Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

ATORVASTATIN TAB [10 MG]

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3007245
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

ATORVASTATIN TAB [40 MG]

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000040
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

ATORVASTATIN TAB [40 MG]

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000040
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

ATROPINE INJ SYR [0.1 MG/ML] 10 ML

Facility

$26.00

Service Code	HCPCS J0461
Hospital Charge Code	3000041
Hospital Revenue Code	259
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare	$23.40
Rate for Payer: BCBS MT CHIP	$23.40
Rate for Payer: BCBS MT Closed Plan Network	$24.70
Rate for Payer: BCBS MT HealthLink	$23.40
Rate for Payer: BCBS MT Medicare	$23.40
Rate for Payer: BCBS MT POS	$24.70
Rate for Payer: BCBS MT Traditional	$26.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cigna Commercial	$24.70
Rate for Payer: Cigna Medicare	$23.40
Rate for Payer: Medicaid All Medicaid	$23.92
Rate for Payer: Medicare All Medicare	$18.20
Rate for Payer: Monida Allegiance	$24.70
Rate for Payer: Monida First Choice Health	$25.22
Rate for Payer: Monida Montana Health Co-op	$24.70
Rate for Payer: Monida PacificSource	$24.70

ATROPINE INJ SYR [0.1 MG/ML] 10 ML

Facility

$26.00

Service Code	HCPCS J0461
Hospital Charge Code	3000041
Hospital Revenue Code	259
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare	$23.40
Rate for Payer: BCBS MT CHIP	$23.40
Rate for Payer: BCBS MT Closed Plan Network	$24.70
Rate for Payer: BCBS MT HealthLink	$23.40
Rate for Payer: BCBS MT Medicare	$23.40
Rate for Payer: BCBS MT POS	$24.70
Rate for Payer: BCBS MT Traditional	$26.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cigna Commercial	$24.70
Rate for Payer: Cigna Medicare	$23.40
Rate for Payer: Medicaid All Medicaid	$23.92
Rate for Payer: Medicare All Medicare	$18.20
Rate for Payer: Monida Allegiance	$24.70
Rate for Payer: Monida First Choice Health	$25.22
Rate for Payer: Monida Montana Health Co-op	$24.70
Rate for Payer: Monida PacificSource	$24.70

ATROPINE OPTH [1 %] 5 ML

Facility

$146.00

Service Code	HCPCS J3490
Hospital Charge Code	3000042
Hospital Revenue Code	259
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare	$131.40
Rate for Payer: BCBS MT CHIP	$131.40
Rate for Payer: BCBS MT Closed Plan Network	$138.70
Rate for Payer: BCBS MT HealthLink	$131.40
Rate for Payer: BCBS MT Medicare	$131.40
Rate for Payer: BCBS MT POS	$138.70
Rate for Payer: BCBS MT Traditional	$146.00
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cigna Commercial	$138.70
Rate for Payer: Cigna Medicare	$131.40
Rate for Payer: Medicaid All Medicaid	$134.32
Rate for Payer: Medicare All Medicare	$102.20
Rate for Payer: Monida Allegiance	$138.70
Rate for Payer: Monida First Choice Health	$141.62
Rate for Payer: Monida Montana Health Co-op	$138.70
Rate for Payer: Monida PacificSource	$138.70

ATROPINE OPTH [1 %] 5 ML

Facility

$146.00

Service Code	HCPCS J3490
Hospital Charge Code	3000042
Hospital Revenue Code	259
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare	$131.40
Rate for Payer: BCBS MT CHIP	$131.40
Rate for Payer: BCBS MT Closed Plan Network	$138.70
Rate for Payer: BCBS MT HealthLink	$131.40
Rate for Payer: BCBS MT Medicare	$131.40
Rate for Payer: BCBS MT POS	$138.70
Rate for Payer: BCBS MT Traditional	$146.00
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cigna Commercial	$138.70
Rate for Payer: Cigna Medicare	$131.40
Rate for Payer: Medicaid All Medicaid	$134.32
Rate for Payer: Medicare All Medicare	$102.20
Rate for Payer: Monida Allegiance	$138.70
Rate for Payer: Monida First Choice Health	$141.62
Rate for Payer: Monida Montana Health Co-op	$138.70
Rate for Payer: Monida PacificSource	$138.70

ATROPINE SULFATE 0.4 MG/ML VIAL SDV

Facility

$32.00

Service Code	HCPCS J0461
Hospital Charge Code	3007068
Hospital Revenue Code	250
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare	$28.80
Rate for Payer: BCBS MT CHIP	$28.80
Rate for Payer: BCBS MT Closed Plan Network	$30.40
Rate for Payer: BCBS MT HealthLink	$28.80
Rate for Payer: BCBS MT Medicare	$28.80
Rate for Payer: BCBS MT POS	$30.40
Rate for Payer: BCBS MT Traditional	$32.00
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial	$30.40
Rate for Payer: Cigna Medicare	$28.80
Rate for Payer: Medicaid All Medicaid	$29.44
Rate for Payer: Medicare All Medicare	$22.40
Rate for Payer: Monida Allegiance	$30.40
Rate for Payer: Monida First Choice Health	$31.04
Rate for Payer: Monida Montana Health Co-op	$30.40
Rate for Payer: Monida PacificSource	$30.40

ATROPINE SULFATE 0.4 MG/ML VIAL SDV

Facility

$32.00

Service Code	HCPCS J0461
Hospital Charge Code	3007068
Hospital Revenue Code	250
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare	$28.80
Rate for Payer: BCBS MT CHIP	$28.80
Rate for Payer: BCBS MT Closed Plan Network	$30.40
Rate for Payer: BCBS MT HealthLink	$28.80
Rate for Payer: BCBS MT Medicare	$28.80
Rate for Payer: BCBS MT POS	$30.40
Rate for Payer: BCBS MT Traditional	$32.00
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial	$30.40
Rate for Payer: Cigna Medicare	$28.80
Rate for Payer: Medicaid All Medicaid	$29.44
Rate for Payer: Medicare All Medicare	$22.40
Rate for Payer: Monida Allegiance	$30.40
Rate for Payer: Monida First Choice Health	$31.04
Rate for Payer: Monida Montana Health Co-op	$30.40
Rate for Payer: Monida PacificSource	$30.40

ATTENDS YOUTH XSMALL

Facility

$43.00

Hospital Charge Code	80030413
Hospital Revenue Code	270
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare	$38.70
Rate for Payer: BCBS MT CHIP	$38.70
Rate for Payer: BCBS MT Closed Plan Network	$40.85
Rate for Payer: BCBS MT HealthLink	$38.70
Rate for Payer: BCBS MT Medicare	$38.70
Rate for Payer: BCBS MT POS	$40.85
Rate for Payer: BCBS MT Traditional	$43.00
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial	$40.85
Rate for Payer: Cigna Medicare	$38.70
Rate for Payer: Medicaid All Medicaid	$39.56
Rate for Payer: Medicare All Medicare	$30.10
Rate for Payer: Monida Allegiance	$40.85
Rate for Payer: Monida First Choice Health	$41.71
Rate for Payer: Monida Montana Health Co-op	$40.85
Rate for Payer: Monida PacificSource	$40.85

ATTENDS YOUTH XSMALL

Facility

$43.00

Hospital Charge Code	80030413
Hospital Revenue Code	270
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare	$38.70
Rate for Payer: BCBS MT CHIP	$38.70
Rate for Payer: BCBS MT Closed Plan Network	$40.85
Rate for Payer: BCBS MT HealthLink	$38.70
Rate for Payer: BCBS MT Medicare	$38.70
Rate for Payer: BCBS MT POS	$40.85
Rate for Payer: BCBS MT Traditional	$43.00
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial	$40.85
Rate for Payer: Cigna Medicare	$38.70
Rate for Payer: Medicaid All Medicaid	$39.56
Rate for Payer: Medicare All Medicare	$30.10
Rate for Payer: Monida Allegiance	$40.85
Rate for Payer: Monida First Choice Health	$41.71
Rate for Payer: Monida Montana Health Co-op	$40.85
Rate for Payer: Monida PacificSource	$40.85

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

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

Know your out-of-pocket cost for care.

All Charges