Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

METHOCARBAMOL TAB [750 MG]

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000311
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 [750 MG]

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000311
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

METHOTREXATE INJ [25 MG/ML] 2ML NF

Facility

$28.00

Service Code	HCPCS J9260
Hospital Charge Code	3007426
Hospital Revenue Code	250
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare	$25.20
Rate for Payer: BCBS MT CHIP	$25.20
Rate for Payer: BCBS MT Closed Plan Network	$26.60
Rate for Payer: BCBS MT HealthLink	$25.20
Rate for Payer: BCBS MT Medicare	$25.20
Rate for Payer: BCBS MT POS	$26.60
Rate for Payer: BCBS MT Traditional	$28.00
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cigna Commercial	$26.60
Rate for Payer: Cigna Medicare	$25.20
Rate for Payer: Medicaid All Medicaid	$25.76
Rate for Payer: Medicare All Medicare	$19.60
Rate for Payer: Monida Allegiance	$26.60
Rate for Payer: Monida First Choice Health	$27.16
Rate for Payer: Monida Montana Health Co-op	$26.60
Rate for Payer: Monida PacificSource	$26.60

METHOTREXATE INJ [25 MG/ML] 2ML NF

Facility

$28.00

Service Code	HCPCS J9260
Hospital Charge Code	3007426
Hospital Revenue Code	250
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare	$25.20
Rate for Payer: BCBS MT CHIP	$25.20
Rate for Payer: BCBS MT Closed Plan Network	$26.60
Rate for Payer: BCBS MT HealthLink	$25.20
Rate for Payer: BCBS MT Medicare	$25.20
Rate for Payer: BCBS MT POS	$26.60
Rate for Payer: BCBS MT Traditional	$28.00
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cigna Commercial	$26.60
Rate for Payer: Cigna Medicare	$25.20
Rate for Payer: Medicaid All Medicaid	$25.76
Rate for Payer: Medicare All Medicare	$19.60
Rate for Payer: Monida Allegiance	$26.60
Rate for Payer: Monida First Choice Health	$27.16
Rate for Payer: Monida Montana Health Co-op	$26.60
Rate for Payer: Monida PacificSource	$26.60

METHOTREXATE TAB [2.5 MG] NF

Facility

$12.00

Service Code	HCPCS J8610
Hospital Charge Code	3007261
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare	$10.80
Rate for Payer: BCBS MT CHIP	$10.80
Rate for Payer: BCBS MT Closed Plan Network	$11.40
Rate for Payer: BCBS MT HealthLink	$10.80
Rate for Payer: BCBS MT Medicare	$10.80
Rate for Payer: BCBS MT POS	$11.40
Rate for Payer: BCBS MT Traditional	$12.00
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna Commercial	$11.40
Rate for Payer: Cigna Medicare	$10.80
Rate for Payer: Medicaid All Medicaid	$11.04
Rate for Payer: Medicare All Medicare	$8.40
Rate for Payer: Monida Allegiance	$11.40
Rate for Payer: Monida First Choice Health	$11.64
Rate for Payer: Monida Montana Health Co-op	$11.40
Rate for Payer: Monida PacificSource	$11.40

METHOTREXATE TAB [2.5 MG] NF

Facility

$12.00

Service Code	HCPCS J8610
Hospital Charge Code	3007261
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare	$10.80
Rate for Payer: BCBS MT CHIP	$10.80
Rate for Payer: BCBS MT Closed Plan Network	$11.40
Rate for Payer: BCBS MT HealthLink	$10.80
Rate for Payer: BCBS MT Medicare	$10.80
Rate for Payer: BCBS MT POS	$11.40
Rate for Payer: BCBS MT Traditional	$12.00
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna Commercial	$11.40
Rate for Payer: Cigna Medicare	$10.80
Rate for Payer: Medicaid All Medicaid	$11.04
Rate for Payer: Medicare All Medicare	$8.40
Rate for Payer: Monida Allegiance	$11.40
Rate for Payer: Monida First Choice Health	$11.64
Rate for Payer: Monida Montana Health Co-op	$11.40
Rate for Payer: Monida PacificSource	$11.40

METHYLERGONOVINE MALEATE 0.2MG/ML

Facility

$75.90

Service Code	NDC 51991014417
Hospital Charge Code	3007379
Hospital Revenue Code	250
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$75.90
Rate for Payer: Aetna Commercial	$72.11
Rate for Payer: Aetna Medicare	$68.31
Rate for Payer: BCBS MT CHIP	$68.31
Rate for Payer: BCBS MT Closed Plan Network	$72.11
Rate for Payer: BCBS MT HealthLink	$68.31
Rate for Payer: BCBS MT Medicare	$68.31
Rate for Payer: BCBS MT POS	$72.11
Rate for Payer: BCBS MT Traditional	$75.90
Rate for Payer: Cash Price	$68.31
Rate for Payer: Cigna Commercial	$72.11
Rate for Payer: Cigna Medicare	$68.31
Rate for Payer: Medicaid All Medicaid	$69.83
Rate for Payer: Medicare All Medicare	$53.13
Rate for Payer: Monida Allegiance	$72.11
Rate for Payer: Monida First Choice Health	$73.62
Rate for Payer: Monida Montana Health Co-op	$72.11
Rate for Payer: Monida PacificSource	$72.11

METHYLERGONOVINE MALEATE 0.2MG/ML

Facility

$75.90

Service Code	NDC 51991014417
Hospital Charge Code	3007379
Hospital Revenue Code	250
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$75.90
Rate for Payer: Aetna Commercial	$72.11
Rate for Payer: Aetna Medicare	$68.31
Rate for Payer: BCBS MT CHIP	$68.31
Rate for Payer: BCBS MT Closed Plan Network	$72.11
Rate for Payer: BCBS MT HealthLink	$68.31
Rate for Payer: BCBS MT Medicare	$68.31
Rate for Payer: BCBS MT POS	$72.11
Rate for Payer: BCBS MT Traditional	$75.90
Rate for Payer: Cash Price	$68.31
Rate for Payer: Cigna Commercial	$72.11
Rate for Payer: Cigna Medicare	$68.31
Rate for Payer: Medicaid All Medicaid	$69.83
Rate for Payer: Medicare All Medicare	$53.13
Rate for Payer: Monida Allegiance	$72.11
Rate for Payer: Monida First Choice Health	$73.62
Rate for Payer: Monida Montana Health Co-op	$72.11
Rate for Payer: Monida PacificSource	$72.11

METHYLERGONOVINE MAL INJ [0.2 MG/ML] NF

Facility

$80.00

Service Code	HCPCS J2210
Hospital Charge Code	3000312
Hospital Revenue Code	259
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare	$72.00
Rate for Payer: BCBS MT CHIP	$72.00
Rate for Payer: BCBS MT Closed Plan Network	$76.00
Rate for Payer: BCBS MT HealthLink	$72.00
Rate for Payer: BCBS MT Medicare	$72.00
Rate for Payer: BCBS MT POS	$76.00
Rate for Payer: BCBS MT Traditional	$80.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare	$72.00
Rate for Payer: Medicaid All Medicaid	$73.60
Rate for Payer: Medicare All Medicare	$56.00
Rate for Payer: Monida Allegiance	$76.00
Rate for Payer: Monida First Choice Health	$77.60
Rate for Payer: Monida Montana Health Co-op	$76.00
Rate for Payer: Monida PacificSource	$76.00

METHYLERGONOVINE MAL INJ [0.2 MG/ML] NF

Facility

$80.00

Service Code	HCPCS J2210
Hospital Charge Code	3000312
Hospital Revenue Code	259
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare	$72.00
Rate for Payer: BCBS MT CHIP	$72.00
Rate for Payer: BCBS MT Closed Plan Network	$76.00
Rate for Payer: BCBS MT HealthLink	$72.00
Rate for Payer: BCBS MT Medicare	$72.00
Rate for Payer: BCBS MT POS	$76.00
Rate for Payer: BCBS MT Traditional	$80.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare	$72.00
Rate for Payer: Medicaid All Medicaid	$73.60
Rate for Payer: Medicare All Medicare	$56.00
Rate for Payer: Monida Allegiance	$76.00
Rate for Payer: Monida First Choice Health	$77.60
Rate for Payer: Monida Montana Health Co-op	$76.00
Rate for Payer: Monida PacificSource	$76.00

METHYLMALONIC ACID, QUANT (706961)

Facility

$131.00

Service Code	HCPCS 83921
Hospital Charge Code	4083921
Hospital Revenue Code	300
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$131.00
Rate for Payer: Aetna Commercial	$124.45
Rate for Payer: Aetna Medicare	$117.90
Rate for Payer: BCBS MT CHIP	$117.90
Rate for Payer: BCBS MT Closed Plan Network	$124.45
Rate for Payer: BCBS MT HealthLink	$117.90
Rate for Payer: BCBS MT Medicare	$117.90
Rate for Payer: BCBS MT POS	$124.45
Rate for Payer: BCBS MT Traditional	$131.00
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cigna Commercial	$124.45
Rate for Payer: Cigna Medicare	$117.90
Rate for Payer: Medicaid All Medicaid	$120.52
Rate for Payer: Medicare All Medicare	$91.70
Rate for Payer: Monida Allegiance	$124.45
Rate for Payer: Monida First Choice Health	$127.07
Rate for Payer: Monida Montana Health Co-op	$124.45
Rate for Payer: Monida PacificSource	$124.45

METHYLMALONIC ACID, QUANT (706961)

Facility

$131.00

Service Code	HCPCS 83921
Hospital Charge Code	4083921
Hospital Revenue Code	300
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$131.00
Rate for Payer: Aetna Commercial	$124.45
Rate for Payer: Aetna Medicare	$117.90
Rate for Payer: BCBS MT CHIP	$117.90
Rate for Payer: BCBS MT Closed Plan Network	$124.45
Rate for Payer: BCBS MT HealthLink	$117.90
Rate for Payer: BCBS MT Medicare	$117.90
Rate for Payer: BCBS MT POS	$124.45
Rate for Payer: BCBS MT Traditional	$131.00
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cigna Commercial	$124.45
Rate for Payer: Cigna Medicare	$117.90
Rate for Payer: Medicaid All Medicaid	$120.52
Rate for Payer: Medicare All Medicare	$91.70
Rate for Payer: Monida Allegiance	$124.45
Rate for Payer: Monida First Choice Health	$127.07
Rate for Payer: Monida Montana Health Co-op	$124.45
Rate for Payer: Monida PacificSource	$124.45

METHYLNALTREXONE INJ [12 MG]

Facility

$530.00

Service Code	HCPCS J3490
Hospital Charge Code	3000313
Hospital Revenue Code	259
Min. Negotiated Rate	$371.00
Max. Negotiated Rate	$530.00
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare	$477.00
Rate for Payer: BCBS MT CHIP	$477.00
Rate for Payer: BCBS MT Closed Plan Network	$503.50
Rate for Payer: BCBS MT HealthLink	$477.00
Rate for Payer: BCBS MT Medicare	$477.00
Rate for Payer: BCBS MT POS	$503.50
Rate for Payer: BCBS MT Traditional	$530.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cigna Commercial	$503.50
Rate for Payer: Cigna Medicare	$477.00
Rate for Payer: Medicaid All Medicaid	$487.60
Rate for Payer: Medicare All Medicare	$371.00
Rate for Payer: Monida Allegiance	$503.50
Rate for Payer: Monida First Choice Health	$514.10
Rate for Payer: Monida Montana Health Co-op	$503.50
Rate for Payer: Monida PacificSource	$503.50

METHYLNALTREXONE INJ [12 MG]

Facility

$530.00

Service Code	HCPCS J3490
Hospital Charge Code	3000313
Hospital Revenue Code	259
Min. Negotiated Rate	$371.00
Max. Negotiated Rate	$530.00
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare	$477.00
Rate for Payer: BCBS MT CHIP	$477.00
Rate for Payer: BCBS MT Closed Plan Network	$503.50
Rate for Payer: BCBS MT HealthLink	$477.00
Rate for Payer: BCBS MT Medicare	$477.00
Rate for Payer: BCBS MT POS	$503.50
Rate for Payer: BCBS MT Traditional	$530.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cigna Commercial	$503.50
Rate for Payer: Cigna Medicare	$477.00
Rate for Payer: Medicaid All Medicaid	$487.60
Rate for Payer: Medicare All Medicare	$371.00
Rate for Payer: Monida Allegiance	$503.50
Rate for Payer: Monida First Choice Health	$514.10
Rate for Payer: Monida Montana Health Co-op	$503.50
Rate for Payer: Monida PacificSource	$503.50

METHYLPREDNISOLONE 1GM INJ NF

Facility

$265.00

Service Code	HCPCS J2919
Hospital Charge Code	3000314
Hospital Revenue Code	259
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$265.00
Rate for Payer: Aetna Commercial	$251.75
Rate for Payer: Aetna Medicare	$238.50
Rate for Payer: BCBS MT CHIP	$238.50
Rate for Payer: BCBS MT Closed Plan Network	$251.75
Rate for Payer: BCBS MT HealthLink	$238.50
Rate for Payer: BCBS MT Medicare	$238.50
Rate for Payer: BCBS MT POS	$251.75
Rate for Payer: BCBS MT Traditional	$265.00
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cigna Commercial	$251.75
Rate for Payer: Cigna Medicare	$238.50
Rate for Payer: Medicaid All Medicaid	$243.80
Rate for Payer: Medicare All Medicare	$185.50
Rate for Payer: Monida Allegiance	$251.75
Rate for Payer: Monida First Choice Health	$257.05
Rate for Payer: Monida Montana Health Co-op	$251.75
Rate for Payer: Monida PacificSource	$251.75

METHYLPREDNISOLONE 1GM INJ NF

Facility

$265.00

Service Code	HCPCS J2919
Hospital Charge Code	3000314
Hospital Revenue Code	259
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$265.00
Rate for Payer: Aetna Commercial	$251.75
Rate for Payer: Aetna Medicare	$238.50
Rate for Payer: BCBS MT CHIP	$238.50
Rate for Payer: BCBS MT Closed Plan Network	$251.75
Rate for Payer: BCBS MT HealthLink	$238.50
Rate for Payer: BCBS MT Medicare	$238.50
Rate for Payer: BCBS MT POS	$251.75
Rate for Payer: BCBS MT Traditional	$265.00
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cigna Commercial	$251.75
Rate for Payer: Cigna Medicare	$238.50
Rate for Payer: Medicaid All Medicaid	$243.80
Rate for Payer: Medicare All Medicare	$185.50
Rate for Payer: Monida Allegiance	$251.75
Rate for Payer: Monida First Choice Health	$257.05
Rate for Payer: Monida Montana Health Co-op	$251.75
Rate for Payer: Monida PacificSource	$251.75

METHYLPREDNISOLONE INJ [125 MG]

Facility

$41.00

Service Code	HCPCS J2919
Hospital Charge Code	3000528
Hospital Revenue Code	250
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare	$36.90
Rate for Payer: BCBS MT CHIP	$36.90
Rate for Payer: BCBS MT Closed Plan Network	$38.95
Rate for Payer: BCBS MT HealthLink	$36.90
Rate for Payer: BCBS MT Medicare	$36.90
Rate for Payer: BCBS MT POS	$38.95
Rate for Payer: BCBS MT Traditional	$41.00
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial	$38.95
Rate for Payer: Cigna Medicare	$36.90
Rate for Payer: Medicaid All Medicaid	$37.72
Rate for Payer: Medicare All Medicare	$28.70
Rate for Payer: Monida Allegiance	$38.95
Rate for Payer: Monida First Choice Health	$39.77
Rate for Payer: Monida Montana Health Co-op	$38.95
Rate for Payer: Monida PacificSource	$38.95

METHYLPREDNISOLONE INJ [125 MG]

Facility

$41.00

Service Code	HCPCS J2919
Hospital Charge Code	3000528
Hospital Revenue Code	250
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare	$36.90
Rate for Payer: BCBS MT CHIP	$36.90
Rate for Payer: BCBS MT Closed Plan Network	$38.95
Rate for Payer: BCBS MT HealthLink	$36.90
Rate for Payer: BCBS MT Medicare	$36.90
Rate for Payer: BCBS MT POS	$38.95
Rate for Payer: BCBS MT Traditional	$41.00
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial	$38.95
Rate for Payer: Cigna Medicare	$36.90
Rate for Payer: Medicaid All Medicaid	$37.72
Rate for Payer: Medicare All Medicare	$28.70
Rate for Payer: Monida Allegiance	$38.95
Rate for Payer: Monida First Choice Health	$39.77
Rate for Payer: Monida Montana Health Co-op	$38.95
Rate for Payer: Monida PacificSource	$38.95

METHYLPREDNISOLONE INJ [40 MG/ML]

Facility

$25.00

Service Code	HCPCS J2919
Hospital Charge Code	3000316
Hospital Revenue Code	259
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS MT CHIP	$22.50
Rate for Payer: BCBS MT Closed Plan Network	$23.75
Rate for Payer: BCBS MT HealthLink	$22.50
Rate for Payer: BCBS MT Medicare	$22.50
Rate for Payer: BCBS MT POS	$23.75
Rate for Payer: BCBS MT Traditional	$25.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: Cigna Medicare	$22.50
Rate for Payer: Medicaid All Medicaid	$23.00
Rate for Payer: Medicare All Medicare	$17.50
Rate for Payer: Monida Allegiance	$23.75
Rate for Payer: Monida First Choice Health	$24.25
Rate for Payer: Monida Montana Health Co-op	$23.75
Rate for Payer: Monida PacificSource	$23.75

METHYLPREDNISOLONE INJ [40 MG/ML]

Facility

$25.00

Service Code	HCPCS J2919
Hospital Charge Code	3000316
Hospital Revenue Code	259
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS MT CHIP	$22.50
Rate for Payer: BCBS MT Closed Plan Network	$23.75
Rate for Payer: BCBS MT HealthLink	$22.50
Rate for Payer: BCBS MT Medicare	$22.50
Rate for Payer: BCBS MT POS	$23.75
Rate for Payer: BCBS MT Traditional	$25.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: Cigna Medicare	$22.50
Rate for Payer: Medicaid All Medicaid	$23.00
Rate for Payer: Medicare All Medicare	$17.50
Rate for Payer: Monida Allegiance	$23.75
Rate for Payer: Monida First Choice Health	$24.25
Rate for Payer: Monida Montana Health Co-op	$23.75
Rate for Payer: Monida PacificSource	$23.75

METHYLPREDNISOLONE TAB [4 MG] 21 PACK

Facility

$96.00

Service Code	HCPCS J7509
Hospital Charge Code	3000317
Hospital Revenue Code	250
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare	$86.40
Rate for Payer: BCBS MT CHIP	$86.40
Rate for Payer: BCBS MT Closed Plan Network	$91.20
Rate for Payer: BCBS MT HealthLink	$86.40
Rate for Payer: BCBS MT Medicare	$86.40
Rate for Payer: BCBS MT POS	$91.20
Rate for Payer: BCBS MT Traditional	$96.00
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial	$91.20
Rate for Payer: Cigna Medicare	$86.40
Rate for Payer: Medicaid All Medicaid	$88.32
Rate for Payer: Medicare All Medicare	$67.20
Rate for Payer: Monida Allegiance	$91.20
Rate for Payer: Monida First Choice Health	$93.12
Rate for Payer: Monida Montana Health Co-op	$91.20
Rate for Payer: Monida PacificSource	$91.20

METHYLPREDNISOLONE TAB [4 MG] 21 PACK

Facility

$96.00

Service Code	HCPCS J7509
Hospital Charge Code	3000317
Hospital Revenue Code	250
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare	$86.40
Rate for Payer: BCBS MT CHIP	$86.40
Rate for Payer: BCBS MT Closed Plan Network	$91.20
Rate for Payer: BCBS MT HealthLink	$86.40
Rate for Payer: BCBS MT Medicare	$86.40
Rate for Payer: BCBS MT POS	$91.20
Rate for Payer: BCBS MT Traditional	$96.00
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial	$91.20
Rate for Payer: Cigna Medicare	$86.40
Rate for Payer: Medicaid All Medicaid	$88.32
Rate for Payer: Medicare All Medicare	$67.20
Rate for Payer: Monida Allegiance	$91.20
Rate for Payer: Monida First Choice Health	$93.12
Rate for Payer: Monida Montana Health Co-op	$91.20
Rate for Payer: Monida PacificSource	$91.20

METOCLOPRAMIDE INJ [5 MG/ML]

Facility

$8.00

Service Code	HCPCS J2765
Hospital Charge Code	3000318
Hospital Revenue Code	258
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

METOCLOPRAMIDE INJ [5 MG/ML]

Facility

$8.00

Service Code	HCPCS J2765
Hospital Charge Code	3000318
Hospital Revenue Code	258
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

METOCLOPRAMIDE TAB [10 MG]

Facility

$8.00

Service Code	HCPCS J3490
Hospital Charge Code	3000319
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

Know your out-of-pocket cost for care.

All Charges