Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PIPERACILLIN/TAZOBACTAM 4.5GM VIAL

Facility

$70.00

Service Code	HCPCS J2543
Hospital Charge Code	3007376
Hospital Revenue Code	250
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCBS MT CHIP	$63.00
Rate for Payer: BCBS MT Closed Plan Network	$66.50
Rate for Payer: BCBS MT HealthLink	$63.00
Rate for Payer: BCBS MT Medicare	$63.00
Rate for Payer: BCBS MT POS	$66.50
Rate for Payer: BCBS MT Traditional	$70.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial	$66.50
Rate for Payer: Cigna Medicare	$63.00
Rate for Payer: Medicaid All Medicaid	$64.40
Rate for Payer: Medicare All Medicare	$49.00
Rate for Payer: Monida Allegiance	$66.50
Rate for Payer: Monida First Choice Health	$67.90
Rate for Payer: Monida Montana Health Co-op	$66.50
Rate for Payer: Monida PacificSource	$66.50

PIPETTE TRANSFER 5 ML (500/B

Facility

$27.64

Hospital Charge Code	90195104
Hospital Revenue Code	270
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$27.64
Rate for Payer: Aetna Commercial	$26.26
Rate for Payer: Aetna Medicare	$24.88
Rate for Payer: BCBS MT CHIP	$24.88
Rate for Payer: BCBS MT Closed Plan Network	$26.26
Rate for Payer: BCBS MT HealthLink	$24.88
Rate for Payer: BCBS MT Medicare	$24.88
Rate for Payer: BCBS MT POS	$26.26
Rate for Payer: BCBS MT Traditional	$27.64
Rate for Payer: Cash Price	$24.88
Rate for Payer: Cigna Commercial	$26.26
Rate for Payer: Cigna Medicare	$24.88
Rate for Payer: Medicaid All Medicaid	$25.43
Rate for Payer: Medicare All Medicare	$19.35
Rate for Payer: Monida Allegiance	$26.26
Rate for Payer: Monida First Choice Health	$26.81
Rate for Payer: Monida Montana Health Co-op	$26.26
Rate for Payer: Monida PacificSource	$26.26

PIPETTE TRANSFER 5 ML (500/B

Facility

$27.64

Hospital Charge Code	90195104
Hospital Revenue Code	270
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$27.64
Rate for Payer: Aetna Commercial	$26.26
Rate for Payer: Aetna Medicare	$24.88
Rate for Payer: BCBS MT CHIP	$24.88
Rate for Payer: BCBS MT Closed Plan Network	$26.26
Rate for Payer: BCBS MT HealthLink	$24.88
Rate for Payer: BCBS MT Medicare	$24.88
Rate for Payer: BCBS MT POS	$26.26
Rate for Payer: BCBS MT Traditional	$27.64
Rate for Payer: Cash Price	$24.88
Rate for Payer: Cigna Commercial	$26.26
Rate for Payer: Cigna Medicare	$24.88
Rate for Payer: Medicaid All Medicaid	$25.43
Rate for Payer: Medicare All Medicare	$19.35
Rate for Payer: Monida Allegiance	$26.26
Rate for Payer: Monida First Choice Health	$26.81
Rate for Payer: Monida Montana Health Co-op	$26.26
Rate for Payer: Monida PacificSource	$26.26

PLAIN PACKING STRIPS 1/4IN

Facility

$35.00

Hospital Charge Code	80030182
Hospital Revenue Code	270
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$33.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS MT CHIP	$31.50
Rate for Payer: BCBS MT Closed Plan Network	$33.25
Rate for Payer: BCBS MT HealthLink	$31.50
Rate for Payer: BCBS MT Medicare	$31.50
Rate for Payer: BCBS MT POS	$33.25
Rate for Payer: BCBS MT Traditional	$35.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial	$33.25
Rate for Payer: Cigna Medicare	$31.50
Rate for Payer: Medicaid All Medicaid	$32.20
Rate for Payer: Medicare All Medicare	$24.50
Rate for Payer: Monida Allegiance	$33.25
Rate for Payer: Monida First Choice Health	$33.95
Rate for Payer: Monida Montana Health Co-op	$33.25
Rate for Payer: Monida PacificSource	$33.25

PLAIN PACKING STRIPS 1/4IN

Facility

$35.00

Hospital Charge Code	80030182
Hospital Revenue Code	270
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$33.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS MT CHIP	$31.50
Rate for Payer: BCBS MT Closed Plan Network	$33.25
Rate for Payer: BCBS MT HealthLink	$31.50
Rate for Payer: BCBS MT Medicare	$31.50
Rate for Payer: BCBS MT POS	$33.25
Rate for Payer: BCBS MT Traditional	$35.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial	$33.25
Rate for Payer: Cigna Medicare	$31.50
Rate for Payer: Medicaid All Medicaid	$32.20
Rate for Payer: Medicare All Medicare	$24.50
Rate for Payer: Monida Allegiance	$33.25
Rate for Payer: Monida First Choice Health	$33.95
Rate for Payer: Monida Montana Health Co-op	$33.25
Rate for Payer: Monida PacificSource	$33.25

PLATELET COUNT, BLOOD

Facility

$68.00

Service Code	CPT 85049
Hospital Charge Code	4085049
Hospital Revenue Code	305
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare	$61.20
Rate for Payer: BCBS MT CHIP	$61.20
Rate for Payer: BCBS MT Closed Plan Network	$64.60
Rate for Payer: BCBS MT HealthLink	$61.20
Rate for Payer: BCBS MT Medicare	$61.20
Rate for Payer: BCBS MT POS	$64.60
Rate for Payer: BCBS MT Traditional	$68.00
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna Commercial	$64.60
Rate for Payer: Cigna Medicare	$61.20
Rate for Payer: Medicaid All Medicaid	$62.56
Rate for Payer: Medicare All Medicare	$47.60
Rate for Payer: Monida Allegiance	$64.60
Rate for Payer: Monida First Choice Health	$65.96
Rate for Payer: Monida Montana Health Co-op	$64.60
Rate for Payer: Monida PacificSource	$64.60

PLATELET COUNT, BLOOD

Facility

$68.00

Service Code	CPT 85049
Hospital Charge Code	4085049
Hospital Revenue Code	305
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare	$61.20
Rate for Payer: BCBS MT CHIP	$61.20
Rate for Payer: BCBS MT Closed Plan Network	$64.60
Rate for Payer: BCBS MT HealthLink	$61.20
Rate for Payer: BCBS MT Medicare	$61.20
Rate for Payer: BCBS MT POS	$64.60
Rate for Payer: BCBS MT Traditional	$68.00
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna Commercial	$64.60
Rate for Payer: Cigna Medicare	$61.20
Rate for Payer: Medicaid All Medicaid	$62.56
Rate for Payer: Medicare All Medicare	$47.60
Rate for Payer: Monida Allegiance	$64.60
Rate for Payer: Monida First Choice Health	$65.96
Rate for Payer: Monida Montana Health Co-op	$64.60
Rate for Payer: Monida PacificSource	$64.60

PLEURAL DRNG, PERC,W/INS OF CATH-W/O IMA

Facility

$2,196.00

Service Code	CPT 32556
Hospital Charge Code	1032556
Hospital Revenue Code	450
Min. Negotiated Rate	$1,537.20
Max. Negotiated Rate	$2,196.00
Rate for Payer: Aetna Commercial	$2,086.20
Rate for Payer: Aetna Medicare	$1,976.40
Rate for Payer: BCBS MT CHIP	$1,976.40
Rate for Payer: BCBS MT Closed Plan Network	$2,086.20
Rate for Payer: BCBS MT HealthLink	$1,976.40
Rate for Payer: BCBS MT Medicare	$1,976.40
Rate for Payer: BCBS MT POS	$2,086.20
Rate for Payer: BCBS MT Traditional	$2,196.00
Rate for Payer: Cash Price	$1,976.40
Rate for Payer: Cigna Commercial	$2,086.20
Rate for Payer: Cigna Medicare	$1,976.40
Rate for Payer: Medicaid All Medicaid	$2,020.32
Rate for Payer: Medicare All Medicare	$1,537.20
Rate for Payer: Monida Allegiance	$2,086.20
Rate for Payer: Monida First Choice Health	$2,130.12
Rate for Payer: Monida Montana Health Co-op	$2,086.20
Rate for Payer: Monida PacificSource	$2,086.20

PLEURAL DRNG, PERC,W/INS OF CATH-W/O IMA

Facility

$2,196.00

Service Code	CPT 32556
Hospital Charge Code	1032556
Hospital Revenue Code	450
Min. Negotiated Rate	$1,537.20
Max. Negotiated Rate	$2,196.00
Rate for Payer: Aetna Commercial	$2,086.20
Rate for Payer: Aetna Medicare	$1,976.40
Rate for Payer: BCBS MT CHIP	$1,976.40
Rate for Payer: BCBS MT Closed Plan Network	$2,086.20
Rate for Payer: BCBS MT HealthLink	$1,976.40
Rate for Payer: BCBS MT Medicare	$1,976.40
Rate for Payer: BCBS MT POS	$2,086.20
Rate for Payer: BCBS MT Traditional	$2,196.00
Rate for Payer: Cash Price	$1,976.40
Rate for Payer: Cigna Commercial	$2,086.20
Rate for Payer: Cigna Medicare	$1,976.40
Rate for Payer: Medicaid All Medicaid	$2,020.32
Rate for Payer: Medicare All Medicare	$1,537.20
Rate for Payer: Monida Allegiance	$2,086.20
Rate for Payer: Monida First Choice Health	$2,130.12
Rate for Payer: Monida Montana Health Co-op	$2,086.20
Rate for Payer: Monida PacificSource	$2,086.20

PNEUMOCOCCAL<5YRS PCV13

Facility

$743.00

Service Code	CPT 90670
Hospital Charge Code	8090670
Hospital Revenue Code	521
Min. Negotiated Rate	$520.10
Max. Negotiated Rate	$743.00
Rate for Payer: Aetna Commercial	$705.85
Rate for Payer: Aetna Medicare	$668.70
Rate for Payer: BCBS MT CHIP	$668.70
Rate for Payer: BCBS MT Closed Plan Network	$705.85
Rate for Payer: BCBS MT HealthLink	$668.70
Rate for Payer: BCBS MT Medicare	$668.70
Rate for Payer: BCBS MT POS	$705.85
Rate for Payer: BCBS MT Traditional	$743.00
Rate for Payer: Cash Price	$668.70
Rate for Payer: Cigna Commercial	$705.85
Rate for Payer: Cigna Medicare	$668.70
Rate for Payer: Medicaid All Medicaid	$683.56
Rate for Payer: Medicare All Medicare	$520.10
Rate for Payer: Monida Allegiance	$705.85
Rate for Payer: Monida First Choice Health	$720.71
Rate for Payer: Monida Montana Health Co-op	$705.85
Rate for Payer: Monida PacificSource	$705.85

PNEUMOCOCCAL<5YRS PCV13

Facility

$743.00

Service Code	CPT 90670
Hospital Charge Code	8090670
Hospital Revenue Code	521
Min. Negotiated Rate	$520.10
Max. Negotiated Rate	$743.00
Rate for Payer: Aetna Commercial	$705.85
Rate for Payer: Aetna Medicare	$668.70
Rate for Payer: BCBS MT CHIP	$668.70
Rate for Payer: BCBS MT Closed Plan Network	$705.85
Rate for Payer: BCBS MT HealthLink	$668.70
Rate for Payer: BCBS MT Medicare	$668.70
Rate for Payer: BCBS MT POS	$705.85
Rate for Payer: BCBS MT Traditional	$743.00
Rate for Payer: Cash Price	$668.70
Rate for Payer: Cigna Commercial	$705.85
Rate for Payer: Cigna Medicare	$668.70
Rate for Payer: Medicaid All Medicaid	$683.56
Rate for Payer: Medicare All Medicare	$520.10
Rate for Payer: Monida Allegiance	$705.85
Rate for Payer: Monida First Choice Health	$720.71
Rate for Payer: Monida Montana Health Co-op	$705.85
Rate for Payer: Monida PacificSource	$705.85

PODDUS BOOT LG

Facility

$58.00

Hospital Charge Code	2840128
Hospital Revenue Code	270
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$58.00
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare	$52.20
Rate for Payer: BCBS MT CHIP	$52.20
Rate for Payer: BCBS MT Closed Plan Network	$55.10
Rate for Payer: BCBS MT HealthLink	$52.20
Rate for Payer: BCBS MT Medicare	$52.20
Rate for Payer: BCBS MT POS	$55.10
Rate for Payer: BCBS MT Traditional	$58.00
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial	$55.10
Rate for Payer: Cigna Medicare	$52.20
Rate for Payer: Medicaid All Medicaid	$53.36
Rate for Payer: Medicare All Medicare	$40.60
Rate for Payer: Monida Allegiance	$55.10
Rate for Payer: Monida First Choice Health	$56.26
Rate for Payer: Monida Montana Health Co-op	$55.10
Rate for Payer: Monida PacificSource	$55.10

PODDUS BOOT LG

Facility

$58.00

Hospital Charge Code	2840128
Hospital Revenue Code	270
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$58.00
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare	$52.20
Rate for Payer: BCBS MT CHIP	$52.20
Rate for Payer: BCBS MT Closed Plan Network	$55.10
Rate for Payer: BCBS MT HealthLink	$52.20
Rate for Payer: BCBS MT Medicare	$52.20
Rate for Payer: BCBS MT POS	$55.10
Rate for Payer: BCBS MT Traditional	$58.00
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial	$55.10
Rate for Payer: Cigna Medicare	$52.20
Rate for Payer: Medicaid All Medicaid	$53.36
Rate for Payer: Medicare All Medicare	$40.60
Rate for Payer: Monida Allegiance	$55.10
Rate for Payer: Monida First Choice Health	$56.26
Rate for Payer: Monida Montana Health Co-op	$55.10
Rate for Payer: Monida PacificSource	$55.10

PODDUS BOOT XLG

Facility

$49.00

Hospital Charge Code	2893464
Hospital Revenue Code	290
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: BCBS MT CHIP	$44.10
Rate for Payer: BCBS MT Closed Plan Network	$46.55
Rate for Payer: BCBS MT HealthLink	$44.10
Rate for Payer: BCBS MT Medicare	$44.10
Rate for Payer: BCBS MT POS	$46.55
Rate for Payer: BCBS MT Traditional	$49.00
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cigna Commercial	$46.55
Rate for Payer: Cigna Medicare	$44.10
Rate for Payer: Medicaid All Medicaid	$45.08
Rate for Payer: Medicare All Medicare	$34.30
Rate for Payer: Monida Allegiance	$46.55
Rate for Payer: Monida First Choice Health	$47.53
Rate for Payer: Monida Montana Health Co-op	$46.55
Rate for Payer: Monida PacificSource	$46.55

PODDUS BOOT XLG

Facility

$49.00

Hospital Charge Code	2893464
Hospital Revenue Code	290
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: BCBS MT CHIP	$44.10
Rate for Payer: BCBS MT Closed Plan Network	$46.55
Rate for Payer: BCBS MT HealthLink	$44.10
Rate for Payer: BCBS MT Medicare	$44.10
Rate for Payer: BCBS MT POS	$46.55
Rate for Payer: BCBS MT Traditional	$49.00
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cigna Commercial	$46.55
Rate for Payer: Cigna Medicare	$44.10
Rate for Payer: Medicaid All Medicaid	$45.08
Rate for Payer: Medicare All Medicare	$34.30
Rate for Payer: Monida Allegiance	$46.55
Rate for Payer: Monida First Choice Health	$47.53
Rate for Payer: Monida Montana Health Co-op	$46.55
Rate for Payer: Monida PacificSource	$46.55

POLYCY VERA JAK2 V617F W REFLEX TO EXON

Facility

$700.00

Service Code	CPT 81270
Hospital Charge Code	4088101
Hospital Revenue Code	302
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare	$630.00
Rate for Payer: BCBS MT CHIP	$630.00
Rate for Payer: BCBS MT Closed Plan Network	$665.00
Rate for Payer: BCBS MT HealthLink	$630.00
Rate for Payer: BCBS MT Medicare	$630.00
Rate for Payer: BCBS MT POS	$665.00
Rate for Payer: BCBS MT Traditional	$700.00
Rate for Payer: Cash Price	$630.00
Rate for Payer: Cigna Commercial	$665.00
Rate for Payer: Cigna Medicare	$630.00
Rate for Payer: Medicaid All Medicaid	$644.00
Rate for Payer: Medicare All Medicare	$490.00
Rate for Payer: Monida Allegiance	$665.00
Rate for Payer: Monida First Choice Health	$679.00
Rate for Payer: Monida Montana Health Co-op	$665.00
Rate for Payer: Monida PacificSource	$665.00

POLYCY VERA JAK2 V617F W REFLEX TO EXON

Facility

$700.00

Service Code	CPT 81270
Hospital Charge Code	4088101
Hospital Revenue Code	302
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare	$630.00
Rate for Payer: BCBS MT CHIP	$630.00
Rate for Payer: BCBS MT Closed Plan Network	$665.00
Rate for Payer: BCBS MT HealthLink	$630.00
Rate for Payer: BCBS MT Medicare	$630.00
Rate for Payer: BCBS MT POS	$665.00
Rate for Payer: BCBS MT Traditional	$700.00
Rate for Payer: Cash Price	$630.00
Rate for Payer: Cigna Commercial	$665.00
Rate for Payer: Cigna Medicare	$630.00
Rate for Payer: Medicaid All Medicaid	$644.00
Rate for Payer: Medicare All Medicare	$490.00
Rate for Payer: Monida Allegiance	$665.00
Rate for Payer: Monida First Choice Health	$679.00
Rate for Payer: Monida Montana Health Co-op	$665.00
Rate for Payer: Monida PacificSource	$665.00

POLYETHYLENE GLYCOL POWD [17 GM]

Facility

$5.00

Service Code	HCPCS A9150
Hospital Charge Code	3000391
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

POLYETHYLENE GLYCOL POWD [17 GM]

Facility

$5.00

Service Code	HCPCS A9150
Hospital Charge Code	3000391
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

PORPHOBILINOGEN

Facility

$96.75

Service Code	CPT 84110
Hospital Charge Code	4087953
Hospital Revenue Code	302
Min. Negotiated Rate	$67.72
Max. Negotiated Rate	$96.75
Rate for Payer: Aetna Commercial	$91.91
Rate for Payer: Aetna Medicare	$87.08
Rate for Payer: BCBS MT CHIP	$87.08
Rate for Payer: BCBS MT Closed Plan Network	$91.91
Rate for Payer: BCBS MT HealthLink	$87.08
Rate for Payer: BCBS MT Medicare	$87.08
Rate for Payer: BCBS MT POS	$91.91
Rate for Payer: BCBS MT Traditional	$96.75
Rate for Payer: Cash Price	$87.08
Rate for Payer: Cigna Commercial	$91.91
Rate for Payer: Cigna Medicare	$87.08
Rate for Payer: Medicaid All Medicaid	$89.01
Rate for Payer: Medicare All Medicare	$67.72
Rate for Payer: Monida Allegiance	$91.91
Rate for Payer: Monida First Choice Health	$93.85
Rate for Payer: Monida Montana Health Co-op	$91.91
Rate for Payer: Monida PacificSource	$91.91

PORPHOBILINOGEN

Facility

$96.75

Service Code	CPT 84110
Hospital Charge Code	4087953
Hospital Revenue Code	302
Min. Negotiated Rate	$67.72
Max. Negotiated Rate	$96.75
Rate for Payer: Aetna Commercial	$91.91
Rate for Payer: Aetna Medicare	$87.08
Rate for Payer: BCBS MT CHIP	$87.08
Rate for Payer: BCBS MT Closed Plan Network	$91.91
Rate for Payer: BCBS MT HealthLink	$87.08
Rate for Payer: BCBS MT Medicare	$87.08
Rate for Payer: BCBS MT POS	$91.91
Rate for Payer: BCBS MT Traditional	$96.75
Rate for Payer: Cash Price	$87.08
Rate for Payer: Cigna Commercial	$91.91
Rate for Payer: Cigna Medicare	$87.08
Rate for Payer: Medicaid All Medicaid	$89.01
Rate for Payer: Medicare All Medicare	$67.72
Rate for Payer: Monida Allegiance	$91.91
Rate for Payer: Monida First Choice Health	$93.85
Rate for Payer: Monida Montana Health Co-op	$91.91
Rate for Payer: Monida PacificSource	$91.91

POSEY BED ALARM

Facility

$30.00

Hospital Charge Code	80040190
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS MT CHIP	$27.00
Rate for Payer: BCBS MT Closed Plan Network	$28.50
Rate for Payer: BCBS MT HealthLink	$27.00
Rate for Payer: BCBS MT Medicare	$27.00
Rate for Payer: BCBS MT POS	$28.50
Rate for Payer: BCBS MT Traditional	$30.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare	$27.00
Rate for Payer: Medicaid All Medicaid	$27.60
Rate for Payer: Medicare All Medicare	$21.00
Rate for Payer: Monida Allegiance	$28.50
Rate for Payer: Monida First Choice Health	$29.10
Rate for Payer: Monida Montana Health Co-op	$28.50
Rate for Payer: Monida PacificSource	$28.50

POSEY BED ALARM

Facility

$30.00

Hospital Charge Code	80040190
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS MT CHIP	$27.00
Rate for Payer: BCBS MT Closed Plan Network	$28.50
Rate for Payer: BCBS MT HealthLink	$27.00
Rate for Payer: BCBS MT Medicare	$27.00
Rate for Payer: BCBS MT POS	$28.50
Rate for Payer: BCBS MT Traditional	$30.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare	$27.00
Rate for Payer: Medicaid All Medicaid	$27.60
Rate for Payer: Medicare All Medicare	$21.00
Rate for Payer: Monida Allegiance	$28.50
Rate for Payer: Monida First Choice Health	$29.10
Rate for Payer: Monida Montana Health Co-op	$28.50
Rate for Payer: Monida PacificSource	$28.50

POSEY CHAIR ALARM

Facility

$61.00

Hospital Charge Code	80040192
Hospital Revenue Code	270
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare	$54.90
Rate for Payer: BCBS MT CHIP	$54.90
Rate for Payer: BCBS MT Closed Plan Network	$57.95
Rate for Payer: BCBS MT HealthLink	$54.90
Rate for Payer: BCBS MT Medicare	$54.90
Rate for Payer: BCBS MT POS	$57.95
Rate for Payer: BCBS MT Traditional	$61.00
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: Cigna Medicare	$54.90
Rate for Payer: Medicaid All Medicaid	$56.12
Rate for Payer: Medicare All Medicare	$42.70
Rate for Payer: Monida Allegiance	$57.95
Rate for Payer: Monida First Choice Health	$59.17
Rate for Payer: Monida Montana Health Co-op	$57.95
Rate for Payer: Monida PacificSource	$57.95

POSEY CHAIR ALARM

Facility

$61.00

Hospital Charge Code	80040192
Hospital Revenue Code	270
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare	$54.90
Rate for Payer: BCBS MT CHIP	$54.90
Rate for Payer: BCBS MT Closed Plan Network	$57.95
Rate for Payer: BCBS MT HealthLink	$54.90
Rate for Payer: BCBS MT Medicare	$54.90
Rate for Payer: BCBS MT POS	$57.95
Rate for Payer: BCBS MT Traditional	$61.00
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: Cigna Medicare	$54.90
Rate for Payer: Medicaid All Medicaid	$56.12
Rate for Payer: Medicare All Medicare	$42.70
Rate for Payer: Monida Allegiance	$57.95
Rate for Payer: Monida First Choice Health	$59.17
Rate for Payer: Monida Montana Health Co-op	$57.95
Rate for Payer: Monida PacificSource	$57.95

Know your out-of-pocket cost for care.

All Charges