Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PROFEE US OF FETAL UMBILICAL ARTERY FLO

Professional

Both

$91.00

Service Code	CPT 76820
Hospital Charge Code	50002414
Hospital Revenue Code	972
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$88.27
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

PROFEE US OF HIPS, INFANT

Professional

Both

$115.00

Service Code	CPT 76886
Hospital Charge Code	50002415
Hospital Revenue Code	972
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$111.55
Rate for Payer: Aetna Commercial	$109.25
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Medicaid All Medicaid	$105.80
Rate for Payer: Medicare All Medicare	$80.50
Rate for Payer: Monida Allegiance	$109.25
Rate for Payer: Monida First Choice Health	$111.55
Rate for Payer: Monida Montana Health Co-op	$109.25
Rate for Payer: Monida PacificSource	$109.25

PROFEE US OPH DX B-SCAN

Professional

Both

$118.00

Service Code	CPT 76512
Hospital Charge Code	50002408
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 PELVIC COMP NON OB

Professional

Both

$127.00

Service Code	CPT 76856
Hospital Charge Code	50002416
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 PELVIC LMT NON OB

Professional

Both

$91.00

Service Code	CPT 76857
Hospital Charge Code	50002418
Hospital Revenue Code	972
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$88.27
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

PROFEE US PELVIS BUNDLED

Professional

Both

$127.00

Service Code	CPT 76856
Hospital Charge Code	50002417
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 POST VOID RESIDUAL

Professional

Both

$47.00

Service Code	CPT 51798
Hospital Charge Code	50002419
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 RETROPERITONEAL COMP RENALS

Professional

Both

$136.00

Service Code	CPT 76770
Hospital Charge Code	50002421
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

PROFEE US RETROPERITONEAL LMT AORTA

Professional

Both

$107.00

Service Code	CPT 76775
Hospital Charge Code	50002422
Hospital Revenue Code	972
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$103.79
Rate for Payer: Aetna Commercial	$101.65
Rate for Payer: Aetna Medicare	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Medicaid All Medicaid	$98.44
Rate for Payer: Medicare All Medicare	$74.90
Rate for Payer: Monida Allegiance	$101.65
Rate for Payer: Monida First Choice Health	$103.79
Rate for Payer: Monida Montana Health Co-op	$101.65
Rate for Payer: Monida PacificSource	$101.65

PROFEE US SOFT TISSUE ABDOMEN

Professional

Both

$108.00

Service Code	CPT 76705
Hospital Charge Code	50002423
Hospital Revenue Code	972
Min. Negotiated Rate	$75.60
Max. Negotiated Rate	$104.76
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare	$97.20
Rate for Payer: Cash Price	$97.20
Rate for Payer: Medicaid All Medicaid	$99.36
Rate for Payer: Medicare All Medicare	$75.60
Rate for Payer: Monida Allegiance	$102.60
Rate for Payer: Monida First Choice Health	$104.76
Rate for Payer: Monida Montana Health Co-op	$102.60
Rate for Payer: Monida PacificSource	$102.60

PROFEE US SOFT TISSUE CHEST

Professional

Both

$106.00

Service Code	CPT 76604
Hospital Charge Code	50002424
Hospital Revenue Code	972
Min. Negotiated Rate	$74.20
Max. Negotiated Rate	$102.82
Rate for Payer: Aetna Commercial	$100.70
Rate for Payer: Aetna Medicare	$95.40
Rate for Payer: Cash Price	$95.40
Rate for Payer: Medicaid All Medicaid	$97.52
Rate for Payer: Medicare All Medicare	$74.20
Rate for Payer: Monida Allegiance	$100.70
Rate for Payer: Monida First Choice Health	$102.82
Rate for Payer: Monida Montana Health Co-op	$100.70
Rate for Payer: Monida PacificSource	$100.70

PROFEE US SOFT TISSUE EXTREMITY LMT

Professional

Both

$128.00

Service Code	CPT 76882
Hospital Charge Code	50002425
Hospital Revenue Code	972
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$124.16
Rate for Payer: Aetna Commercial	$121.60
Rate for Payer: Aetna Medicare	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Medicaid All Medicaid	$117.76
Rate for Payer: Medicare All Medicare	$89.60
Rate for Payer: Monida Allegiance	$121.60
Rate for Payer: Monida First Choice Health	$124.16
Rate for Payer: Monida Montana Health Co-op	$121.60
Rate for Payer: Monida PacificSource	$121.60

PROFEE US SOFT TISSUE PELVIS

Professional

Both

$91.00

Service Code	CPT 76857
Hospital Charge Code	50002426
Hospital Revenue Code	972
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$88.27
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

PROFEE US TCD EMBOLI DETECT W/O INJ

Professional

Both

$226.00

Service Code	CPT 93892
Hospital Charge Code	50002436
Hospital Revenue Code	972
Min. Negotiated Rate	$158.20
Max. Negotiated Rate	$219.22
Rate for Payer: Aetna Commercial	$214.70
Rate for Payer: Aetna Medicare	$203.40
Rate for Payer: Cash Price	$203.40
Rate for Payer: Medicaid All Medicaid	$207.92
Rate for Payer: Medicare All Medicare	$158.20
Rate for Payer: Monida Allegiance	$214.70
Rate for Payer: Monida First Choice Health	$219.22
Rate for Payer: Monida Montana Health Co-op	$214.70
Rate for Payer: Monida PacificSource	$214.70

PROFEE US TESTICULAR SCROTUM

Professional

Both

$118.00

Service Code	CPT 76870
Hospital Charge Code	50002429
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 THYROID

Professional

Both

$105.00

Service Code	CPT 76536
Hospital Charge Code	50002430
Hospital Revenue Code	972
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$101.85
Rate for Payer: Aetna Commercial	$99.75
Rate for Payer: Aetna Medicare	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Medicaid All Medicaid	$96.60
Rate for Payer: Medicare All Medicare	$73.50
Rate for Payer: Monida Allegiance	$99.75
Rate for Payer: Monida First Choice Health	$101.85
Rate for Payer: Monida Montana Health Co-op	$99.75
Rate for Payer: Monida PacificSource	$99.75

PROFEE US TO DETERMINE LENGTH FROM CORN

Professional

Both

$88.00

Service Code	CPT 76516
Hospital Charge Code	50002431
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 TRANSVAGINAL US NON-OB

Professional

Both

$128.00

Service Code	CPT 76830
Hospital Charge Code	50002437
Hospital Revenue Code	972
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$124.16
Rate for Payer: Aetna Commercial	$121.60
Rate for Payer: Aetna Medicare	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Medicaid All Medicaid	$117.76
Rate for Payer: Medicare All Medicare	$89.60
Rate for Payer: Monida Allegiance	$121.60
Rate for Payer: Monida First Choice Health	$124.16
Rate for Payer: Monida Montana Health Co-op	$121.60
Rate for Payer: Monida PacificSource	$121.60

PROFEE US TRANSVAGINAL US OBSTETRIC

Professional

Both

$139.00

Service Code	CPT 76817
Hospital Charge Code	50002438
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 TRANS VAG LMT

Professional

Both

$91.00

Service Code	CPT 76857
Hospital Charge Code	50002432
Hospital Revenue Code	972
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$88.27
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

PROFEE US UMBILICAL CORD OCCLUD W/US

Professional

Both

$289.00

Service Code	CPT 59072
Hospital Charge Code	50002401
Hospital Revenue Code	972
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$280.33
Rate for Payer: Aetna Commercial	$274.55
Rate for Payer: Aetna Medicare	$260.10
Rate for Payer: Cash Price	$260.10
Rate for Payer: Medicaid All Medicaid	$265.88
Rate for Payer: Medicare All Medicare	$202.30
Rate for Payer: Monida Allegiance	$274.55
Rate for Payer: Monida First Choice Health	$280.33
Rate for Payer: Monida Montana Health Co-op	$274.55
Rate for Payer: Monida PacificSource	$274.55

PROFEE US UPPER EXT ARTERIAL DUPLEX BILA

Professional

Both

$146.00

Service Code	CPT 93930
Hospital Charge Code	50002443
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 VENOUS DOPP BILATERAL

Professional

Both

$125.00

Service Code	CPT 93970
Hospital Charge Code	50002440
Hospital Revenue Code	972
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$121.25
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Medicaid All Medicaid	$115.00
Rate for Payer: Medicare All Medicare	$87.50
Rate for Payer: Monida Allegiance	$118.75
Rate for Payer: Monida First Choice Health	$121.25
Rate for Payer: Monida Montana Health Co-op	$118.75
Rate for Payer: Monida PacificSource	$118.75

PROFEE US VENOUS DOPP SINGLE

Professional

Both

$81.00

Service Code	CPT 93971
Hospital Charge Code	50002441
Hospital Revenue Code	972
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$78.57
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: Aetna Medicare	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Medicaid All Medicaid	$74.52
Rate for Payer: Medicare All Medicare	$56.70
Rate for Payer: Monida Allegiance	$76.95
Rate for Payer: Monida First Choice Health	$78.57
Rate for Payer: Monida Montana Health Co-op	$76.95
Rate for Payer: Monida PacificSource	$76.95

PROFEE VASCULAR STUDY

Professional

Both

$212.00

Service Code	CPT 93975
Hospital Charge Code	50002390
Hospital Revenue Code	972
Min. Negotiated Rate	$148.40
Max. Negotiated Rate	$205.64
Rate for Payer: Aetna Commercial	$201.40
Rate for Payer: Aetna Medicare	$190.80
Rate for Payer: Cash Price	$190.80
Rate for Payer: Medicaid All Medicaid	$195.04
Rate for Payer: Medicare All Medicare	$148.40
Rate for Payer: Monida Allegiance	$201.40
Rate for Payer: Monida First Choice Health	$205.64
Rate for Payer: Monida Montana Health Co-op	$201.40
Rate for Payer: Monida PacificSource	$201.40

Know your out-of-pocket cost for care.

All Charges