Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

AUDIOMETRY PURE TONE

Facility

$111.00

Service Code	CPT 92552
Hospital Charge Code	8092552
Hospital Revenue Code	521
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna Commercial	$105.45
Rate for Payer: Aetna Medicare	$99.90
Rate for Payer: BCBS MT CHIP	$99.90
Rate for Payer: BCBS MT Closed Plan Network	$105.45
Rate for Payer: BCBS MT HealthLink	$99.90
Rate for Payer: BCBS MT Medicare	$99.90
Rate for Payer: BCBS MT POS	$105.45
Rate for Payer: BCBS MT Traditional	$111.00
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cigna Commercial	$105.45
Rate for Payer: Cigna Medicare	$99.90
Rate for Payer: Medicaid All Medicaid	$102.12
Rate for Payer: Medicare All Medicare	$77.70
Rate for Payer: Monida Allegiance	$105.45
Rate for Payer: Monida First Choice Health	$107.67
Rate for Payer: Monida Montana Health Co-op	$105.45
Rate for Payer: Monida PacificSource	$105.45

AUDITMICRO LINR AMMONIA

Facility

$375.00

Hospital Charge Code	90197125
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$356.25
Rate for Payer: Aetna Medicare	$337.50
Rate for Payer: BCBS MT CHIP	$337.50
Rate for Payer: BCBS MT Closed Plan Network	$356.25
Rate for Payer: BCBS MT HealthLink	$337.50
Rate for Payer: BCBS MT Medicare	$337.50
Rate for Payer: BCBS MT POS	$356.25
Rate for Payer: BCBS MT Traditional	$375.00
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$356.25
Rate for Payer: Cigna Medicare	$337.50
Rate for Payer: Medicaid All Medicaid	$345.00
Rate for Payer: Medicare All Medicare	$262.50
Rate for Payer: Monida Allegiance	$356.25
Rate for Payer: Monida First Choice Health	$363.75
Rate for Payer: Monida Montana Health Co-op	$356.25
Rate for Payer: Monida PacificSource	$356.25

AUDITMICRO LINR AMMONIA

Facility

$375.00

Hospital Charge Code	90197125
Hospital Revenue Code	270
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$356.25
Rate for Payer: Aetna Medicare	$337.50
Rate for Payer: BCBS MT CHIP	$337.50
Rate for Payer: BCBS MT Closed Plan Network	$356.25
Rate for Payer: BCBS MT HealthLink	$337.50
Rate for Payer: BCBS MT Medicare	$337.50
Rate for Payer: BCBS MT POS	$356.25
Rate for Payer: BCBS MT Traditional	$375.00
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$356.25
Rate for Payer: Cigna Medicare	$337.50
Rate for Payer: Medicaid All Medicaid	$345.00
Rate for Payer: Medicare All Medicare	$262.50
Rate for Payer: Monida Allegiance	$356.25
Rate for Payer: Monida First Choice Health	$363.75
Rate for Payer: Monida Montana Health Co-op	$356.25
Rate for Payer: Monida PacificSource	$356.25

AUDITMICRO LINR CARDIAC TNIH

Facility

$380.41

Hospital Charge Code	90197122
Hospital Revenue Code	270
Min. Negotiated Rate	$266.29
Max. Negotiated Rate	$380.41
Rate for Payer: Aetna Commercial	$361.39
Rate for Payer: Aetna Medicare	$342.37
Rate for Payer: BCBS MT CHIP	$342.37
Rate for Payer: BCBS MT Closed Plan Network	$361.39
Rate for Payer: BCBS MT HealthLink	$342.37
Rate for Payer: BCBS MT Medicare	$342.37
Rate for Payer: BCBS MT POS	$361.39
Rate for Payer: BCBS MT Traditional	$380.41
Rate for Payer: Cash Price	$342.37
Rate for Payer: Cigna Commercial	$361.39
Rate for Payer: Cigna Medicare	$342.37
Rate for Payer: Medicaid All Medicaid	$349.98
Rate for Payer: Medicare All Medicare	$266.29
Rate for Payer: Monida Allegiance	$361.39
Rate for Payer: Monida First Choice Health	$369.00
Rate for Payer: Monida Montana Health Co-op	$361.39
Rate for Payer: Monida PacificSource	$361.39

AUDITMICRO LINR CARDIAC TNIH

Facility

$380.41

Hospital Charge Code	90197122
Hospital Revenue Code	270
Min. Negotiated Rate	$266.29
Max. Negotiated Rate	$380.41
Rate for Payer: Aetna Commercial	$361.39
Rate for Payer: Aetna Medicare	$342.37
Rate for Payer: BCBS MT CHIP	$342.37
Rate for Payer: BCBS MT Closed Plan Network	$361.39
Rate for Payer: BCBS MT HealthLink	$342.37
Rate for Payer: BCBS MT Medicare	$342.37
Rate for Payer: BCBS MT POS	$361.39
Rate for Payer: BCBS MT Traditional	$380.41
Rate for Payer: Cash Price	$342.37
Rate for Payer: Cigna Commercial	$361.39
Rate for Payer: Cigna Medicare	$342.37
Rate for Payer: Medicaid All Medicaid	$349.98
Rate for Payer: Medicare All Medicare	$266.29
Rate for Payer: Monida Allegiance	$361.39
Rate for Payer: Monida First Choice Health	$369.00
Rate for Payer: Monida Montana Health Co-op	$361.39
Rate for Payer: Monida PacificSource	$361.39

AUDITMICRO LINR CRP

Facility

$324.07

Hospital Charge Code	90197156
Hospital Revenue Code	270
Min. Negotiated Rate	$226.85
Max. Negotiated Rate	$324.07
Rate for Payer: Aetna Commercial	$307.87
Rate for Payer: Aetna Medicare	$291.66
Rate for Payer: BCBS MT CHIP	$291.66
Rate for Payer: BCBS MT Closed Plan Network	$307.87
Rate for Payer: BCBS MT HealthLink	$291.66
Rate for Payer: BCBS MT Medicare	$291.66
Rate for Payer: BCBS MT POS	$307.87
Rate for Payer: BCBS MT Traditional	$324.07
Rate for Payer: Cash Price	$291.66
Rate for Payer: Cigna Commercial	$307.87
Rate for Payer: Cigna Medicare	$291.66
Rate for Payer: Medicaid All Medicaid	$298.14
Rate for Payer: Medicare All Medicare	$226.85
Rate for Payer: Monida Allegiance	$307.87
Rate for Payer: Monida First Choice Health	$314.35
Rate for Payer: Monida Montana Health Co-op	$307.87
Rate for Payer: Monida PacificSource	$307.87

AUDITMICRO LINR CRP

Facility

$324.07

Hospital Charge Code	90197156
Hospital Revenue Code	270
Min. Negotiated Rate	$226.85
Max. Negotiated Rate	$324.07
Rate for Payer: Aetna Commercial	$307.87
Rate for Payer: Aetna Medicare	$291.66
Rate for Payer: BCBS MT CHIP	$291.66
Rate for Payer: BCBS MT Closed Plan Network	$307.87
Rate for Payer: BCBS MT HealthLink	$291.66
Rate for Payer: BCBS MT Medicare	$291.66
Rate for Payer: BCBS MT POS	$307.87
Rate for Payer: BCBS MT Traditional	$324.07
Rate for Payer: Cash Price	$291.66
Rate for Payer: Cigna Commercial	$307.87
Rate for Payer: Cigna Medicare	$291.66
Rate for Payer: Medicaid All Medicaid	$298.14
Rate for Payer: Medicare All Medicare	$226.85
Rate for Payer: Monida Allegiance	$307.87
Rate for Payer: Monida First Choice Health	$314.35
Rate for Payer: Monida Montana Health Co-op	$307.87
Rate for Payer: Monida PacificSource	$307.87

AUDITMICRO LINR DDIMER

Facility

$420.21

Hospital Charge Code	90197080
Hospital Revenue Code	270
Min. Negotiated Rate	$294.15
Max. Negotiated Rate	$420.21
Rate for Payer: Aetna Commercial	$399.20
Rate for Payer: Aetna Medicare	$378.19
Rate for Payer: BCBS MT CHIP	$378.19
Rate for Payer: BCBS MT Closed Plan Network	$399.20
Rate for Payer: BCBS MT HealthLink	$378.19
Rate for Payer: BCBS MT Medicare	$378.19
Rate for Payer: BCBS MT POS	$399.20
Rate for Payer: BCBS MT Traditional	$420.21
Rate for Payer: Cash Price	$378.19
Rate for Payer: Cigna Commercial	$399.20
Rate for Payer: Cigna Medicare	$378.19
Rate for Payer: Medicaid All Medicaid	$386.59
Rate for Payer: Medicare All Medicare	$294.15
Rate for Payer: Monida Allegiance	$399.20
Rate for Payer: Monida First Choice Health	$407.60
Rate for Payer: Monida Montana Health Co-op	$399.20
Rate for Payer: Monida PacificSource	$399.20

AUDITMICRO LINR DDIMER

Facility

$420.21

Hospital Charge Code	90197080
Hospital Revenue Code	270
Min. Negotiated Rate	$294.15
Max. Negotiated Rate	$420.21
Rate for Payer: Aetna Commercial	$399.20
Rate for Payer: Aetna Medicare	$378.19
Rate for Payer: BCBS MT CHIP	$378.19
Rate for Payer: BCBS MT Closed Plan Network	$399.20
Rate for Payer: BCBS MT HealthLink	$378.19
Rate for Payer: BCBS MT Medicare	$378.19
Rate for Payer: BCBS MT POS	$399.20
Rate for Payer: BCBS MT Traditional	$420.21
Rate for Payer: Cash Price	$378.19
Rate for Payer: Cigna Commercial	$399.20
Rate for Payer: Cigna Medicare	$378.19
Rate for Payer: Medicaid All Medicaid	$386.59
Rate for Payer: Medicare All Medicare	$294.15
Rate for Payer: Monida Allegiance	$399.20
Rate for Payer: Monida First Choice Health	$407.60
Rate for Payer: Monida Montana Health Co-op	$399.20
Rate for Payer: Monida PacificSource	$399.20

AUDITMICRO LINR GEN CHEM

Facility

$369.21

Hospital Charge Code	90197121
Hospital Revenue Code	270
Min. Negotiated Rate	$258.45
Max. Negotiated Rate	$369.21
Rate for Payer: Aetna Commercial	$350.75
Rate for Payer: Aetna Medicare	$332.29
Rate for Payer: BCBS MT CHIP	$332.29
Rate for Payer: BCBS MT Closed Plan Network	$350.75
Rate for Payer: BCBS MT HealthLink	$332.29
Rate for Payer: BCBS MT Medicare	$332.29
Rate for Payer: BCBS MT POS	$350.75
Rate for Payer: BCBS MT Traditional	$369.21
Rate for Payer: Cash Price	$332.29
Rate for Payer: Cigna Commercial	$350.75
Rate for Payer: Cigna Medicare	$332.29
Rate for Payer: Medicaid All Medicaid	$339.67
Rate for Payer: Medicare All Medicare	$258.45
Rate for Payer: Monida Allegiance	$350.75
Rate for Payer: Monida First Choice Health	$358.13
Rate for Payer: Monida Montana Health Co-op	$350.75
Rate for Payer: Monida PacificSource	$350.75

AUDITMICRO LINR GEN CHEM

Facility

$369.21

Hospital Charge Code	90197121
Hospital Revenue Code	270
Min. Negotiated Rate	$258.45
Max. Negotiated Rate	$369.21
Rate for Payer: Aetna Commercial	$350.75
Rate for Payer: Aetna Medicare	$332.29
Rate for Payer: BCBS MT CHIP	$332.29
Rate for Payer: BCBS MT Closed Plan Network	$350.75
Rate for Payer: BCBS MT HealthLink	$332.29
Rate for Payer: BCBS MT Medicare	$332.29
Rate for Payer: BCBS MT POS	$350.75
Rate for Payer: BCBS MT Traditional	$369.21
Rate for Payer: Cash Price	$332.29
Rate for Payer: Cigna Commercial	$350.75
Rate for Payer: Cigna Medicare	$332.29
Rate for Payer: Medicaid All Medicaid	$339.67
Rate for Payer: Medicare All Medicare	$258.45
Rate for Payer: Monida Allegiance	$350.75
Rate for Payer: Monida First Choice Health	$358.13
Rate for Payer: Monida Montana Health Co-op	$350.75
Rate for Payer: Monida PacificSource	$350.75

AUDITMICRO LINR HBA1C

Facility

$335.12

Hospital Charge Code	90197123
Hospital Revenue Code	270
Min. Negotiated Rate	$234.58
Max. Negotiated Rate	$335.12
Rate for Payer: Aetna Commercial	$318.36
Rate for Payer: Aetna Medicare	$301.61
Rate for Payer: BCBS MT CHIP	$301.61
Rate for Payer: BCBS MT Closed Plan Network	$318.36
Rate for Payer: BCBS MT HealthLink	$301.61
Rate for Payer: BCBS MT Medicare	$301.61
Rate for Payer: BCBS MT POS	$318.36
Rate for Payer: BCBS MT Traditional	$335.12
Rate for Payer: Cash Price	$301.61
Rate for Payer: Cigna Commercial	$318.36
Rate for Payer: Cigna Medicare	$301.61
Rate for Payer: Medicaid All Medicaid	$308.31
Rate for Payer: Medicare All Medicare	$234.58
Rate for Payer: Monida Allegiance	$318.36
Rate for Payer: Monida First Choice Health	$325.07
Rate for Payer: Monida Montana Health Co-op	$318.36
Rate for Payer: Monida PacificSource	$318.36

AUDITMICRO LINR HBA1C

Facility

$335.12

Hospital Charge Code	90197123
Hospital Revenue Code	270
Min. Negotiated Rate	$234.58
Max. Negotiated Rate	$335.12
Rate for Payer: Aetna Commercial	$318.36
Rate for Payer: Aetna Medicare	$301.61
Rate for Payer: BCBS MT CHIP	$301.61
Rate for Payer: BCBS MT Closed Plan Network	$318.36
Rate for Payer: BCBS MT HealthLink	$301.61
Rate for Payer: BCBS MT Medicare	$301.61
Rate for Payer: BCBS MT POS	$318.36
Rate for Payer: BCBS MT Traditional	$335.12
Rate for Payer: Cash Price	$301.61
Rate for Payer: Cigna Commercial	$318.36
Rate for Payer: Cigna Medicare	$301.61
Rate for Payer: Medicaid All Medicaid	$308.31
Rate for Payer: Medicare All Medicare	$234.58
Rate for Payer: Monida Allegiance	$318.36
Rate for Payer: Monida First Choice Health	$325.07
Rate for Payer: Monida Montana Health Co-op	$318.36
Rate for Payer: Monida PacificSource	$318.36

AUDITMICRO LINR IMMUNOASSAY

Facility

$369.21

Hospital Charge Code	90197120
Hospital Revenue Code	270
Min. Negotiated Rate	$258.45
Max. Negotiated Rate	$369.21
Rate for Payer: Aetna Commercial	$350.75
Rate for Payer: Aetna Medicare	$332.29
Rate for Payer: BCBS MT CHIP	$332.29
Rate for Payer: BCBS MT Closed Plan Network	$350.75
Rate for Payer: BCBS MT HealthLink	$332.29
Rate for Payer: BCBS MT Medicare	$332.29
Rate for Payer: BCBS MT POS	$350.75
Rate for Payer: BCBS MT Traditional	$369.21
Rate for Payer: Cash Price	$332.29
Rate for Payer: Cigna Commercial	$350.75
Rate for Payer: Cigna Medicare	$332.29
Rate for Payer: Medicaid All Medicaid	$339.67
Rate for Payer: Medicare All Medicare	$258.45
Rate for Payer: Monida Allegiance	$350.75
Rate for Payer: Monida First Choice Health	$358.13
Rate for Payer: Monida Montana Health Co-op	$350.75
Rate for Payer: Monida PacificSource	$350.75

AUDITMICRO LINR IMMUNOASSAY

Facility

$369.21

Hospital Charge Code	90197120
Hospital Revenue Code	270
Min. Negotiated Rate	$258.45
Max. Negotiated Rate	$369.21
Rate for Payer: Aetna Commercial	$350.75
Rate for Payer: Aetna Medicare	$332.29
Rate for Payer: BCBS MT CHIP	$332.29
Rate for Payer: BCBS MT Closed Plan Network	$350.75
Rate for Payer: BCBS MT HealthLink	$332.29
Rate for Payer: BCBS MT Medicare	$332.29
Rate for Payer: BCBS MT POS	$350.75
Rate for Payer: BCBS MT Traditional	$369.21
Rate for Payer: Cash Price	$332.29
Rate for Payer: Cigna Commercial	$350.75
Rate for Payer: Cigna Medicare	$332.29
Rate for Payer: Medicaid All Medicaid	$339.67
Rate for Payer: Medicare All Medicare	$258.45
Rate for Payer: Monida Allegiance	$350.75
Rate for Payer: Monida First Choice Health	$358.13
Rate for Payer: Monida Montana Health Co-op	$350.75
Rate for Payer: Monida PacificSource	$350.75

AUDITMICRO LINR LIPIDS

Facility

$380.00

Hospital Charge Code	90197119
Hospital Revenue Code	270
Min. Negotiated Rate	$266.00
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare	$342.00
Rate for Payer: BCBS MT CHIP	$342.00
Rate for Payer: BCBS MT Closed Plan Network	$361.00
Rate for Payer: BCBS MT HealthLink	$342.00
Rate for Payer: BCBS MT Medicare	$342.00
Rate for Payer: BCBS MT POS	$361.00
Rate for Payer: BCBS MT Traditional	$380.00
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cigna Commercial	$361.00
Rate for Payer: Cigna Medicare	$342.00
Rate for Payer: Medicaid All Medicaid	$349.60
Rate for Payer: Medicare All Medicare	$266.00
Rate for Payer: Monida Allegiance	$361.00
Rate for Payer: Monida First Choice Health	$368.60
Rate for Payer: Monida Montana Health Co-op	$361.00
Rate for Payer: Monida PacificSource	$361.00

AUDITMICRO LINR LIPIDS

Facility

$380.00

Hospital Charge Code	90197119
Hospital Revenue Code	270
Min. Negotiated Rate	$266.00
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare	$342.00
Rate for Payer: BCBS MT CHIP	$342.00
Rate for Payer: BCBS MT Closed Plan Network	$361.00
Rate for Payer: BCBS MT HealthLink	$342.00
Rate for Payer: BCBS MT Medicare	$342.00
Rate for Payer: BCBS MT POS	$361.00
Rate for Payer: BCBS MT Traditional	$380.00
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cigna Commercial	$361.00
Rate for Payer: Cigna Medicare	$342.00
Rate for Payer: Medicaid All Medicaid	$349.60
Rate for Payer: Medicare All Medicare	$266.00
Rate for Payer: Monida Allegiance	$361.00
Rate for Payer: Monida First Choice Health	$368.60
Rate for Payer: Monida Montana Health Co-op	$361.00
Rate for Payer: Monida PacificSource	$361.00

AUDITMICRO LINR PATHFAST NTBNP

Facility

$201.69

Hospital Charge Code	90197079
Hospital Revenue Code	270
Min. Negotiated Rate	$141.18
Max. Negotiated Rate	$201.69
Rate for Payer: Aetna Commercial	$191.61
Rate for Payer: Aetna Medicare	$181.52
Rate for Payer: BCBS MT CHIP	$181.52
Rate for Payer: BCBS MT Closed Plan Network	$191.61
Rate for Payer: BCBS MT HealthLink	$181.52
Rate for Payer: BCBS MT Medicare	$181.52
Rate for Payer: BCBS MT POS	$191.61
Rate for Payer: BCBS MT Traditional	$201.69
Rate for Payer: Cash Price	$181.52
Rate for Payer: Cigna Commercial	$191.61
Rate for Payer: Cigna Medicare	$181.52
Rate for Payer: Medicaid All Medicaid	$185.55
Rate for Payer: Medicare All Medicare	$141.18
Rate for Payer: Monida Allegiance	$191.61
Rate for Payer: Monida First Choice Health	$195.64
Rate for Payer: Monida Montana Health Co-op	$191.61
Rate for Payer: Monida PacificSource	$191.61

AUDITMICRO LINR PATHFAST NTBNP

Facility

$201.69

Hospital Charge Code	90197079
Hospital Revenue Code	270
Min. Negotiated Rate	$141.18
Max. Negotiated Rate	$201.69
Rate for Payer: Aetna Commercial	$191.61
Rate for Payer: Aetna Medicare	$181.52
Rate for Payer: BCBS MT CHIP	$181.52
Rate for Payer: BCBS MT Closed Plan Network	$191.61
Rate for Payer: BCBS MT HealthLink	$181.52
Rate for Payer: BCBS MT Medicare	$181.52
Rate for Payer: BCBS MT POS	$191.61
Rate for Payer: BCBS MT Traditional	$201.69
Rate for Payer: Cash Price	$181.52
Rate for Payer: Cigna Commercial	$191.61
Rate for Payer: Cigna Medicare	$181.52
Rate for Payer: Medicaid All Medicaid	$185.55
Rate for Payer: Medicare All Medicare	$141.18
Rate for Payer: Monida Allegiance	$191.61
Rate for Payer: Monida First Choice Health	$195.64
Rate for Payer: Monida Montana Health Co-op	$191.61
Rate for Payer: Monida PacificSource	$191.61

AUDITMICRO LINR PROCALCITONIN

Facility

$337.38

Hospital Charge Code	90197155
Hospital Revenue Code	270
Min. Negotiated Rate	$236.17
Max. Negotiated Rate	$337.38
Rate for Payer: Aetna Commercial	$320.51
Rate for Payer: Aetna Medicare	$303.64
Rate for Payer: BCBS MT CHIP	$303.64
Rate for Payer: BCBS MT Closed Plan Network	$320.51
Rate for Payer: BCBS MT HealthLink	$303.64
Rate for Payer: BCBS MT Medicare	$303.64
Rate for Payer: BCBS MT POS	$320.51
Rate for Payer: BCBS MT Traditional	$337.38
Rate for Payer: Cash Price	$303.64
Rate for Payer: Cigna Commercial	$320.51
Rate for Payer: Cigna Medicare	$303.64
Rate for Payer: Medicaid All Medicaid	$310.39
Rate for Payer: Medicare All Medicare	$236.17
Rate for Payer: Monida Allegiance	$320.51
Rate for Payer: Monida First Choice Health	$327.26
Rate for Payer: Monida Montana Health Co-op	$320.51
Rate for Payer: Monida PacificSource	$320.51

AUDITMICRO LINR PROCALCITONIN

Facility

$337.38

Hospital Charge Code	90197155
Hospital Revenue Code	270
Min. Negotiated Rate	$236.17
Max. Negotiated Rate	$337.38
Rate for Payer: Aetna Commercial	$320.51
Rate for Payer: Aetna Medicare	$303.64
Rate for Payer: BCBS MT CHIP	$303.64
Rate for Payer: BCBS MT Closed Plan Network	$320.51
Rate for Payer: BCBS MT HealthLink	$303.64
Rate for Payer: BCBS MT Medicare	$303.64
Rate for Payer: BCBS MT POS	$320.51
Rate for Payer: BCBS MT Traditional	$337.38
Rate for Payer: Cash Price	$303.64
Rate for Payer: Cigna Commercial	$320.51
Rate for Payer: Cigna Medicare	$303.64
Rate for Payer: Medicaid All Medicaid	$310.39
Rate for Payer: Medicare All Medicare	$236.17
Rate for Payer: Monida Allegiance	$320.51
Rate for Payer: Monida First Choice Health	$327.26
Rate for Payer: Monida Montana Health Co-op	$320.51
Rate for Payer: Monida PacificSource	$320.51

AUDITMICRO LINR TDM

Facility

$355.38

Hospital Charge Code	90197178
Hospital Revenue Code	270
Min. Negotiated Rate	$248.77
Max. Negotiated Rate	$355.38
Rate for Payer: Aetna Commercial	$337.61
Rate for Payer: Aetna Medicare	$319.84
Rate for Payer: BCBS MT CHIP	$319.84
Rate for Payer: BCBS MT Closed Plan Network	$337.61
Rate for Payer: BCBS MT HealthLink	$319.84
Rate for Payer: BCBS MT Medicare	$319.84
Rate for Payer: BCBS MT POS	$337.61
Rate for Payer: BCBS MT Traditional	$355.38
Rate for Payer: Cash Price	$319.84
Rate for Payer: Cigna Commercial	$337.61
Rate for Payer: Cigna Medicare	$319.84
Rate for Payer: Medicaid All Medicaid	$326.95
Rate for Payer: Medicare All Medicare	$248.77
Rate for Payer: Monida Allegiance	$337.61
Rate for Payer: Monida First Choice Health	$344.72
Rate for Payer: Monida Montana Health Co-op	$337.61
Rate for Payer: Monida PacificSource	$337.61

AUDITMICRO LINR TDM

Facility

$355.38

Hospital Charge Code	90197178
Hospital Revenue Code	270
Min. Negotiated Rate	$248.77
Max. Negotiated Rate	$355.38
Rate for Payer: Aetna Commercial	$337.61
Rate for Payer: Aetna Medicare	$319.84
Rate for Payer: BCBS MT CHIP	$319.84
Rate for Payer: BCBS MT Closed Plan Network	$337.61
Rate for Payer: BCBS MT HealthLink	$319.84
Rate for Payer: BCBS MT Medicare	$319.84
Rate for Payer: BCBS MT POS	$337.61
Rate for Payer: BCBS MT Traditional	$355.38
Rate for Payer: Cash Price	$319.84
Rate for Payer: Cigna Commercial	$337.61
Rate for Payer: Cigna Medicare	$319.84
Rate for Payer: Medicaid All Medicaid	$326.95
Rate for Payer: Medicare All Medicare	$248.77
Rate for Payer: Monida Allegiance	$337.61
Rate for Payer: Monida First Choice Health	$344.72
Rate for Payer: Monida Montana Health Co-op	$337.61
Rate for Payer: Monida PacificSource	$337.61

AUDITMICRO LINR VITAMIN D

Facility

$201.89

Hospital Charge Code	90197124
Hospital Revenue Code	270
Min. Negotiated Rate	$141.32
Max. Negotiated Rate	$201.89
Rate for Payer: Aetna Commercial	$191.80
Rate for Payer: Aetna Medicare	$181.70
Rate for Payer: BCBS MT CHIP	$181.70
Rate for Payer: BCBS MT Closed Plan Network	$191.80
Rate for Payer: BCBS MT HealthLink	$181.70
Rate for Payer: BCBS MT Medicare	$181.70
Rate for Payer: BCBS MT POS	$191.80
Rate for Payer: BCBS MT Traditional	$201.89
Rate for Payer: Cash Price	$181.70
Rate for Payer: Cigna Commercial	$191.80
Rate for Payer: Cigna Medicare	$181.70
Rate for Payer: Medicaid All Medicaid	$185.74
Rate for Payer: Medicare All Medicare	$141.32
Rate for Payer: Monida Allegiance	$191.80
Rate for Payer: Monida First Choice Health	$195.83
Rate for Payer: Monida Montana Health Co-op	$191.80
Rate for Payer: Monida PacificSource	$191.80

AUDITMICRO LINR VITAMIN D

Facility

$201.89

Hospital Charge Code	90197124
Hospital Revenue Code	270
Min. Negotiated Rate	$141.32
Max. Negotiated Rate	$201.89
Rate for Payer: Aetna Commercial	$191.80
Rate for Payer: Aetna Medicare	$181.70
Rate for Payer: BCBS MT CHIP	$181.70
Rate for Payer: BCBS MT Closed Plan Network	$191.80
Rate for Payer: BCBS MT HealthLink	$181.70
Rate for Payer: BCBS MT Medicare	$181.70
Rate for Payer: BCBS MT POS	$191.80
Rate for Payer: BCBS MT Traditional	$201.89
Rate for Payer: Cash Price	$181.70
Rate for Payer: Cigna Commercial	$191.80
Rate for Payer: Cigna Medicare	$181.70
Rate for Payer: Medicaid All Medicaid	$185.74
Rate for Payer: Medicare All Medicare	$141.32
Rate for Payer: Monida Allegiance	$191.80
Rate for Payer: Monida First Choice Health	$195.83
Rate for Payer: Monida Montana Health Co-op	$191.80
Rate for Payer: Monida PacificSource	$191.80

Know your out-of-pocket cost for care.

All Charges