Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

CARBIDOPA/LEVODOPA TAB [10 MG/100 MG] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3007494
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$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

CARBIDOPA/LEVODOPA TAB [10 MG/100 MG] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3007494
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$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

CARBIDOPA/LEVODOPA TAB [25 MG/250 MG] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000611
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$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

CARBIDOPA/LEVODOPA TAB [25 MG/250 MG] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000611
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$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

CARBIDOPA/ LEVO ER TAB [23.75-95MG] NF

Facility

$16.00

Service Code	HCPCS J8499
Hospital Charge Code	3000513
Hospital Revenue Code	250
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare	$14.40
Rate for Payer: BCBS MT CHIP	$14.40
Rate for Payer: BCBS MT Closed Plan Network	$15.20
Rate for Payer: BCBS MT HealthLink	$14.40
Rate for Payer: BCBS MT Medicare	$14.40
Rate for Payer: BCBS MT POS	$15.20
Rate for Payer: BCBS MT Traditional	$16.00
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna Commercial	$15.20
Rate for Payer: Cigna Medicare	$14.40
Rate for Payer: Medicaid All Medicaid	$14.72
Rate for Payer: Medicare All Medicare	$11.20
Rate for Payer: Monida Allegiance	$15.20
Rate for Payer: Monida First Choice Health	$15.52
Rate for Payer: Monida Montana Health Co-op	$15.20
Rate for Payer: Monida PacificSource	$15.20

CARBIDOPA/ LEVO ER TAB [23.75-95MG] NF

Facility

$16.00

Service Code	HCPCS J8499
Hospital Charge Code	3000513
Hospital Revenue Code	250
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare	$14.40
Rate for Payer: BCBS MT CHIP	$14.40
Rate for Payer: BCBS MT Closed Plan Network	$15.20
Rate for Payer: BCBS MT HealthLink	$14.40
Rate for Payer: BCBS MT Medicare	$14.40
Rate for Payer: BCBS MT POS	$15.20
Rate for Payer: BCBS MT Traditional	$16.00
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna Commercial	$15.20
Rate for Payer: Cigna Medicare	$14.40
Rate for Payer: Medicaid All Medicaid	$14.72
Rate for Payer: Medicare All Medicare	$11.20
Rate for Payer: Monida Allegiance	$15.20
Rate for Payer: Monida First Choice Health	$15.52
Rate for Payer: Monida Montana Health Co-op	$15.20
Rate for Payer: Monida PacificSource	$15.20

CARBIDOPA/ LEVO TAB [25-100 MG]

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000069
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$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

CARBIDOPA/ LEVO TAB [25-100 MG]

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000069
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$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

CARBON DIOXIDE

Facility

$50.00

Service Code	CPT 82374
Hospital Charge Code	4082374
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare	$45.00
Rate for Payer: BCBS MT CHIP	$45.00
Rate for Payer: BCBS MT Closed Plan Network	$47.50
Rate for Payer: BCBS MT HealthLink	$45.00
Rate for Payer: BCBS MT Medicare	$45.00
Rate for Payer: BCBS MT POS	$47.50
Rate for Payer: BCBS MT Traditional	$50.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: Cigna Medicare	$45.00
Rate for Payer: Medicaid All Medicaid	$46.00
Rate for Payer: Medicare All Medicare	$35.00
Rate for Payer: Monida Allegiance	$47.50
Rate for Payer: Monida First Choice Health	$48.50
Rate for Payer: Monida Montana Health Co-op	$47.50
Rate for Payer: Monida PacificSource	$47.50

CARBON DIOXIDE

Facility

$50.00

Service Code	CPT 82374
Hospital Charge Code	4082374
Hospital Revenue Code	300
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare	$45.00
Rate for Payer: BCBS MT CHIP	$45.00
Rate for Payer: BCBS MT Closed Plan Network	$47.50
Rate for Payer: BCBS MT HealthLink	$45.00
Rate for Payer: BCBS MT Medicare	$45.00
Rate for Payer: BCBS MT POS	$47.50
Rate for Payer: BCBS MT Traditional	$50.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: Cigna Medicare	$45.00
Rate for Payer: Medicaid All Medicaid	$46.00
Rate for Payer: Medicare All Medicare	$35.00
Rate for Payer: Monida Allegiance	$47.50
Rate for Payer: Monida First Choice Health	$48.50
Rate for Payer: Monida Montana Health Co-op	$47.50
Rate for Payer: Monida PacificSource	$47.50

CARBON MONOXIDE

Facility

$160.00

Service Code	CPT 82375
Hospital Charge Code	4088029
Hospital Revenue Code	302
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$160.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare	$144.00
Rate for Payer: BCBS MT CHIP	$144.00
Rate for Payer: BCBS MT Closed Plan Network	$152.00
Rate for Payer: BCBS MT HealthLink	$144.00
Rate for Payer: BCBS MT Medicare	$144.00
Rate for Payer: BCBS MT POS	$152.00
Rate for Payer: BCBS MT Traditional	$160.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna Commercial	$152.00
Rate for Payer: Cigna Medicare	$144.00
Rate for Payer: Medicaid All Medicaid	$147.20
Rate for Payer: Medicare All Medicare	$112.00
Rate for Payer: Monida Allegiance	$152.00
Rate for Payer: Monida First Choice Health	$155.20
Rate for Payer: Monida Montana Health Co-op	$152.00
Rate for Payer: Monida PacificSource	$152.00

CARBON MONOXIDE

Facility

$160.00

Service Code	CPT 82375
Hospital Charge Code	4088029
Hospital Revenue Code	302
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$160.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare	$144.00
Rate for Payer: BCBS MT CHIP	$144.00
Rate for Payer: BCBS MT Closed Plan Network	$152.00
Rate for Payer: BCBS MT HealthLink	$144.00
Rate for Payer: BCBS MT Medicare	$144.00
Rate for Payer: BCBS MT POS	$152.00
Rate for Payer: BCBS MT Traditional	$160.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cigna Commercial	$152.00
Rate for Payer: Cigna Medicare	$144.00
Rate for Payer: Medicaid All Medicaid	$147.20
Rate for Payer: Medicare All Medicare	$112.00
Rate for Payer: Monida Allegiance	$152.00
Rate for Payer: Monida First Choice Health	$155.20
Rate for Payer: Monida Montana Health Co-op	$152.00
Rate for Payer: Monida PacificSource	$152.00

CARBOPROST TROMETHAMINE 250MCG/ML

Facility

$515.10

Hospital Charge Code	3007378
Hospital Revenue Code	250
Min. Negotiated Rate	$360.57
Max. Negotiated Rate	$515.10
Rate for Payer: Aetna Commercial	$489.35
Rate for Payer: Aetna Medicare	$463.59
Rate for Payer: BCBS MT CHIP	$463.59
Rate for Payer: BCBS MT Closed Plan Network	$489.35
Rate for Payer: BCBS MT HealthLink	$463.59
Rate for Payer: BCBS MT Medicare	$463.59
Rate for Payer: BCBS MT POS	$489.35
Rate for Payer: BCBS MT Traditional	$515.10
Rate for Payer: Cash Price	$463.59
Rate for Payer: Cigna Commercial	$489.35
Rate for Payer: Cigna Medicare	$463.59
Rate for Payer: Medicaid All Medicaid	$473.89
Rate for Payer: Medicare All Medicare	$360.57
Rate for Payer: Monida Allegiance	$489.35
Rate for Payer: Monida First Choice Health	$499.65
Rate for Payer: Monida Montana Health Co-op	$489.35
Rate for Payer: Monida PacificSource	$489.35

CARBOPROST TROMETHAMINE 250MCG/ML

Facility

$515.10

Hospital Charge Code	3007378
Hospital Revenue Code	250
Min. Negotiated Rate	$360.57
Max. Negotiated Rate	$515.10
Rate for Payer: Aetna Commercial	$489.35
Rate for Payer: Aetna Medicare	$463.59
Rate for Payer: BCBS MT CHIP	$463.59
Rate for Payer: BCBS MT Closed Plan Network	$489.35
Rate for Payer: BCBS MT HealthLink	$463.59
Rate for Payer: BCBS MT Medicare	$463.59
Rate for Payer: BCBS MT POS	$489.35
Rate for Payer: BCBS MT Traditional	$515.10
Rate for Payer: Cash Price	$463.59
Rate for Payer: Cigna Commercial	$489.35
Rate for Payer: Cigna Medicare	$463.59
Rate for Payer: Medicaid All Medicaid	$473.89
Rate for Payer: Medicare All Medicare	$360.57
Rate for Payer: Monida Allegiance	$489.35
Rate for Payer: Monida First Choice Health	$499.65
Rate for Payer: Monida Montana Health Co-op	$489.35
Rate for Payer: Monida PacificSource	$489.35

CARBOPROST TROMETHAMINE 250 MCG SDV

Facility

$515.10

Hospital Charge Code	3007341
Hospital Revenue Code	250
Min. Negotiated Rate	$360.57
Max. Negotiated Rate	$515.10
Rate for Payer: Aetna Commercial	$489.35
Rate for Payer: Aetna Medicare	$463.59
Rate for Payer: BCBS MT CHIP	$463.59
Rate for Payer: BCBS MT Closed Plan Network	$489.35
Rate for Payer: BCBS MT HealthLink	$463.59
Rate for Payer: BCBS MT Medicare	$463.59
Rate for Payer: BCBS MT POS	$489.35
Rate for Payer: BCBS MT Traditional	$515.10
Rate for Payer: Cash Price	$463.59
Rate for Payer: Cigna Commercial	$489.35
Rate for Payer: Cigna Medicare	$463.59
Rate for Payer: Medicaid All Medicaid	$473.89
Rate for Payer: Medicare All Medicare	$360.57
Rate for Payer: Monida Allegiance	$489.35
Rate for Payer: Monida First Choice Health	$499.65
Rate for Payer: Monida Montana Health Co-op	$489.35
Rate for Payer: Monida PacificSource	$489.35

CARBOPROST TROMETHAMINE 250 MCG SDV

Facility

$515.10

Hospital Charge Code	3007341
Hospital Revenue Code	250
Min. Negotiated Rate	$360.57
Max. Negotiated Rate	$515.10
Rate for Payer: Aetna Commercial	$489.35
Rate for Payer: Aetna Medicare	$463.59
Rate for Payer: BCBS MT CHIP	$463.59
Rate for Payer: BCBS MT Closed Plan Network	$489.35
Rate for Payer: BCBS MT HealthLink	$463.59
Rate for Payer: BCBS MT Medicare	$463.59
Rate for Payer: BCBS MT POS	$489.35
Rate for Payer: BCBS MT Traditional	$515.10
Rate for Payer: Cash Price	$463.59
Rate for Payer: Cigna Commercial	$489.35
Rate for Payer: Cigna Medicare	$463.59
Rate for Payer: Medicaid All Medicaid	$473.89
Rate for Payer: Medicare All Medicare	$360.57
Rate for Payer: Monida Allegiance	$489.35
Rate for Payer: Monida First Choice Health	$499.65
Rate for Payer: Monida Montana Health Co-op	$489.35
Rate for Payer: Monida PacificSource	$489.35

CARCINOEMBRYONIC ANTIGEN (002139)

Facility

$78.00

Service Code	CPT 82378
Hospital Charge Code	4082378
Hospital Revenue Code	301
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

CARCINOEMBRYONIC ANTIGEN (002139)

Facility

$78.00

Service Code	CPT 82378
Hospital Charge Code	4082378
Hospital Revenue Code	301
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

CARDIAC ARREST TREAT AT SCENE AMBULANCE

Facility

$890.00

Service Code	HCPCS A0999
Hospital Charge Code	600999
Hospital Revenue Code	540
Min. Negotiated Rate	$623.00
Max. Negotiated Rate	$890.00
Rate for Payer: Aetna Commercial	$845.50
Rate for Payer: Aetna Medicare	$801.00
Rate for Payer: BCBS MT CHIP	$801.00
Rate for Payer: BCBS MT Closed Plan Network	$845.50
Rate for Payer: BCBS MT HealthLink	$801.00
Rate for Payer: BCBS MT Medicare	$801.00
Rate for Payer: BCBS MT POS	$845.50
Rate for Payer: BCBS MT Traditional	$890.00
Rate for Payer: Cash Price	$801.00
Rate for Payer: Cigna Commercial	$845.50
Rate for Payer: Cigna Medicare	$801.00
Rate for Payer: Medicaid All Medicaid	$818.80
Rate for Payer: Medicare All Medicare	$623.00
Rate for Payer: Monida Allegiance	$845.50
Rate for Payer: Monida First Choice Health	$863.30
Rate for Payer: Monida Montana Health Co-op	$845.50
Rate for Payer: Monida PacificSource	$845.50

CARDIAC ARREST TREAT AT SCENE AMBULANCE

Facility

$890.00

Service Code	HCPCS A0999
Hospital Charge Code	600999
Hospital Revenue Code	540
Min. Negotiated Rate	$623.00
Max. Negotiated Rate	$890.00
Rate for Payer: Aetna Commercial	$845.50
Rate for Payer: Aetna Medicare	$801.00
Rate for Payer: BCBS MT CHIP	$801.00
Rate for Payer: BCBS MT Closed Plan Network	$845.50
Rate for Payer: BCBS MT HealthLink	$801.00
Rate for Payer: BCBS MT Medicare	$801.00
Rate for Payer: BCBS MT POS	$845.50
Rate for Payer: BCBS MT Traditional	$890.00
Rate for Payer: Cash Price	$801.00
Rate for Payer: Cigna Commercial	$845.50
Rate for Payer: Cigna Medicare	$801.00
Rate for Payer: Medicaid All Medicaid	$818.80
Rate for Payer: Medicare All Medicare	$623.00
Rate for Payer: Monida Allegiance	$845.50
Rate for Payer: Monida First Choice Health	$863.30
Rate for Payer: Monida Montana Health Co-op	$845.50
Rate for Payer: Monida PacificSource	$845.50

CARDIAC TROPONINS CONTROL LEV

Facility

$182.43

Hospital Charge Code	90196530
Hospital Revenue Code	270
Min. Negotiated Rate	$127.70
Max. Negotiated Rate	$182.43
Rate for Payer: Aetna Commercial	$173.31
Rate for Payer: Aetna Medicare	$164.19
Rate for Payer: BCBS MT CHIP	$164.19
Rate for Payer: BCBS MT Closed Plan Network	$173.31
Rate for Payer: BCBS MT HealthLink	$164.19
Rate for Payer: BCBS MT Medicare	$164.19
Rate for Payer: BCBS MT POS	$173.31
Rate for Payer: BCBS MT Traditional	$182.43
Rate for Payer: Cash Price	$164.19
Rate for Payer: Cigna Commercial	$173.31
Rate for Payer: Cigna Medicare	$164.19
Rate for Payer: Medicaid All Medicaid	$167.84
Rate for Payer: Medicare All Medicare	$127.70
Rate for Payer: Monida Allegiance	$173.31
Rate for Payer: Monida First Choice Health	$176.96
Rate for Payer: Monida Montana Health Co-op	$173.31
Rate for Payer: Monida PacificSource	$173.31

CARDIAC TROPONINS CONTROL LEV

Facility

$182.43

Hospital Charge Code	90196530
Hospital Revenue Code	270
Min. Negotiated Rate	$127.70
Max. Negotiated Rate	$182.43
Rate for Payer: Aetna Commercial	$173.31
Rate for Payer: Aetna Medicare	$164.19
Rate for Payer: BCBS MT CHIP	$164.19
Rate for Payer: BCBS MT Closed Plan Network	$173.31
Rate for Payer: BCBS MT HealthLink	$164.19
Rate for Payer: BCBS MT Medicare	$164.19
Rate for Payer: BCBS MT POS	$173.31
Rate for Payer: BCBS MT Traditional	$182.43
Rate for Payer: Cash Price	$164.19
Rate for Payer: Cigna Commercial	$173.31
Rate for Payer: Cigna Medicare	$164.19
Rate for Payer: Medicaid All Medicaid	$167.84
Rate for Payer: Medicare All Medicare	$127.70
Rate for Payer: Monida Allegiance	$173.31
Rate for Payer: Monida First Choice Health	$176.96
Rate for Payer: Monida Montana Health Co-op	$173.31
Rate for Payer: Monida PacificSource	$173.31

CARDIOGRAPHY 12I NTREP & REPORT ONLY

Facility

$54.00

Service Code	CPT 93010
Hospital Charge Code	8093010
Hospital Revenue Code	521
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$48.60
Rate for Payer: BCBS MT CHIP	$48.60
Rate for Payer: BCBS MT Closed Plan Network	$51.30
Rate for Payer: BCBS MT HealthLink	$48.60
Rate for Payer: BCBS MT Medicare	$48.60
Rate for Payer: BCBS MT POS	$51.30
Rate for Payer: BCBS MT Traditional	$54.00
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cigna Commercial	$51.30
Rate for Payer: Cigna Medicare	$48.60
Rate for Payer: Medicaid All Medicaid	$49.68
Rate for Payer: Medicare All Medicare	$37.80
Rate for Payer: Monida Allegiance	$51.30
Rate for Payer: Monida First Choice Health	$52.38
Rate for Payer: Monida Montana Health Co-op	$51.30
Rate for Payer: Monida PacificSource	$51.30

CARDIOGRAPHY 12I NTREP & REPORT ONLY

Facility

$54.00

Service Code	CPT 93010
Hospital Charge Code	8093010
Hospital Revenue Code	521
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$48.60
Rate for Payer: BCBS MT CHIP	$48.60
Rate for Payer: BCBS MT Closed Plan Network	$51.30
Rate for Payer: BCBS MT HealthLink	$48.60
Rate for Payer: BCBS MT Medicare	$48.60
Rate for Payer: BCBS MT POS	$51.30
Rate for Payer: BCBS MT Traditional	$54.00
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cigna Commercial	$51.30
Rate for Payer: Cigna Medicare	$48.60
Rate for Payer: Medicaid All Medicaid	$49.68
Rate for Payer: Medicare All Medicare	$37.80
Rate for Payer: Monida Allegiance	$51.30
Rate for Payer: Monida First Choice Health	$52.38
Rate for Payer: Monida Montana Health Co-op	$51.30
Rate for Payer: Monida PacificSource	$51.30

CARDIOGRAPHY 1-3 LEAD INTREP&REPORT

Facility

$52.00

Service Code	CPT 93040
Hospital Charge Code	8093040
Hospital Revenue Code	521
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare	$46.80
Rate for Payer: BCBS MT CHIP	$46.80
Rate for Payer: BCBS MT Closed Plan Network	$49.40
Rate for Payer: BCBS MT HealthLink	$46.80
Rate for Payer: BCBS MT Medicare	$46.80
Rate for Payer: BCBS MT POS	$49.40
Rate for Payer: BCBS MT Traditional	$52.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial	$49.40
Rate for Payer: Cigna Medicare	$46.80
Rate for Payer: Medicaid All Medicaid	$47.84
Rate for Payer: Medicare All Medicare	$36.40
Rate for Payer: Monida Allegiance	$49.40
Rate for Payer: Monida First Choice Health	$50.44
Rate for Payer: Monida Montana Health Co-op	$49.40
Rate for Payer: Monida PacificSource	$49.40

Know your out-of-pocket cost for care.

All Charges