Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PRO FEE DEBRIDEMENT 20SQCM OR LESS 97597

Professional

Both

$66.00

Service Code	CPT 97597
Hospital Charge Code	797597
Hospital Revenue Code	960
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$64.02
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Medicaid All Medicaid	$60.72
Rate for Payer: Medicare All Medicare	$46.20
Rate for Payer: Monida Allegiance	$62.70
Rate for Payer: Monida First Choice Health	$64.02
Rate for Payer: Monida Montana Health Co-op	$62.70
Rate for Payer: Monida PacificSource	$62.70

PRO FEE DEBRIDEMENT EA ADD 20SQCM 97598

Professional

Both

$45.00

Service Code	CPT 97598
Hospital Charge Code	797598
Hospital Revenue Code	982
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$43.65
Rate for Payer: Aetna Commercial	$42.75
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Medicaid All Medicaid	$41.40
Rate for Payer: Medicare All Medicare	$31.50
Rate for Payer: Monida Allegiance	$42.75
Rate for Payer: Monida First Choice Health	$43.65
Rate for Payer: Monida Montana Health Co-op	$42.75
Rate for Payer: Monida PacificSource	$42.75

PRO FEE DEBRIDE NON-SELECT W/O ANES97602

Professional

Both

$100.00

Service Code	CPT 97602
Hospital Charge Code	797602
Hospital Revenue Code	982
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$97.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Medicaid All Medicaid	$92.00
Rate for Payer: Medicare All Medicare	$70.00
Rate for Payer: Monida Allegiance	$95.00
Rate for Payer: Monida First Choice Health	$97.00
Rate for Payer: Monida Montana Health Co-op	$95.00
Rate for Payer: Monida PacificSource	$95.00

PRO FEE DESTRUCTION NEUROLYTIC AGT GENI

Professional

Both

$759.00

Service Code	CPT 64624
Hospital Charge Code	7664624
Hospital Revenue Code	964
Min. Negotiated Rate	$531.30
Max. Negotiated Rate	$759.00
Rate for Payer: Aetna Commercial	$721.05
Rate for Payer: Aetna Medicare	$683.10
Rate for Payer: BCBS MT CHIP	$683.10
Rate for Payer: BCBS MT Closed Plan Network	$721.05
Rate for Payer: BCBS MT HealthLink	$683.10
Rate for Payer: BCBS MT Medicare	$683.10
Rate for Payer: BCBS MT POS	$721.05
Rate for Payer: BCBS MT Traditional	$759.00
Rate for Payer: Cash Price	$683.10
Rate for Payer: Cigna Commercial	$721.05
Rate for Payer: Cigna Medicare	$683.10
Rate for Payer: Medicaid All Medicaid	$698.28
Rate for Payer: Medicare All Medicare	$531.30
Rate for Payer: Monida Allegiance	$721.05
Rate for Payer: Monida First Choice Health	$736.23
Rate for Payer: Monida Montana Health Co-op	$721.05
Rate for Payer: Monida PacificSource	$721.05

PRO FEE DRAIN ABSCESS, CYST DENTO 41800

Professional

Both

$63.00

Service Code	CPT 41800
Hospital Charge Code	741800
Hospital Revenue Code	981
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$59.85
Rate for Payer: Aetna Medicare	$56.70
Rate for Payer: BCBS MT CHIP	$56.70
Rate for Payer: BCBS MT Closed Plan Network	$59.85
Rate for Payer: BCBS MT HealthLink	$56.70
Rate for Payer: BCBS MT Medicare	$56.70
Rate for Payer: BCBS MT POS	$59.85
Rate for Payer: BCBS MT Traditional	$63.00
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna Commercial	$59.85
Rate for Payer: Cigna Medicare	$56.70
Rate for Payer: Medicaid All Medicaid	$57.96
Rate for Payer: Medicare All Medicare	$44.10
Rate for Payer: Monida Allegiance	$59.85
Rate for Payer: Monida First Choice Health	$61.11
Rate for Payer: Monida Montana Health Co-op	$59.85
Rate for Payer: Monida PacificSource	$59.85

PRO FEE DRAIN/INJ JOINT/BURSA W/US 20604

Professional

Both

$238.00

Service Code	CPT 20604
Hospital Charge Code	720604
Hospital Revenue Code	964
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$238.00
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare	$214.20
Rate for Payer: BCBS MT CHIP	$214.20
Rate for Payer: BCBS MT Closed Plan Network	$226.10
Rate for Payer: BCBS MT HealthLink	$214.20
Rate for Payer: BCBS MT Medicare	$214.20
Rate for Payer: BCBS MT POS	$226.10
Rate for Payer: BCBS MT Traditional	$238.00
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cigna Commercial	$226.10
Rate for Payer: Cigna Medicare	$214.20
Rate for Payer: Medicaid All Medicaid	$218.96
Rate for Payer: Medicare All Medicare	$166.60
Rate for Payer: Monida Allegiance	$226.10
Rate for Payer: Monida First Choice Health	$230.86
Rate for Payer: Monida Montana Health Co-op	$226.10
Rate for Payer: Monida PacificSource	$226.10

PROFEE ECHO BUBBLE STUDY

Professional

Both

$264.00

Service Code	CPT 93306
Hospital Charge Code	50002391
Hospital Revenue Code	972
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$256.08
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Medicaid All Medicaid	$242.88
Rate for Payer: Medicare All Medicare	$184.80
Rate for Payer: Monida Allegiance	$250.80
Rate for Payer: Monida First Choice Health	$256.08
Rate for Payer: Monida Montana Health Co-op	$250.80
Rate for Payer: Monida PacificSource	$250.80

PROFEE ECHO COMPLETE

Professional

Both

$264.00

Service Code	CPT 93306
Hospital Charge Code	50002392
Hospital Revenue Code	972
Min. Negotiated Rate	$184.80
Max. Negotiated Rate	$256.08
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Medicaid All Medicaid	$242.88
Rate for Payer: Medicare All Medicare	$184.80
Rate for Payer: Monida Allegiance	$250.80
Rate for Payer: Monida First Choice Health	$256.08
Rate for Payer: Monida Montana Health Co-op	$250.80
Rate for Payer: Monida PacificSource	$250.80

PROFEE ECHO EXAM OF FETAL HEART

Professional

Both

$304.00

Service Code	CPT 76825
Hospital Charge Code	50002393
Hospital Revenue Code	972
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$294.88
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Medicaid All Medicaid	$279.68
Rate for Payer: Medicare All Medicare	$212.80
Rate for Payer: Monida Allegiance	$288.80
Rate for Payer: Monida First Choice Health	$294.88
Rate for Payer: Monida Montana Health Co-op	$288.80
Rate for Payer: Monida PacificSource	$288.80

PROFEE ECHO EXAM UTERUS

Professional

Both

$133.00

Service Code	CPT 76831
Hospital Charge Code	50002394
Hospital Revenue Code	972
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$129.01
Rate for Payer: Aetna Commercial	$126.35
Rate for Payer: Aetna Medicare	$119.70
Rate for Payer: Cash Price	$119.70
Rate for Payer: Medicaid All Medicaid	$122.36
Rate for Payer: Medicare All Medicare	$93.10
Rate for Payer: Monida Allegiance	$126.35
Rate for Payer: Monida First Choice Health	$129.01
Rate for Payer: Monida Montana Health Co-op	$126.35
Rate for Payer: Monida PacificSource	$126.35

PROFEE ECHO LIMITED

Professional

Both

$95.00

Service Code	CPT 93308
Hospital Charge Code	50002395
Hospital Revenue Code	972
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$92.15
Rate for Payer: Aetna Commercial	$90.25
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Medicaid All Medicaid	$87.40
Rate for Payer: Medicare All Medicare	$66.50
Rate for Payer: Monida Allegiance	$90.25
Rate for Payer: Monida First Choice Health	$92.15
Rate for Payer: Monida Montana Health Co-op	$90.25
Rate for Payer: Monida PacificSource	$90.25

PROFEE ECHO REAL TIME IMAGING

Professional

Both

$118.00

Service Code	CPT 76506
Hospital Charge Code	50002396
Hospital Revenue Code	972
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$114.46
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Medicaid All Medicaid	$108.56
Rate for Payer: Medicare All Medicare	$82.60
Rate for Payer: Monida Allegiance	$112.10
Rate for Payer: Monida First Choice Health	$114.46
Rate for Payer: Monida Montana Health Co-op	$112.10
Rate for Payer: Monida PacificSource	$112.10

PROFEE EGD 43235

Professional

Both

$404.00

Service Code	CPT 43235
Hospital Charge Code	584000
Hospital Revenue Code	960
Min. Negotiated Rate	$282.80
Max. Negotiated Rate	$391.88
Rate for Payer: Aetna Commercial	$383.80
Rate for Payer: Aetna Medicare	$363.60
Rate for Payer: Cash Price	$363.60
Rate for Payer: Medicaid All Medicaid	$371.68
Rate for Payer: Medicare All Medicare	$282.80
Rate for Payer: Monida Allegiance	$383.80
Rate for Payer: Monida First Choice Health	$391.88
Rate for Payer: Monida Montana Health Co-op	$383.80
Rate for Payer: Monida PacificSource	$383.80

PROFEE EGD W/ BIOPSY 43239

Professional

Both

$454.00

Service Code	CPT 43239
Hospital Charge Code	5840001
Hospital Revenue Code	960
Min. Negotiated Rate	$317.80
Max. Negotiated Rate	$440.38
Rate for Payer: Aetna Commercial	$431.30
Rate for Payer: Aetna Medicare	$408.60
Rate for Payer: Cash Price	$408.60
Rate for Payer: Medicaid All Medicaid	$417.68
Rate for Payer: Medicare All Medicare	$317.80
Rate for Payer: Monida Allegiance	$431.30
Rate for Payer: Monida First Choice Health	$440.38
Rate for Payer: Monida Montana Health Co-op	$431.30
Rate for Payer: Monida PacificSource	$431.30

PRO FEE EKG 12 LEAD

Professional

Both

$18.00

Service Code	CPT 93010
Hospital Charge Code	793010
Hospital Revenue Code	985
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$17.46
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Medicaid All Medicaid	$16.56
Rate for Payer: Medicare All Medicare	$12.60
Rate for Payer: Monida Allegiance	$17.10
Rate for Payer: Monida First Choice Health	$17.46
Rate for Payer: Monida Montana Health Co-op	$17.10
Rate for Payer: Monida PacificSource	$17.10

PRO FEE EPISTAXIS, COMPLEX

Professional

Both

$99.00

Service Code	CPT 30903
Hospital Charge Code	730903
Hospital Revenue Code	981
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare	$89.10
Rate for Payer: BCBS MT CHIP	$89.10
Rate for Payer: BCBS MT Closed Plan Network	$94.05
Rate for Payer: BCBS MT HealthLink	$89.10
Rate for Payer: BCBS MT Medicare	$89.10
Rate for Payer: BCBS MT POS	$94.05
Rate for Payer: BCBS MT Traditional	$99.00
Rate for Payer: Cash Price	$89.10
Rate for Payer: Cigna Commercial	$94.05
Rate for Payer: Cigna Medicare	$89.10
Rate for Payer: Medicaid All Medicaid	$91.08
Rate for Payer: Medicare All Medicare	$69.30
Rate for Payer: Monida Allegiance	$94.05
Rate for Payer: Monida First Choice Health	$96.03
Rate for Payer: Monida Montana Health Co-op	$94.05
Rate for Payer: Monida PacificSource	$94.05

PRO FEE EPISTAXIS, INITIAL

Professional

Both

$89.00

Service Code	CPT 30905
Hospital Charge Code	730905
Hospital Revenue Code	981
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$89.00
Rate for Payer: Aetna Commercial	$84.55
Rate for Payer: Aetna Medicare	$80.10
Rate for Payer: BCBS MT CHIP	$80.10
Rate for Payer: BCBS MT Closed Plan Network	$84.55
Rate for Payer: BCBS MT HealthLink	$80.10
Rate for Payer: BCBS MT Medicare	$80.10
Rate for Payer: BCBS MT POS	$84.55
Rate for Payer: BCBS MT Traditional	$89.00
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna Commercial	$84.55
Rate for Payer: Cigna Medicare	$80.10
Rate for Payer: Medicaid All Medicaid	$81.88
Rate for Payer: Medicare All Medicare	$62.30
Rate for Payer: Monida Allegiance	$84.55
Rate for Payer: Monida First Choice Health	$86.33
Rate for Payer: Monida Montana Health Co-op	$84.55
Rate for Payer: Monida PacificSource	$84.55

PRO FEE EPISTAXIS, SIMPLE

Professional

Both

$89.00

Service Code	CPT 30901
Hospital Charge Code	730901
Hospital Revenue Code	981
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$89.00
Rate for Payer: Aetna Commercial	$84.55
Rate for Payer: Aetna Medicare	$80.10
Rate for Payer: BCBS MT CHIP	$80.10
Rate for Payer: BCBS MT Closed Plan Network	$84.55
Rate for Payer: BCBS MT HealthLink	$80.10
Rate for Payer: BCBS MT Medicare	$80.10
Rate for Payer: BCBS MT POS	$84.55
Rate for Payer: BCBS MT Traditional	$89.00
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna Commercial	$84.55
Rate for Payer: Cigna Medicare	$80.10
Rate for Payer: Medicaid All Medicaid	$81.88
Rate for Payer: Medicare All Medicare	$62.30
Rate for Payer: Monida Allegiance	$84.55
Rate for Payer: Monida First Choice Health	$86.33
Rate for Payer: Monida Montana Health Co-op	$84.55
Rate for Payer: Monida PacificSource	$84.55

PRO FEE ER APPLICATION OF SHORT LEG SPLI

Professional

Both

$262.00

Service Code	CPT 29515
Hospital Charge Code	7229515
Hospital Revenue Code	981
Min. Negotiated Rate	$183.40
Max. Negotiated Rate	$262.00
Rate for Payer: Aetna Commercial	$248.90
Rate for Payer: Aetna Medicare	$235.80
Rate for Payer: BCBS MT CHIP	$235.80
Rate for Payer: BCBS MT Closed Plan Network	$248.90
Rate for Payer: BCBS MT HealthLink	$235.80
Rate for Payer: BCBS MT Medicare	$235.80
Rate for Payer: BCBS MT POS	$248.90
Rate for Payer: BCBS MT Traditional	$262.00
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cigna Commercial	$248.90
Rate for Payer: Cigna Medicare	$235.80
Rate for Payer: Medicaid All Medicaid	$241.04
Rate for Payer: Medicare All Medicare	$183.40
Rate for Payer: Monida Allegiance	$248.90
Rate for Payer: Monida First Choice Health	$254.14
Rate for Payer: Monida Montana Health Co-op	$248.90
Rate for Payer: Monida PacificSource	$248.90

PRO FEE ER APPLICATION SPLINT LONG 29105

Professional

Both

$214.00

Service Code	CPT 29105
Hospital Charge Code	729105
Hospital Revenue Code	981
Min. Negotiated Rate	$149.80
Max. Negotiated Rate	$214.00
Rate for Payer: Aetna Commercial	$203.30
Rate for Payer: Aetna Medicare	$192.60
Rate for Payer: BCBS MT CHIP	$192.60
Rate for Payer: BCBS MT Closed Plan Network	$203.30
Rate for Payer: BCBS MT HealthLink	$192.60
Rate for Payer: BCBS MT Medicare	$192.60
Rate for Payer: BCBS MT POS	$203.30
Rate for Payer: BCBS MT Traditional	$214.00
Rate for Payer: Cash Price	$192.60
Rate for Payer: Cigna Commercial	$203.30
Rate for Payer: Cigna Medicare	$192.60
Rate for Payer: Medicaid All Medicaid	$196.88
Rate for Payer: Medicare All Medicare	$149.80
Rate for Payer: Monida Allegiance	$203.30
Rate for Payer: Monida First Choice Health	$207.58
Rate for Payer: Monida Montana Health Co-op	$203.30
Rate for Payer: Monida PacificSource	$203.30

PRO FEE ER APPL OF LONG LEG SPLINT

Professional

Both

$278.00

Service Code	CPT 29505
Hospital Charge Code	7229505
Hospital Revenue Code	981
Min. Negotiated Rate	$194.60
Max. Negotiated Rate	$278.00
Rate for Payer: Aetna Commercial	$264.10
Rate for Payer: Aetna Medicare	$250.20
Rate for Payer: BCBS MT CHIP	$250.20
Rate for Payer: BCBS MT Closed Plan Network	$264.10
Rate for Payer: BCBS MT HealthLink	$250.20
Rate for Payer: BCBS MT Medicare	$250.20
Rate for Payer: BCBS MT POS	$264.10
Rate for Payer: BCBS MT Traditional	$278.00
Rate for Payer: Cash Price	$250.20
Rate for Payer: Cigna Commercial	$264.10
Rate for Payer: Cigna Medicare	$250.20
Rate for Payer: Medicaid All Medicaid	$255.76
Rate for Payer: Medicare All Medicare	$194.60
Rate for Payer: Monida Allegiance	$264.10
Rate for Payer: Monida First Choice Health	$269.66
Rate for Payer: Monida Montana Health Co-op	$264.10
Rate for Payer: Monida PacificSource	$264.10

PRO FEE ER BRIEF 99281

Professional

Both

$35.00

Service Code	CPT 99281
Hospital Charge Code	799281
Hospital Revenue Code	981
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

PRO FEE ER CARDIOPULMONARY RESUSC 92950

Professional

Both

$316.00

Service Code	CPT 92950
Hospital Charge Code	792950
Hospital Revenue Code	981
Min. Negotiated Rate	$221.20
Max. Negotiated Rate	$316.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare	$284.40
Rate for Payer: BCBS MT CHIP	$284.40
Rate for Payer: BCBS MT Closed Plan Network	$300.20
Rate for Payer: BCBS MT HealthLink	$284.40
Rate for Payer: BCBS MT Medicare	$284.40
Rate for Payer: BCBS MT POS	$300.20
Rate for Payer: BCBS MT Traditional	$316.00
Rate for Payer: Cash Price	$284.40
Rate for Payer: Cigna Commercial	$300.20
Rate for Payer: Cigna Medicare	$284.40
Rate for Payer: Medicaid All Medicaid	$290.72
Rate for Payer: Medicare All Medicare	$221.20
Rate for Payer: Monida Allegiance	$300.20
Rate for Payer: Monida First Choice Health	$306.52
Rate for Payer: Monida Montana Health Co-op	$300.20
Rate for Payer: Monida PacificSource	$300.20

PRO FEE ER CLOSED TRT NOSE FX W/O STAB

Professional

Both

$312.00

Service Code	CPT 21315
Hospital Charge Code	721315
Hospital Revenue Code	981
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare	$280.80
Rate for Payer: BCBS MT CHIP	$280.80
Rate for Payer: BCBS MT Closed Plan Network	$296.40
Rate for Payer: BCBS MT HealthLink	$280.80
Rate for Payer: BCBS MT Medicare	$280.80
Rate for Payer: BCBS MT POS	$296.40
Rate for Payer: BCBS MT Traditional	$312.00
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cigna Commercial	$296.40
Rate for Payer: Cigna Medicare	$280.80
Rate for Payer: Medicaid All Medicaid	$287.04
Rate for Payer: Medicare All Medicare	$218.40
Rate for Payer: Monida Allegiance	$296.40
Rate for Payer: Monida First Choice Health	$302.64
Rate for Payer: Monida Montana Health Co-op	$296.40
Rate for Payer: Monida PacificSource	$296.40

PRO FEE ER COMPREHENSIVE 99285

Professional

Both

$462.00

Service Code	CPT 99285
Hospital Charge Code	799285
Hospital Revenue Code	981
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$462.00
Rate for Payer: Aetna Commercial	$438.90
Rate for Payer: Aetna Medicare	$415.80
Rate for Payer: BCBS MT CHIP	$415.80
Rate for Payer: BCBS MT Closed Plan Network	$438.90
Rate for Payer: BCBS MT HealthLink	$415.80
Rate for Payer: BCBS MT Medicare	$415.80
Rate for Payer: BCBS MT POS	$438.90
Rate for Payer: BCBS MT Traditional	$462.00
Rate for Payer: Cash Price	$415.80
Rate for Payer: Cigna Commercial	$438.90
Rate for Payer: Cigna Medicare	$415.80
Rate for Payer: Medicaid All Medicaid	$425.04
Rate for Payer: Medicare All Medicare	$323.40
Rate for Payer: Monida Allegiance	$438.90
Rate for Payer: Monida First Choice Health	$448.14
Rate for Payer: Monida Montana Health Co-op	$438.90
Rate for Payer: Monida PacificSource	$438.90

Know your out-of-pocket cost for care.

All Charges