Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PROFEE MR UPPR XT W CON LT

Professional

Both

$228.00

Service Code	CPT 73219
Hospital Charge Code	50002199
Hospital Revenue Code	972
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$221.16
Rate for Payer: Aetna Commercial	$216.60
Rate for Payer: Aetna Medicare	$205.20
Rate for Payer: Cash Price	$205.20
Rate for Payer: Medicaid All Medicaid	$209.76
Rate for Payer: Medicare All Medicare	$159.60
Rate for Payer: Monida Allegiance	$216.60
Rate for Payer: Monida First Choice Health	$221.16
Rate for Payer: Monida Montana Health Co-op	$216.60
Rate for Payer: Monida PacificSource	$216.60

PROFEE MR UPPR XT W CON RT

Professional

Both

$228.00

Service Code	CPT 73219
Hospital Charge Code	50002200
Hospital Revenue Code	972
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$221.16
Rate for Payer: Aetna Commercial	$216.60
Rate for Payer: Aetna Medicare	$205.20
Rate for Payer: Cash Price	$205.20
Rate for Payer: Medicaid All Medicaid	$209.76
Rate for Payer: Medicare All Medicare	$159.60
Rate for Payer: Monida Allegiance	$216.60
Rate for Payer: Monida First Choice Health	$221.16
Rate for Payer: Monida Montana Health Co-op	$216.60
Rate for Payer: Monida PacificSource	$216.60

PROFEE MR UPPR XT WO CON LT

Professional

Both

$191.00

Service Code	CPT 73218
Hospital Charge Code	50002201
Hospital Revenue Code	972
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$185.27
Rate for Payer: Aetna Commercial	$181.45
Rate for Payer: Aetna Medicare	$171.90
Rate for Payer: Cash Price	$171.90
Rate for Payer: Medicaid All Medicaid	$175.72
Rate for Payer: Medicare All Medicare	$133.70
Rate for Payer: Monida Allegiance	$181.45
Rate for Payer: Monida First Choice Health	$185.27
Rate for Payer: Monida Montana Health Co-op	$181.45
Rate for Payer: Monida PacificSource	$181.45

PROFEE MR UPPR XT WO CON RT

Professional

Both

$191.00

Service Code	CPT 73218
Hospital Charge Code	50002202
Hospital Revenue Code	972
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$185.27
Rate for Payer: Aetna Commercial	$181.45
Rate for Payer: Aetna Medicare	$171.90
Rate for Payer: Cash Price	$171.90
Rate for Payer: Medicaid All Medicaid	$175.72
Rate for Payer: Medicare All Medicare	$133.70
Rate for Payer: Monida Allegiance	$181.45
Rate for Payer: Monida First Choice Health	$185.27
Rate for Payer: Monida Montana Health Co-op	$181.45
Rate for Payer: Monida PacificSource	$181.45

PROFEE MR UPPR XT WO&W CON LT

Professional

Both

$306.00

Service Code	CPT 73220
Hospital Charge Code	50002203
Hospital Revenue Code	972
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$296.82
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare	$275.40
Rate for Payer: Cash Price	$275.40
Rate for Payer: Medicaid All Medicaid	$281.52
Rate for Payer: Medicare All Medicare	$214.20
Rate for Payer: Monida Allegiance	$290.70
Rate for Payer: Monida First Choice Health	$296.82
Rate for Payer: Monida Montana Health Co-op	$290.70
Rate for Payer: Monida PacificSource	$290.70

PROFEE MR UPPR XT WO&W CON RT

Professional

Both

$306.00

Service Code	CPT 73220
Hospital Charge Code	50002204
Hospital Revenue Code	972
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$296.82
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare	$275.40
Rate for Payer: Cash Price	$275.40
Rate for Payer: Medicaid All Medicaid	$281.52
Rate for Payer: Medicare All Medicare	$214.20
Rate for Payer: Monida Allegiance	$290.70
Rate for Payer: Monida First Choice Health	$296.82
Rate for Payer: Monida Montana Health Co-op	$290.70
Rate for Payer: Monida PacificSource	$290.70

PROFEE MR WRIST LT W CONTRAST

Professional

Both

$229.00

Service Code	CPT 73222
Hospital Charge Code	50002205
Hospital Revenue Code	972
Min. Negotiated Rate	$160.30
Max. Negotiated Rate	$222.13
Rate for Payer: Aetna Commercial	$217.55
Rate for Payer: Aetna Medicare	$206.10
Rate for Payer: Cash Price	$206.10
Rate for Payer: Medicaid All Medicaid	$210.68
Rate for Payer: Medicare All Medicare	$160.30
Rate for Payer: Monida Allegiance	$217.55
Rate for Payer: Monida First Choice Health	$222.13
Rate for Payer: Monida Montana Health Co-op	$217.55
Rate for Payer: Monida PacificSource	$217.55

PROFEE MR WRIST LT WO CONTRAST

Professional

Both

$191.00

Service Code	CPT 73221
Hospital Charge Code	50002207
Hospital Revenue Code	972
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$185.27
Rate for Payer: Aetna Commercial	$181.45
Rate for Payer: Aetna Medicare	$171.90
Rate for Payer: Cash Price	$171.90
Rate for Payer: Medicaid All Medicaid	$175.72
Rate for Payer: Medicare All Medicare	$133.70
Rate for Payer: Monida Allegiance	$181.45
Rate for Payer: Monida First Choice Health	$185.27
Rate for Payer: Monida Montana Health Co-op	$181.45
Rate for Payer: Monida PacificSource	$181.45

PROFEE MR WRIST LT W WO CONTRAST

Professional

Both

$306.00

Service Code	CPT 73223
Hospital Charge Code	50002206
Hospital Revenue Code	972
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$296.82
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare	$275.40
Rate for Payer: Cash Price	$275.40
Rate for Payer: Medicaid All Medicaid	$281.52
Rate for Payer: Medicare All Medicare	$214.20
Rate for Payer: Monida Allegiance	$290.70
Rate for Payer: Monida First Choice Health	$296.82
Rate for Payer: Monida Montana Health Co-op	$290.70
Rate for Payer: Monida PacificSource	$290.70

PROFEE MR WRIST RT W CONTRAST

Professional

Both

$229.00

Service Code	CPT 73222
Hospital Charge Code	50002208
Hospital Revenue Code	972
Min. Negotiated Rate	$160.30
Max. Negotiated Rate	$222.13
Rate for Payer: Aetna Commercial	$217.55
Rate for Payer: Aetna Medicare	$206.10
Rate for Payer: Cash Price	$206.10
Rate for Payer: Medicaid All Medicaid	$210.68
Rate for Payer: Medicare All Medicare	$160.30
Rate for Payer: Monida Allegiance	$217.55
Rate for Payer: Monida First Choice Health	$222.13
Rate for Payer: Monida Montana Health Co-op	$217.55
Rate for Payer: Monida PacificSource	$217.55

PROFEE MR WRIST RT WO CONTRAST

Professional

Both

$191.00

Service Code	CPT 73221
Hospital Charge Code	50002210
Hospital Revenue Code	972
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$185.27
Rate for Payer: Aetna Commercial	$181.45
Rate for Payer: Aetna Medicare	$171.90
Rate for Payer: Cash Price	$171.90
Rate for Payer: Medicaid All Medicaid	$175.72
Rate for Payer: Medicare All Medicare	$133.70
Rate for Payer: Monida Allegiance	$181.45
Rate for Payer: Monida First Choice Health	$185.27
Rate for Payer: Monida Montana Health Co-op	$181.45
Rate for Payer: Monida PacificSource	$181.45

PROFEE MR WRIST RT W WO CONTRAST

Professional

Both

$306.00

Service Code	CPT 73223
Hospital Charge Code	50002209
Hospital Revenue Code	972
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$296.82
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare	$275.40
Rate for Payer: Cash Price	$275.40
Rate for Payer: Medicaid All Medicaid	$281.52
Rate for Payer: Medicare All Medicare	$214.20
Rate for Payer: Monida Allegiance	$290.70
Rate for Payer: Monida First Choice Health	$296.82
Rate for Payer: Monida Montana Health Co-op	$290.70
Rate for Payer: Monida PacificSource	$290.70

PRO FEE NJX AA&/STRD NRV NRVTG SI JT

Professional

Both

$159.14

Service Code	CPT 64451
Hospital Charge Code	7664451
Hospital Revenue Code	964
Min. Negotiated Rate	$111.40
Max. Negotiated Rate	$159.14
Rate for Payer: Aetna Commercial	$151.18
Rate for Payer: Aetna Medicare	$143.23
Rate for Payer: BCBS MT CHIP	$143.23
Rate for Payer: BCBS MT Closed Plan Network	$151.18
Rate for Payer: BCBS MT HealthLink	$143.23
Rate for Payer: BCBS MT Medicare	$143.23
Rate for Payer: BCBS MT POS	$151.18
Rate for Payer: BCBS MT Traditional	$159.14
Rate for Payer: Cash Price	$143.23
Rate for Payer: Cigna Commercial	$151.18
Rate for Payer: Cigna Medicare	$143.23
Rate for Payer: Medicaid All Medicaid	$146.41
Rate for Payer: Medicare All Medicare	$111.40
Rate for Payer: Monida Allegiance	$151.18
Rate for Payer: Monida First Choice Health	$154.37
Rate for Payer: Monida Montana Health Co-op	$151.18
Rate for Payer: Monida PacificSource	$151.18

PRO FEE OP IJ DESTR, PLANTAR NERV 64632

Professional

Both

$351.00

Service Code	CPT 64632
Hospital Charge Code	764632
Hospital Revenue Code	964
Min. Negotiated Rate	$245.70
Max. Negotiated Rate	$351.00
Rate for Payer: Aetna Commercial	$333.45
Rate for Payer: Aetna Medicare	$315.90
Rate for Payer: BCBS MT CHIP	$315.90
Rate for Payer: BCBS MT Closed Plan Network	$333.45
Rate for Payer: BCBS MT HealthLink	$315.90
Rate for Payer: BCBS MT Medicare	$315.90
Rate for Payer: BCBS MT POS	$333.45
Rate for Payer: BCBS MT Traditional	$351.00
Rate for Payer: Cash Price	$315.90
Rate for Payer: Cigna Commercial	$333.45
Rate for Payer: Cigna Medicare	$315.90
Rate for Payer: Medicaid All Medicaid	$322.92
Rate for Payer: Medicare All Medicare	$245.70
Rate for Payer: Monida Allegiance	$333.45
Rate for Payer: Monida First Choice Health	$340.47
Rate for Payer: Monida Montana Health Co-op	$333.45
Rate for Payer: Monida PacificSource	$333.45

PRO FEE OP IJ DESTR, PUDENDAL NERV 64630

Professional

Both

$1,002.00

Service Code	CPT 64630
Hospital Charge Code	764630
Hospital Revenue Code	964
Min. Negotiated Rate	$701.40
Max. Negotiated Rate	$1,002.00
Rate for Payer: Aetna Commercial	$951.90
Rate for Payer: Aetna Medicare	$901.80
Rate for Payer: BCBS MT CHIP	$901.80
Rate for Payer: BCBS MT Closed Plan Network	$951.90
Rate for Payer: BCBS MT HealthLink	$901.80
Rate for Payer: BCBS MT Medicare	$901.80
Rate for Payer: BCBS MT POS	$951.90
Rate for Payer: BCBS MT Traditional	$1,002.00
Rate for Payer: Cash Price	$901.80
Rate for Payer: Cigna Commercial	$951.90
Rate for Payer: Cigna Medicare	$901.80
Rate for Payer: Medicaid All Medicaid	$921.84
Rate for Payer: Medicare All Medicare	$701.40
Rate for Payer: Monida Allegiance	$951.90
Rate for Payer: Monida First Choice Health	$971.94
Rate for Payer: Monida Montana Health Co-op	$951.90
Rate for Payer: Monida PacificSource	$951.90

PRO FEE OP IJ DST. F NER MIGRN TRT 64615

Professional

Both

$638.00

Service Code	CPT 64615
Hospital Charge Code	764615
Hospital Revenue Code	964
Min. Negotiated Rate	$446.60
Max. Negotiated Rate	$638.00
Rate for Payer: Aetna Commercial	$606.10
Rate for Payer: Aetna Medicare	$574.20
Rate for Payer: BCBS MT CHIP	$574.20
Rate for Payer: BCBS MT Closed Plan Network	$606.10
Rate for Payer: BCBS MT HealthLink	$574.20
Rate for Payer: BCBS MT Medicare	$574.20
Rate for Payer: BCBS MT POS	$606.10
Rate for Payer: BCBS MT Traditional	$638.00
Rate for Payer: Cash Price	$574.20
Rate for Payer: Cigna Commercial	$606.10
Rate for Payer: Cigna Medicare	$574.20
Rate for Payer: Medicaid All Medicaid	$586.96
Rate for Payer: Medicare All Medicare	$446.60
Rate for Payer: Monida Allegiance	$606.10
Rate for Payer: Monida First Choice Health	$618.86
Rate for Payer: Monida Montana Health Co-op	$606.10
Rate for Payer: Monida PacificSource	$606.10

PRO FEE OP IJ GREATER OCCIP NV BLK 64405

Professional

Both

$273.00

Service Code	CPT 64405
Hospital Charge Code	764405
Hospital Revenue Code	964
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$273.00
Rate for Payer: Aetna Commercial	$259.35
Rate for Payer: Aetna Medicare	$245.70
Rate for Payer: BCBS MT CHIP	$245.70
Rate for Payer: BCBS MT Closed Plan Network	$259.35
Rate for Payer: BCBS MT HealthLink	$245.70
Rate for Payer: BCBS MT Medicare	$245.70
Rate for Payer: BCBS MT POS	$259.35
Rate for Payer: BCBS MT Traditional	$273.00
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cigna Commercial	$259.35
Rate for Payer: Cigna Medicare	$245.70
Rate for Payer: Medicaid All Medicaid	$251.16
Rate for Payer: Medicare All Medicare	$191.10
Rate for Payer: Monida Allegiance	$259.35
Rate for Payer: Monida First Choice Health	$264.81
Rate for Payer: Monida Montana Health Co-op	$259.35
Rate for Payer: Monida PacificSource	$259.35

PRO FEE OP IJ RFA C/T 1ST JOINT 64633

Professional

Both

$992.00

Service Code	CPT 64633
Hospital Charge Code	764633
Hospital Revenue Code	964
Min. Negotiated Rate	$694.40
Max. Negotiated Rate	$992.00
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: Aetna Medicare	$892.80
Rate for Payer: BCBS MT CHIP	$892.80
Rate for Payer: BCBS MT Closed Plan Network	$942.40
Rate for Payer: BCBS MT HealthLink	$892.80
Rate for Payer: BCBS MT Medicare	$892.80
Rate for Payer: BCBS MT POS	$942.40
Rate for Payer: BCBS MT Traditional	$992.00
Rate for Payer: Cash Price	$892.80
Rate for Payer: Cigna Commercial	$942.40
Rate for Payer: Cigna Medicare	$892.80
Rate for Payer: Medicaid All Medicaid	$912.64
Rate for Payer: Medicare All Medicare	$694.40
Rate for Payer: Monida Allegiance	$942.40
Rate for Payer: Monida First Choice Health	$962.24
Rate for Payer: Monida Montana Health Co-op	$942.40
Rate for Payer: Monida PacificSource	$942.40

PRO FEE OP IJ RFA C/T EA AD ON JT 64634

Professional

Both

$343.00

Service Code	CPT 64634
Hospital Charge Code	764634
Hospital Revenue Code	964
Min. Negotiated Rate	$240.10
Max. Negotiated Rate	$343.00
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare	$308.70
Rate for Payer: BCBS MT CHIP	$308.70
Rate for Payer: BCBS MT Closed Plan Network	$325.85
Rate for Payer: BCBS MT HealthLink	$308.70
Rate for Payer: BCBS MT Medicare	$308.70
Rate for Payer: BCBS MT POS	$325.85
Rate for Payer: BCBS MT Traditional	$343.00
Rate for Payer: Cash Price	$308.70
Rate for Payer: Cigna Commercial	$325.85
Rate for Payer: Cigna Medicare	$308.70
Rate for Payer: Medicaid All Medicaid	$315.56
Rate for Payer: Medicare All Medicare	$240.10
Rate for Payer: Monida Allegiance	$325.85
Rate for Payer: Monida First Choice Health	$332.71
Rate for Payer: Monida Montana Health Co-op	$325.85
Rate for Payer: Monida PacificSource	$325.85

PRO FEE OP IJ RFA PERPH NV/SUPSCAP 64640

Professional

Both

$623.00

Service Code	CPT 64640
Hospital Charge Code	764640
Hospital Revenue Code	964
Min. Negotiated Rate	$436.10
Max. Negotiated Rate	$623.00
Rate for Payer: Aetna Commercial	$591.85
Rate for Payer: Aetna Medicare	$560.70
Rate for Payer: BCBS MT CHIP	$560.70
Rate for Payer: BCBS MT Closed Plan Network	$591.85
Rate for Payer: BCBS MT HealthLink	$560.70
Rate for Payer: BCBS MT Medicare	$560.70
Rate for Payer: BCBS MT POS	$591.85
Rate for Payer: BCBS MT Traditional	$623.00
Rate for Payer: Cash Price	$560.70
Rate for Payer: Cigna Commercial	$591.85
Rate for Payer: Cigna Medicare	$560.70
Rate for Payer: Medicaid All Medicaid	$573.16
Rate for Payer: Medicare All Medicare	$436.10
Rate for Payer: Monida Allegiance	$591.85
Rate for Payer: Monida First Choice Health	$604.31
Rate for Payer: Monida Montana Health Co-op	$591.85
Rate for Payer: Monida PacificSource	$591.85

PRO FEE OP IJ TRANSFOR L/S ADD 64484

Professional

Both

$259.00

Service Code	CPT 64484
Hospital Charge Code	764484
Hospital Revenue Code	964
Min. Negotiated Rate	$181.30
Max. Negotiated Rate	$259.00
Rate for Payer: Aetna Commercial	$246.05
Rate for Payer: Aetna Medicare	$233.10
Rate for Payer: BCBS MT CHIP	$233.10
Rate for Payer: BCBS MT Closed Plan Network	$246.05
Rate for Payer: BCBS MT HealthLink	$233.10
Rate for Payer: BCBS MT Medicare	$233.10
Rate for Payer: BCBS MT POS	$246.05
Rate for Payer: BCBS MT Traditional	$259.00
Rate for Payer: Cash Price	$233.10
Rate for Payer: Cigna Commercial	$246.05
Rate for Payer: Cigna Medicare	$233.10
Rate for Payer: Medicaid All Medicaid	$238.28
Rate for Payer: Medicare All Medicare	$181.30
Rate for Payer: Monida Allegiance	$246.05
Rate for Payer: Monida First Choice Health	$251.23
Rate for Payer: Monida Montana Health Co-op	$246.05
Rate for Payer: Monida PacificSource	$246.05

PRO FEE OP INJ BRACHIAL PLEX W/IMG 64415

Professional

Both

$356.00

Service Code	CPT 64415
Hospital Charge Code	764415
Hospital Revenue Code	964
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$356.00
Rate for Payer: Aetna Commercial	$338.20
Rate for Payer: Aetna Medicare	$320.40
Rate for Payer: BCBS MT CHIP	$320.40
Rate for Payer: BCBS MT Closed Plan Network	$338.20
Rate for Payer: BCBS MT HealthLink	$320.40
Rate for Payer: BCBS MT Medicare	$320.40
Rate for Payer: BCBS MT POS	$338.20
Rate for Payer: BCBS MT Traditional	$356.00
Rate for Payer: Cash Price	$320.40
Rate for Payer: Cigna Commercial	$338.20
Rate for Payer: Cigna Medicare	$320.40
Rate for Payer: Medicaid All Medicaid	$327.52
Rate for Payer: Medicare All Medicare	$249.20
Rate for Payer: Monida Allegiance	$338.20
Rate for Payer: Monida First Choice Health	$345.32
Rate for Payer: Monida Montana Health Co-op	$338.20
Rate for Payer: Monida PacificSource	$338.20

PRO FEE OP INJ CELIAC PLEX BLOCK 64530

Professional

Both

$489.00

Service Code	CPT 64530
Hospital Charge Code	764530
Hospital Revenue Code	964
Min. Negotiated Rate	$342.30
Max. Negotiated Rate	$489.00
Rate for Payer: Aetna Commercial	$464.55
Rate for Payer: Aetna Medicare	$440.10
Rate for Payer: BCBS MT CHIP	$440.10
Rate for Payer: BCBS MT Closed Plan Network	$464.55
Rate for Payer: BCBS MT HealthLink	$440.10
Rate for Payer: BCBS MT Medicare	$440.10
Rate for Payer: BCBS MT POS	$464.55
Rate for Payer: BCBS MT Traditional	$489.00
Rate for Payer: Cash Price	$440.10
Rate for Payer: Cigna Commercial	$464.55
Rate for Payer: Cigna Medicare	$440.10
Rate for Payer: Medicaid All Medicaid	$449.88
Rate for Payer: Medicare All Medicare	$342.30
Rate for Payer: Monida Allegiance	$464.55
Rate for Payer: Monida First Choice Health	$474.33
Rate for Payer: Monida Montana Health Co-op	$464.55
Rate for Payer: Monida PacificSource	$464.55

PRO FEE OP INJ DEST OF FACIAL NER 64612

Professional

Both

$623.00

Service Code	CPT 64612
Hospital Charge Code	764612
Hospital Revenue Code	964
Min. Negotiated Rate	$436.10
Max. Negotiated Rate	$623.00
Rate for Payer: Aetna Commercial	$591.85
Rate for Payer: Aetna Medicare	$560.70
Rate for Payer: BCBS MT CHIP	$560.70
Rate for Payer: BCBS MT Closed Plan Network	$591.85
Rate for Payer: BCBS MT HealthLink	$560.70
Rate for Payer: BCBS MT Medicare	$560.70
Rate for Payer: BCBS MT POS	$591.85
Rate for Payer: BCBS MT Traditional	$623.00
Rate for Payer: Cash Price	$560.70
Rate for Payer: Cigna Commercial	$591.85
Rate for Payer: Cigna Medicare	$560.70
Rate for Payer: Medicaid All Medicaid	$573.16
Rate for Payer: Medicare All Medicare	$436.10
Rate for Payer: Monida Allegiance	$591.85
Rate for Payer: Monida First Choice Health	$604.31
Rate for Payer: Monida Montana Health Co-op	$591.85
Rate for Payer: Monida PacificSource	$591.85

PRO FEE OP INJ FACET JNT C/T 1L 64490

Professional

Both

$544.00

Service Code	CPT 64490
Hospital Charge Code	764490
Hospital Revenue Code	964
Min. Negotiated Rate	$380.80
Max. Negotiated Rate	$544.00
Rate for Payer: Aetna Commercial	$516.80
Rate for Payer: Aetna Medicare	$489.60
Rate for Payer: BCBS MT CHIP	$489.60
Rate for Payer: BCBS MT Closed Plan Network	$516.80
Rate for Payer: BCBS MT HealthLink	$489.60
Rate for Payer: BCBS MT Medicare	$489.60
Rate for Payer: BCBS MT POS	$516.80
Rate for Payer: BCBS MT Traditional	$544.00
Rate for Payer: Cash Price	$489.60
Rate for Payer: Cigna Commercial	$516.80
Rate for Payer: Cigna Medicare	$489.60
Rate for Payer: Medicaid All Medicaid	$500.48
Rate for Payer: Medicare All Medicare	$380.80
Rate for Payer: Monida Allegiance	$516.80
Rate for Payer: Monida First Choice Health	$527.68
Rate for Payer: Monida Montana Health Co-op	$516.80
Rate for Payer: Monida PacificSource	$516.80

Know your out-of-pocket cost for care.

All Charges