Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PROFEE US BLADDER SCANNER POST

Professional

Both

$47.00

Service Code	CPT 51798
Hospital Charge Code	50002381
Hospital Revenue Code	972
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$45.59
Rate for Payer: Aetna Commercial	$44.65
Rate for Payer: Aetna Medicare	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Medicaid All Medicaid	$43.24
Rate for Payer: Medicare All Medicare	$32.90
Rate for Payer: Monida Allegiance	$44.65
Rate for Payer: Monida First Choice Health	$45.59
Rate for Payer: Monida Montana Health Co-op	$44.65
Rate for Payer: Monida PacificSource	$44.65

PROFEE US BREAST

Professional

Both

$136.00

Service Code	CPT 76641
Hospital Charge Code	50002382
Hospital Revenue Code	972
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$131.92
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Medicaid All Medicaid	$125.12
Rate for Payer: Medicare All Medicare	$95.20
Rate for Payer: Monida Allegiance	$129.20
Rate for Payer: Monida First Choice Health	$131.92
Rate for Payer: Monida Montana Health Co-op	$129.20
Rate for Payer: Monida PacificSource	$129.20

PROFEEUS BRST UNI REAL TIME W IMAGE LIMT

Professional

Both

$127.00

Service Code	CPT 76642
Hospital Charge Code	50002383
Hospital Revenue Code	972
Min. Negotiated Rate	$88.90
Max. Negotiated Rate	$123.19
Rate for Payer: Aetna Commercial	$120.65
Rate for Payer: Aetna Medicare	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Medicaid All Medicaid	$116.84
Rate for Payer: Medicare All Medicare	$88.90
Rate for Payer: Monida Allegiance	$120.65
Rate for Payer: Monida First Choice Health	$123.19
Rate for Payer: Monida Montana Health Co-op	$120.65
Rate for Payer: Monida PacificSource	$120.65

PROFEE US CAROTID BILATERAL

Professional

Both

$146.00

Service Code	CPT 93880
Hospital Charge Code	50002384
Hospital Revenue Code	972
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$141.62
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare	$131.40
Rate for Payer: Cash Price	$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

PROFEE US CAROTID UNILATERAL

Professional

Both

$90.00

Service Code	CPT 93882
Hospital Charge Code	50002385
Hospital Revenue Code	972
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Medicaid All Medicaid	$82.80
Rate for Payer: Medicare All Medicare	$63.00
Rate for Payer: Monida Allegiance	$85.50
Rate for Payer: Monida First Choice Health	$87.30
Rate for Payer: Monida Montana Health Co-op	$85.50
Rate for Payer: Monida PacificSource	$85.50

PROFEE US COMPL JOINT R-T W/IMAGE DOC

Professional

Both

$167.00

Service Code	CPT 76881
Hospital Charge Code	50002386
Hospital Revenue Code	972
Min. Negotiated Rate	$116.90
Max. Negotiated Rate	$161.99
Rate for Payer: Aetna Commercial	$158.65
Rate for Payer: Aetna Medicare	$150.30
Rate for Payer: Cash Price	$150.30
Rate for Payer: Medicaid All Medicaid	$153.64
Rate for Payer: Medicare All Medicare	$116.90
Rate for Payer: Monida Allegiance	$158.65
Rate for Payer: Monida First Choice Health	$161.99
Rate for Payer: Monida Montana Health Co-op	$158.65
Rate for Payer: Monida PacificSource	$158.65

PROFEE US COMP TTHRC ECHO CONGENI CARD A

Professional

Both

$235.00

Service Code	CPT 93303
Hospital Charge Code	50002387
Hospital Revenue Code	972
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$227.95
Rate for Payer: Aetna Commercial	$223.25
Rate for Payer: Aetna Medicare	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: Medicaid All Medicaid	$216.20
Rate for Payer: Medicare All Medicare	$164.50
Rate for Payer: Monida Allegiance	$223.25
Rate for Payer: Monida First Choice Health	$227.95
Rate for Payer: Monida Montana Health Co-op	$223.25
Rate for Payer: Monida PacificSource	$223.25

PROFEE US DOPPLER COLOR FLOW ADD-ON

Professional

Both

$12.00

Service Code	CPT 93325
Hospital Charge Code	50002389
Hospital Revenue Code	972
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$11.64
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Medicaid All Medicaid	$11.04
Rate for Payer: Medicare All Medicare	$8.40
Rate for Payer: Monida Allegiance	$11.40
Rate for Payer: Monida First Choice Health	$11.64
Rate for Payer: Monida Montana Health Co-op	$11.40
Rate for Payer: Monida PacificSource	$11.40

PROFEE US ELASTOGRAPHY 1ST TARGET LESION

Professional

Both

$110.00

Service Code	CPT 76982
Hospital Charge Code	50002398
Hospital Revenue Code	972
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$106.70
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Medicaid All Medicaid	$101.20
Rate for Payer: Medicare All Medicare	$77.00
Rate for Payer: Monida Allegiance	$104.50
Rate for Payer: Monida First Choice Health	$106.70
Rate for Payer: Monida Montana Health Co-op	$104.50
Rate for Payer: Monida PacificSource	$104.50

PROFEE US ELASTOGRAPHY EA ADDL TAGET LE

Professional

Both

$90.00

Service Code	CPT 76983
Hospital Charge Code	50002397
Hospital Revenue Code	972
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: Medicaid All Medicaid	$82.80
Rate for Payer: Medicare All Medicare	$63.00
Rate for Payer: Monida Allegiance	$85.50
Rate for Payer: Monida First Choice Health	$87.30
Rate for Payer: Monida Montana Health Co-op	$85.50
Rate for Payer: Monida PacificSource	$85.50

PROFEE US ELASTOGRAPHY OF ORGAN TISSUE

Professional

Both

$111.00

Service Code	CPT 76981
Hospital Charge Code	50002399
Hospital Revenue Code	972
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$107.67
Rate for Payer: Aetna Commercial	$105.45
Rate for Payer: Aetna Medicare	$99.90
Rate for Payer: Cash Price	$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

PROFEE US EXAM K TRANSPL W/DOPPLER

Professional

Both

$140.00

Service Code	CPT 76776
Hospital Charge Code	50002439
Hospital Revenue Code	972
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$135.80
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Medicaid All Medicaid	$128.80
Rate for Payer: Medicare All Medicare	$98.00
Rate for Payer: Monida Allegiance	$133.00
Rate for Payer: Monida First Choice Health	$135.80
Rate for Payer: Monida Montana Health Co-op	$133.00
Rate for Payer: Monida PacificSource	$133.00

PROFEE US EXAM OF EYE

Professional

Both

$118.00

Service Code	CPT 76519
Hospital Charge Code	50002409
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 US EXAM OF EYE THICKNESS

Professional

Both

$30.00

Service Code	CPT 76514
Hospital Charge Code	50002406
Hospital Revenue Code	972
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$29.10
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: Cash Price	$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

PROFEE US GI ENDOSCOPIC ULTRASOUND

Professional

Both

$133.00

Service Code	CPT 76975
Hospital Charge Code	50002402
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 US INTRACRANIAL LIMITED STUDY

Professional

Both

$139.00

Service Code	CPT 93888
Hospital Charge Code	50002435
Hospital Revenue Code	972
Min. Negotiated Rate	$97.30
Max. Negotiated Rate	$134.83
Rate for Payer: Aetna Commercial	$132.05
Rate for Payer: Aetna Medicare	$125.10
Rate for Payer: Cash Price	$125.10
Rate for Payer: Medicaid All Medicaid	$127.88
Rate for Payer: Medicare All Medicare	$97.30
Rate for Payer: Monida Allegiance	$132.05
Rate for Payer: Monida First Choice Health	$134.83
Rate for Payer: Monida Montana Health Co-op	$132.05
Rate for Payer: Monida PacificSource	$132.05

PROFEE US LOWER EXTR STUDY UNILATERAL

Professional

Both

$87.00

Service Code	CPT 93926
Hospital Charge Code	50002404
Hospital Revenue Code	972
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$84.39
Rate for Payer: Aetna Commercial	$82.65
Rate for Payer: Aetna Medicare	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Medicaid All Medicaid	$80.04
Rate for Payer: Medicare All Medicare	$60.90
Rate for Payer: Monida Allegiance	$82.65
Rate for Payer: Monida First Choice Health	$84.39
Rate for Payer: Monida Montana Health Co-op	$82.65
Rate for Payer: Monida PacificSource	$82.65

PROFEE US LOWER EXT STUDY BILATERAL

Professional

Both

$144.00

Service Code	CPT 93925
Hospital Charge Code	50002403
Hospital Revenue Code	972
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$139.68
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Aetna Medicare	$129.60
Rate for Payer: Cash Price	$129.60
Rate for Payer: Medicaid All Medicaid	$132.48
Rate for Payer: Medicare All Medicare	$100.80
Rate for Payer: Monida Allegiance	$136.80
Rate for Payer: Monida First Choice Health	$139.68
Rate for Payer: Monida Montana Health Co-op	$136.80
Rate for Payer: Monida PacificSource	$136.80

PROFEE US NTRACRANIAL COMPLETE STUDY

Professional

Both

$175.00

Service Code	CPT 93886
Hospital Charge Code	50002434
Hospital Revenue Code	972
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$169.75
Rate for Payer: Aetna Commercial	$166.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: Medicaid All Medicaid	$161.00
Rate for Payer: Medicare All Medicare	$122.50
Rate for Payer: Monida Allegiance	$166.25
Rate for Payer: Monida First Choice Health	$169.75
Rate for Payer: Monida Montana Health Co-op	$166.25
Rate for Payer: Monida PacificSource	$166.25

PROFEE US OF BONE DENSITY MEASUREMENT

Professional

Both

$8.00

Service Code	CPT 76977
Hospital Charge Code	50002405
Hospital Revenue Code	972
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$7.76
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: Cash Price	$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

PROFEE US OF EYE DISEASE OR GROWTH

Professional

Both

$138.00

Service Code	CPT 76511
Hospital Charge Code	50002407
Hospital Revenue Code	972
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$133.86
Rate for Payer: Aetna Commercial	$131.10
Rate for Payer: Aetna Medicare	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Medicaid All Medicaid	$126.96
Rate for Payer: Medicare All Medicare	$96.60
Rate for Payer: Monida Allegiance	$131.10
Rate for Payer: Monida First Choice Health	$133.86
Rate for Payer: Monida Montana Health Co-op	$131.10
Rate for Payer: Monida PacificSource	$131.10

PROFEE US OF EYE FORGN BODY LOCALIZATION

Professional

Both

$122.00

Service Code	CPT 76529
Hospital Charge Code	50002410
Hospital Revenue Code	972
Min. Negotiated Rate	$85.40
Max. Negotiated Rate	$118.34
Rate for Payer: Aetna Commercial	$115.90
Rate for Payer: Aetna Medicare	$109.80
Rate for Payer: Cash Price	$109.80
Rate for Payer: Medicaid All Medicaid	$112.24
Rate for Payer: Medicare All Medicare	$85.40
Rate for Payer: Monida Allegiance	$115.90
Rate for Payer: Monida First Choice Health	$118.34
Rate for Payer: Monida Montana Health Co-op	$115.90
Rate for Payer: Monida PacificSource	$115.90

PROFEE US OF EYE TISSUE AND STRUCTURES

Professional

Both

$88.00

Service Code	CPT 76516
Hospital Charge Code	50002411
Hospital Revenue Code	972
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$85.36
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Medicare	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Medicaid All Medicaid	$80.96
Rate for Payer: Medicare All Medicare	$61.60
Rate for Payer: Monida Allegiance	$83.60
Rate for Payer: Monida First Choice Health	$85.36
Rate for Payer: Monida Montana Health Co-op	$83.60
Rate for Payer: Monida PacificSource	$83.60

PROFEE US OF EYE USING WATER BATH METHOD

Professional

Both

$126.00

Service Code	CPT 76513
Hospital Charge Code	50002412
Hospital Revenue Code	972
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$122.22
Rate for Payer: Aetna Commercial	$119.70
Rate for Payer: Aetna Medicare	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Medicaid All Medicaid	$115.92
Rate for Payer: Medicare All Medicare	$88.20
Rate for Payer: Monida Allegiance	$119.70
Rate for Payer: Monida First Choice Health	$122.22
Rate for Payer: Monida Montana Health Co-op	$119.70
Rate for Payer: Monida PacificSource	$119.70

PROFEE US OF FETAL BRAIN ARTERY

Professional

Both

$129.00

Service Code	CPT 76821
Hospital Charge Code	50002413
Hospital Revenue Code	972
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$125.13
Rate for Payer: Aetna Commercial	$122.55
Rate for Payer: Aetna Medicare	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Medicaid All Medicaid	$118.68
Rate for Payer: Medicare All Medicare	$90.30
Rate for Payer: Monida Allegiance	$122.55
Rate for Payer: Monida First Choice Health	$125.13
Rate for Payer: Monida Montana Health Co-op	$122.55
Rate for Payer: Monida PacificSource	$122.55

Know your out-of-pocket cost for care.

All Charges