for Payer: BCBS MT Medicare	$64.80
Rate for Payer: BCBS MT POS	$68.40
Rate for Payer: BCBS MT Traditional	$72.00
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cigna Commercial	$68.40
Rate for Payer: Cigna Medicare	$64.80
Rate for Payer: Medicaid All Medicaid	$66.24
Rate for Payer: Medicare All Medicare	$50.40
Rate for Payer: Monida Allegiance	$68.40
Rate for Payer: Monida First Choice Health	$69.84
Rate for Payer: Monida Montana Health Co-op	$68.40
Rate for Payer: Monida PacificSource	$68.40

MEROPENEM 500MG INJ

Facility

$72.00

Service Code	HCPCS J3490
Hospital Charge Code	3000308
Hospital Revenue Code	258
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare	$64.80
Rate for Payer: BCBS MT CHIP	$64.80
Rate for Payer: BCBS MT Closed Plan Network	$68.40
Rate for Payer: BCBS MT HealthLink	$64.80
Rate for Payer: BCBS MT Medicare	$64.80
Rate for Payer: BCBS MT POS	$68.40
Rate for Payer: BCBS MT Traditional	$72.00
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cigna Commercial	$68.40
Rate for Payer: Cigna Medicare	$64.80
Rate for Payer: Medicaid All Medicaid	$66.24
Rate for Payer: Medicare All Medicare	$50.40
Rate for Payer: Monida Allegiance	$68.40
Rate for Payer: Monida First Choice Health	$69.84
Rate for Payer: Monida Montana Health Co-op	$68.40
Rate for Payer: Monida PacificSource	$68.40

MEROPENEM/NS IVPB : 1GM/50ML

Facility

$79.55

Service Code	NDC 99999999999
Hospital Charge Code	3007276
Hospital Revenue Code	258
Min. Negotiated Rate	$55.69
Max. Negotiated Rate	$79.55
Rate for Payer: Aetna Commercial	$75.57
Rate for Payer: Aetna Medicare	$71.59
Rate for Payer: BCBS MT CHIP	$71.59
Rate for Payer: BCBS MT Closed Plan Network	$75.57
Rate for Payer: BCBS MT HealthLink	$71.59
Rate for Payer: BCBS MT Medicare	$71.59
Rate for Payer: BCBS MT POS	$75.57
Rate for Payer: BCBS MT Traditional	$79.55
Rate for Payer: Cash Price	$71.60
Rate for Payer: Cigna Commercial	$75.57
Rate for Payer: Cigna Medicare	$71.59
Rate for Payer: Medicaid All Medicaid	$73.19
Rate for Payer: Medicare All Medicare	$55.69
Rate for Payer: Monida Allegiance	$75.57
Rate for Payer: Monida First Choice Health	$77.16
Rate for Payer: Monida Montana Health Co-op	$75.57
Rate for Payer: Monida PacificSource	$75.57

MEROPENEM/NS IVPB : 1GM/50ML

Facility

$79.55

Service Code	NDC 99999999999
Hospital Charge Code	3007276
Hospital Revenue Code	258
Min. Negotiated Rate	$55.69
Max. Negotiated Rate	$79.55
Rate for Payer: Aetna Commercial	$75.57
Rate for Payer: Aetna Medicare	$71.59
Rate for Payer: BCBS MT CHIP	$71.59
Rate for Payer: BCBS MT Closed Plan Network	$75.57
Rate for Payer: BCBS MT HealthLink	$71.59
Rate for Payer: BCBS MT Medicare	$71.59
Rate for Payer: BCBS MT POS	$75.57
Rate for Payer: BCBS MT Traditional	$79.55
Rate for Payer: Cash Price	$71.60
Rate for Payer: Cigna Commercial	$75.57
Rate for Payer: Cigna Medicare	$71.59
Rate for Payer: Medicaid All Medicaid	$73.19
Rate for Payer: Medicare All Medicare	$55.69
Rate for Payer: Monida Allegiance	$75.57
Rate for Payer: Monida First Choice Health	$77.16
Rate for Payer: Monida Montana Health Co-op	$75.57
Rate for Payer: Monida PacificSource	$75.57

MESALAMINE 0.375 GRAM CAPSULE-NF

Facility

$14.75

Service Code	NDC 00378137578
Hospital Charge Code	3007345
Hospital Revenue Code	250
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$14.75
Rate for Payer: Aetna Commercial	$14.01
Rate for Payer: Aetna Medicare	$13.28
Rate for Payer: BCBS MT CHIP	$13.28
Rate for Payer: BCBS MT Closed Plan Network	$14.01
Rate for Payer: BCBS MT HealthLink	$13.28
Rate for Payer: BCBS MT Medicare	$13.28
Rate for Payer: BCBS MT POS	$14.01
Rate for Payer: BCBS MT Traditional	$14.75
Rate for Payer: Cash Price	$13.28
Rate for Payer: Cigna Commercial	$14.01
Rate for Payer: Cigna Medicare	$13.28
Rate for Payer: Medicaid All Medicaid	$13.57
Rate for Payer: Medicare All Medicare	$10.32
Rate for Payer: Monida Allegiance	$14.01
Rate for Payer: Monida First Choice Health	$14.31
Rate for Payer: Monida Montana Health Co-op	$14.01
Rate for Payer: Monida PacificSource	$14.01

MESALAMINE 0.375 GRAM CAPSULE-NF

Facility

$14.75

Service Code	NDC 00378137578
Hospital Charge Code	3007345
Hospital Revenue Code	250
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$14.75
Rate for Payer: Aetna Commercial	$14.01
Rate for Payer: Aetna Medicare	$13.28
Rate for Payer: BCBS MT CHIP	$13.28
Rate for Payer: BCBS MT Closed Plan Network	$14.01
Rate for Payer: BCBS MT HealthLink	$13.28
Rate for Payer: BCBS MT Medicare	$13.28
Rate for Payer: BCBS MT POS	$14.01
Rate for Payer: BCBS MT Traditional	$14.75
Rate for Payer: Cash Price	$13.28
Rate for Payer: Cigna Commercial	$14.01
Rate for Payer: Cigna Medicare	$13.28
Rate for Payer: Medicaid All Medicaid	$13.57
Rate for Payer: Medicare All Medicare	$10.32
Rate for Payer: Monida Allegiance	$14.01
Rate for Payer: Monida First Choice Health	$14.31
Rate for Payer: Monida Montana Health Co-op	$14.01
Rate for Payer: Monida PacificSource	$14.01

METANEPHRINES, 24-HOUR, URINE (004234)

Facility

$75.00

Service Code	HCPCS 83835
Hospital Charge Code	4000062
Hospital Revenue Code	300
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$71.25
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCBS MT CHIP	$67.50
Rate for Payer: BCBS MT Closed Plan Network	$71.25
Rate for Payer: BCBS MT HealthLink	$67.50
Rate for Payer: BCBS MT Medicare	$67.50
Rate for Payer: BCBS MT POS	$71.25
Rate for Payer: BCBS MT Traditional	$75.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: Cigna Medicare	$67.50
Rate for Payer: Medicaid All Medicaid	$69.00
Rate for Payer: Medicare All Medicare	$52.50
Rate for Payer: Monida Allegiance	$71.25
Rate for Payer: Monida First Choice Health	$72.75
Rate for Payer: Monida Montana Health Co-op	$71.25
Rate for Payer: Monida PacificSource	$71.25

METANEPHRINES, 24-HOUR, URINE (004234)

Facility

$75.00

Service Code	HCPCS 83835
Hospital Charge Code	4000062
Hospital Revenue Code	300
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$71.25
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCBS MT CHIP	$67.50
Rate for Payer: BCBS MT Closed Plan Network	$71.25
Rate for Payer: BCBS MT HealthLink	$67.50
Rate for Payer: BCBS MT Medicare	$67.50
Rate for Payer: BCBS MT POS	$71.25
Rate for Payer: BCBS MT Traditional	$75.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: Cigna Medicare	$67.50
Rate for Payer: Medicaid All Medicaid	$69.00
Rate for Payer: Medicare All Medicare	$52.50
Rate for Payer: Monida Allegiance	$71.25
Rate for Payer: Monida First Choice Health	$72.75
Rate for Payer: Monida Montana Health Co-op	$71.25
Rate for Payer: Monida PacificSource	$71.25

METANEPHRINES, FREE (121806)

Facility

$394.00

Service Code	HCPCS 83835
Hospital Charge Code	4083835
Hospital Revenue Code	300
Min. Negotiated Rate	$275.80
Max. Negotiated Rate	$394.00
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare	$354.60
Rate for Payer: BCBS MT CHIP	$354.60
Rate for Payer: BCBS MT Closed Plan Network	$374.30
Rate for Payer: BCBS MT HealthLink	$354.60
Rate for Payer: BCBS MT Medicare	$354.60
Rate for Payer: BCBS MT POS	$374.30
Rate for Payer: BCBS MT Traditional	$394.00
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna Commercial	$374.30
Rate for Payer: Cigna Medicare	$354.60
Rate for Payer: Medicaid All Medicaid	$362.48
Rate for Payer: Medicare All Medicare	$275.80
Rate for Payer: Monida Allegiance	$374.30
Rate for Payer: Monida First Choice Health	$382.18
Rate for Payer: Monida Montana Health Co-op	$374.30
Rate for Payer: Monida PacificSource	$374.30

METANEPHRINES, FREE (121806)

Facility

$394.00

Service Code	HCPCS 83835
Hospital Charge Code	4083835
Hospital Revenue Code	300
Min. Negotiated Rate	$275.80
Max. Negotiated Rate	$394.00
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare	$354.60
Rate for Payer: BCBS MT CHIP	$354.60
Rate for Payer: BCBS MT Closed Plan Network	$374.30
Rate for Payer: BCBS MT HealthLink	$354.60
Rate for Payer: BCBS MT Medicare	$354.60
Rate for Payer: BCBS MT POS	$374.30
Rate for Payer: BCBS MT Traditional	$394.00
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna Commercial	$374.30
Rate for Payer: Cigna Medicare	$354.60
Rate for Payer: Medicaid All Medicaid	$362.48
Rate for Payer: Medicare All Medicare	$275.80
Rate for Payer: Monida Allegiance	$374.30
Rate for Payer: Monida First Choice Health	$382.18
Rate for Payer: Monida Montana Health Co-op	$374.30
Rate for Payer: Monida PacificSource	$374.30

METFORMIN ER TAB [500 MG] NF

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000309
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

METFORMIN ER TAB [500 MG] NF

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000309
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

METFORMIN TAB [500 MG]

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000310
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

METFORMIN TAB [500 MG]

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000310
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

METHIMAZOLE TAB [5 MG] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3007526
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

METHIMAZOLE TAB [5 MG] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3007526
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

METHOCARBAMOL TAB [500 MG] NF

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	3000502
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS MT CHIP	$9.00
Rate for Payer: BCBS MT Closed Plan Network	$9.50
Rate for Payer: BCBS MT HealthLink	$9.00
Rate for Payer: BCBS MT Medicare	$9.00
Rate for Payer: BCBS MT POS	$9.50
Rate for Payer: BCBS MT Traditional	$10.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: Cigna Medicare	$9.00
Rate for Payer: Medicaid All Medicaid	$9.20
Rate for Payer: Medicare All Medicare	$7.00
Rate for Payer: Monida Allegiance	$9.50
Rate for Payer: Monida First Choice Health	$9.70
Rate for Payer: Monida Montana Health Co-op	$9.50
Rate for Payer: Monida PacificSource	$9.50

METHOCARBAMOL TAB [500 MG] NF

Facility

$10.00

Service Code	HCPCS J3490
Hospital Charge Code	3000502
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS MT CHIP	$9.00
Rate for Payer: BCBS MT Closed Plan Network	$9.50
Rate for Payer: BCBS MT HealthLink	$9.00
Rate for Payer: BCBS MT Medicare	$9.00
Rate for Payer: BCBS MT POS	$9.50
Rate for Payer: BCBS MT Traditional	$10.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: Cigna Medicare	$9.00
Rate for Payer: Medicaid All Medicaid	$9.20
Rate for Payer: Medicare All Medicare	$7.00
Rate for Payer: Monida Allegiance	$9.50
Rate for Payer: Monida First Choice Health	$9.70
Rate for Payer: Monida Montana Health Co-op	$9.50
Rate for Payer: Monida PacificSource	$9.50

Know your out-of-pocket cost for care.

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