Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

HCG RAPID TEST KIT PREGNANCY

Facility

$37.73

Hospital Charge Code	90196523
Hospital Revenue Code	270
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$37.73
Rate for Payer: Aetna Commercial	$35.84
Rate for Payer: Aetna Medicare	$33.96
Rate for Payer: BCBS MT CHIP	$33.96
Rate for Payer: BCBS MT Closed Plan Network	$35.84
Rate for Payer: BCBS MT HealthLink	$33.96
Rate for Payer: BCBS MT Medicare	$33.96
Rate for Payer: BCBS MT POS	$35.84
Rate for Payer: BCBS MT Traditional	$37.73
Rate for Payer: Cash Price	$33.96
Rate for Payer: Cigna Commercial	$35.84
Rate for Payer: Cigna Medicare	$33.96
Rate for Payer: Medicaid All Medicaid	$34.71
Rate for Payer: Medicare All Medicare	$26.41
Rate for Payer: Monida Allegiance	$35.84
Rate for Payer: Monida First Choice Health	$36.60
Rate for Payer: Monida Montana Health Co-op	$35.84
Rate for Payer: Monida PacificSource	$35.84

HCG, TUMOR MARKER (140450)

Facility

$72.00

Service Code	CPT 84702
Hospital Charge Code	4047021
Hospital Revenue Code	300
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare	$64.80
Rate for Payer: BCBS MT CHIP	$64.80
Rate for Payer: BCBS MT Closed Plan Network	$68.40
Rate for Payer: BCBS MT HealthLink	$64.80
Rate for Payer: BCBS MT Medicare	$64.80
Rate for Payer: BCBS MT POS	$68.40
Rate for Payer: BCBS MT Traditional	$72.00
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cigna Commercial	$68.40
Rate for Payer: Cigna Medicare	$64.80
Rate for Payer: Medicaid All Medicaid	$66.24
Rate for Payer: Medicare All Medicare	$50.40
Rate for Payer: Monida Allegiance	$68.40
Rate for Payer: Monida First Choice Health	$69.84
Rate for Payer: Monida Montana Health Co-op	$68.40
Rate for Payer: Monida PacificSource	$68.40

HCG, TUMOR MARKER (140450)

Facility

$72.00

Service Code	CPT 84702
Hospital Charge Code	4047021
Hospital Revenue Code	300
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare	$64.80
Rate for Payer: BCBS MT CHIP	$64.80
Rate for Payer: BCBS MT Closed Plan Network	$68.40
Rate for Payer: BCBS MT HealthLink	$64.80
Rate for Payer: BCBS MT Medicare	$64.80
Rate for Payer: BCBS MT POS	$68.40
Rate for Payer: BCBS MT Traditional	$72.00
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cigna Commercial	$68.40
Rate for Payer: Cigna Medicare	$64.80
Rate for Payer: Medicaid All Medicaid	$66.24
Rate for Payer: Medicare All Medicare	$50.40
Rate for Payer: Monida Allegiance	$68.40
Rate for Payer: Monida First Choice Health	$69.84
Rate for Payer: Monida Montana Health Co-op	$68.40
Rate for Payer: Monida PacificSource	$68.40

HCV AB W/ RELEX TO QUANT RT-PCR (144050)

Facility

$71.00

Service Code	CPT 86803
Hospital Charge Code	4068031
Hospital Revenue Code	300
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

HCV AB W/ RELEX TO QUANT RT-PCR (144050)

Facility

$71.00

Service Code	CPT 86803
Hospital Charge Code	4068031
Hospital Revenue Code	300
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

HCV RNA DETECTION BY PCR

Facility

$299.00

Service Code	CPT 86803
Hospital Charge Code	4087948
Hospital Revenue Code	300
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$284.05
Rate for Payer: Aetna Medicare	$269.10
Rate for Payer: BCBS MT CHIP	$269.10
Rate for Payer: BCBS MT Closed Plan Network	$284.05
Rate for Payer: BCBS MT HealthLink	$269.10
Rate for Payer: BCBS MT Medicare	$269.10
Rate for Payer: BCBS MT POS	$284.05
Rate for Payer: BCBS MT Traditional	$299.00
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cigna Commercial	$284.05
Rate for Payer: Cigna Medicare	$269.10
Rate for Payer: Medicaid All Medicaid	$275.08
Rate for Payer: Medicare All Medicare	$209.30
Rate for Payer: Monida Allegiance	$284.05
Rate for Payer: Monida First Choice Health	$290.03
Rate for Payer: Monida Montana Health Co-op	$284.05
Rate for Payer: Monida PacificSource	$284.05

HCV RNA DETECTION BY PCR

Facility

$299.00

Service Code	CPT 86803
Hospital Charge Code	4087948
Hospital Revenue Code	300
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$284.05
Rate for Payer: Aetna Medicare	$269.10
Rate for Payer: BCBS MT CHIP	$269.10
Rate for Payer: BCBS MT Closed Plan Network	$284.05
Rate for Payer: BCBS MT HealthLink	$269.10
Rate for Payer: BCBS MT Medicare	$269.10
Rate for Payer: BCBS MT POS	$284.05
Rate for Payer: BCBS MT Traditional	$299.00
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cigna Commercial	$284.05
Rate for Payer: Cigna Medicare	$269.10
Rate for Payer: Medicaid All Medicaid	$275.08
Rate for Payer: Medicare All Medicare	$209.30
Rate for Payer: Monida Allegiance	$284.05
Rate for Payer: Monida First Choice Health	$290.03
Rate for Payer: Monida Montana Health Co-op	$284.05
Rate for Payer: Monida PacificSource	$284.05

.HCV RT-PCR, QUANT

Facility

$339.00

Service Code	CPT 87522
Hospital Charge Code	4087522
Hospital Revenue Code	300
Min. Negotiated Rate	$237.30
Max. Negotiated Rate	$339.00
Rate for Payer: Aetna Commercial	$322.05
Rate for Payer: Aetna Medicare	$305.10
Rate for Payer: BCBS MT CHIP	$305.10
Rate for Payer: BCBS MT Closed Plan Network	$322.05
Rate for Payer: BCBS MT HealthLink	$305.10
Rate for Payer: BCBS MT Medicare	$305.10
Rate for Payer: BCBS MT POS	$322.05
Rate for Payer: BCBS MT Traditional	$339.00
Rate for Payer: Cash Price	$305.10
Rate for Payer: Cigna Commercial	$322.05
Rate for Payer: Cigna Medicare	$305.10
Rate for Payer: Medicaid All Medicaid	$311.88
Rate for Payer: Medicare All Medicare	$237.30
Rate for Payer: Monida Allegiance	$322.05
Rate for Payer: Monida First Choice Health	$328.83
Rate for Payer: Monida Montana Health Co-op	$322.05
Rate for Payer: Monida PacificSource	$322.05

.HCV RT-PCR, QUANT

Facility

$339.00

Service Code	CPT 87522
Hospital Charge Code	4087522
Hospital Revenue Code	300
Min. Negotiated Rate	$237.30
Max. Negotiated Rate	$339.00
Rate for Payer: Aetna Commercial	$322.05
Rate for Payer: Aetna Medicare	$305.10
Rate for Payer: BCBS MT CHIP	$305.10
Rate for Payer: BCBS MT Closed Plan Network	$322.05
Rate for Payer: BCBS MT HealthLink	$305.10
Rate for Payer: BCBS MT Medicare	$305.10
Rate for Payer: BCBS MT POS	$322.05
Rate for Payer: BCBS MT Traditional	$339.00
Rate for Payer: Cash Price	$305.10
Rate for Payer: Cigna Commercial	$322.05
Rate for Payer: Cigna Medicare	$305.10
Rate for Payer: Medicaid All Medicaid	$311.88
Rate for Payer: Medicare All Medicare	$237.30
Rate for Payer: Monida Allegiance	$322.05
Rate for Payer: Monida First Choice Health	$328.83
Rate for Payer: Monida Montana Health Co-op	$322.05
Rate for Payer: Monida PacificSource	$322.05

HEMATOCRIT, BLOOD

Facility

$44.00

Service Code	CPT 85014
Hospital Charge Code	4085014
Hospital Revenue Code	305
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare	$39.60
Rate for Payer: BCBS MT CHIP	$39.60
Rate for Payer: BCBS MT Closed Plan Network	$41.80
Rate for Payer: BCBS MT HealthLink	$39.60
Rate for Payer: BCBS MT Medicare	$39.60
Rate for Payer: BCBS MT POS	$41.80
Rate for Payer: BCBS MT Traditional	$44.00
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial	$41.80
Rate for Payer: Cigna Medicare	$39.60
Rate for Payer: Medicaid All Medicaid	$40.48
Rate for Payer: Medicare All Medicare	$30.80
Rate for Payer: Monida Allegiance	$41.80
Rate for Payer: Monida First Choice Health	$42.68
Rate for Payer: Monida Montana Health Co-op	$41.80
Rate for Payer: Monida PacificSource	$41.80

HEMATOCRIT, BLOOD

Facility

$44.00

Service Code	CPT 85014
Hospital Charge Code	4085014
Hospital Revenue Code	305
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare	$39.60
Rate for Payer: BCBS MT CHIP	$39.60
Rate for Payer: BCBS MT Closed Plan Network	$41.80
Rate for Payer: BCBS MT HealthLink	$39.60
Rate for Payer: BCBS MT Medicare	$39.60
Rate for Payer: BCBS MT POS	$41.80
Rate for Payer: BCBS MT Traditional	$44.00
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial	$41.80
Rate for Payer: Cigna Medicare	$39.60
Rate for Payer: Medicaid All Medicaid	$40.48
Rate for Payer: Medicare All Medicare	$30.80
Rate for Payer: Monida Allegiance	$41.80
Rate for Payer: Monida First Choice Health	$42.68
Rate for Payer: Monida Montana Health Co-op	$41.80
Rate for Payer: Monida PacificSource	$41.80

HEMOCCULT BLOOD CARD SCREENING - RVMC

Facility

$33.00

Service Code	CPT 82270
Hospital Charge Code	8082270
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare	$29.70
Rate for Payer: BCBS MT CHIP	$29.70
Rate for Payer: BCBS MT Closed Plan Network	$31.35
Rate for Payer: BCBS MT HealthLink	$29.70
Rate for Payer: BCBS MT Medicare	$29.70
Rate for Payer: BCBS MT POS	$31.35
Rate for Payer: BCBS MT Traditional	$33.00
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cigna Commercial	$31.35
Rate for Payer: Cigna Medicare	$29.70
Rate for Payer: Medicaid All Medicaid	$30.36
Rate for Payer: Medicare All Medicare	$23.10
Rate for Payer: Monida Allegiance	$31.35
Rate for Payer: Monida First Choice Health	$32.01
Rate for Payer: Monida Montana Health Co-op	$31.35
Rate for Payer: Monida PacificSource	$31.35

HEMOCCULT BLOOD CARD SCREENING - RVMC

Facility

$33.00

Service Code	CPT 82270
Hospital Charge Code	8082270
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare	$29.70
Rate for Payer: BCBS MT CHIP	$29.70
Rate for Payer: BCBS MT Closed Plan Network	$31.35
Rate for Payer: BCBS MT HealthLink	$29.70
Rate for Payer: BCBS MT Medicare	$29.70
Rate for Payer: BCBS MT POS	$31.35
Rate for Payer: BCBS MT Traditional	$33.00
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cigna Commercial	$31.35
Rate for Payer: Cigna Medicare	$29.70
Rate for Payer: Medicaid All Medicaid	$30.36
Rate for Payer: Medicare All Medicare	$23.10
Rate for Payer: Monida Allegiance	$31.35
Rate for Payer: Monida First Choice Health	$32.01
Rate for Payer: Monida Montana Health Co-op	$31.35
Rate for Payer: Monida PacificSource	$31.35

HEMOCCULT BLOOD CARD SCREEN-TWIN BRIDGES

Facility

$33.00

Service Code	CPT 82270
Hospital Charge Code	8182270
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare	$29.70
Rate for Payer: BCBS MT CHIP	$29.70
Rate for Payer: BCBS MT Closed Plan Network	$31.35
Rate for Payer: BCBS MT HealthLink	$29.70
Rate for Payer: BCBS MT Medicare	$29.70
Rate for Payer: BCBS MT POS	$31.35
Rate for Payer: BCBS MT Traditional	$33.00
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cigna Commercial	$31.35
Rate for Payer: Cigna Medicare	$29.70
Rate for Payer: Medicaid All Medicaid	$30.36
Rate for Payer: Medicare All Medicare	$23.10
Rate for Payer: Monida Allegiance	$31.35
Rate for Payer: Monida First Choice Health	$32.01
Rate for Payer: Monida Montana Health Co-op	$31.35
Rate for Payer: Monida PacificSource	$31.35

HEMOCCULT BLOOD CARD SCREEN-TWIN BRIDGES

Facility

$33.00

Service Code	CPT 82270
Hospital Charge Code	8182270
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare	$29.70
Rate for Payer: BCBS MT CHIP	$29.70
Rate for Payer: BCBS MT Closed Plan Network	$31.35
Rate for Payer: BCBS MT HealthLink	$29.70
Rate for Payer: BCBS MT Medicare	$29.70
Rate for Payer: BCBS MT POS	$31.35
Rate for Payer: BCBS MT Traditional	$33.00
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cigna Commercial	$31.35
Rate for Payer: Cigna Medicare	$29.70
Rate for Payer: Medicaid All Medicaid	$30.36
Rate for Payer: Medicare All Medicare	$23.10
Rate for Payer: Monida Allegiance	$31.35
Rate for Payer: Monida First Choice Health	$32.01
Rate for Payer: Monida Montana Health Co-op	$31.35
Rate for Payer: Monida PacificSource	$31.35

HEMOCCULT SINGLE SLIDES

Facility

$30.00

Hospital Charge Code	80030188
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS MT CHIP	$27.00
Rate for Payer: BCBS MT Closed Plan Network	$28.50
Rate for Payer: BCBS MT HealthLink	$27.00
Rate for Payer: BCBS MT Medicare	$27.00
Rate for Payer: BCBS MT POS	$28.50
Rate for Payer: BCBS MT Traditional	$30.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare	$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

HEMOCCULT SINGLE SLIDES

Facility

$30.00

Hospital Charge Code	80030188
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS MT CHIP	$27.00
Rate for Payer: BCBS MT Closed Plan Network	$28.50
Rate for Payer: BCBS MT HealthLink	$27.00
Rate for Payer: BCBS MT Medicare	$27.00
Rate for Payer: BCBS MT POS	$28.50
Rate for Payer: BCBS MT Traditional	$30.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare	$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

HEMOCHROMATOSIS HFE GENE (511345)

Facility

$225.00

Service Code	CPT 81256
Hospital Charge Code	4081256
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$213.75
Rate for Payer: Aetna Medicare	$202.50
Rate for Payer: BCBS MT CHIP	$202.50
Rate for Payer: BCBS MT Closed Plan Network	$213.75
Rate for Payer: BCBS MT HealthLink	$202.50
Rate for Payer: BCBS MT Medicare	$202.50
Rate for Payer: BCBS MT POS	$213.75
Rate for Payer: BCBS MT Traditional	$225.00
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cigna Commercial	$213.75
Rate for Payer: Cigna Medicare	$202.50
Rate for Payer: Medicaid All Medicaid	$207.00
Rate for Payer: Medicare All Medicare	$157.50
Rate for Payer: Monida Allegiance	$213.75
Rate for Payer: Monida First Choice Health	$218.25
Rate for Payer: Monida Montana Health Co-op	$213.75
Rate for Payer: Monida PacificSource	$213.75

HEMOCHROMATOSIS HFE GENE (511345)

Facility

$225.00

Service Code	CPT 81256
Hospital Charge Code	4081256
Hospital Revenue Code	300
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$213.75
Rate for Payer: Aetna Medicare	$202.50
Rate for Payer: BCBS MT CHIP	$202.50
Rate for Payer: BCBS MT Closed Plan Network	$213.75
Rate for Payer: BCBS MT HealthLink	$202.50
Rate for Payer: BCBS MT Medicare	$202.50
Rate for Payer: BCBS MT POS	$213.75
Rate for Payer: BCBS MT Traditional	$225.00
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cigna Commercial	$213.75
Rate for Payer: Cigna Medicare	$202.50
Rate for Payer: Medicaid All Medicaid	$207.00
Rate for Payer: Medicare All Medicare	$157.50
Rate for Payer: Monida Allegiance	$213.75
Rate for Payer: Monida First Choice Health	$218.25
Rate for Payer: Monida Montana Health Co-op	$213.75
Rate for Payer: Monida PacificSource	$213.75

HEMOGLOBIN

Facility

$44.00

Service Code	CPT 85018
Hospital Charge Code	8085018
Hospital Revenue Code	521
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare	$39.60
Rate for Payer: BCBS MT CHIP	$39.60
Rate for Payer: BCBS MT Closed Plan Network	$41.80
Rate for Payer: BCBS MT HealthLink	$39.60
Rate for Payer: BCBS MT Medicare	$39.60
Rate for Payer: BCBS MT POS	$41.80
Rate for Payer: BCBS MT Traditional	$44.00
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial	$41.80
Rate for Payer: Cigna Medicare	$39.60
Rate for Payer: Medicaid All Medicaid	$40.48
Rate for Payer: Medicare All Medicare	$30.80
Rate for Payer: Monida Allegiance	$41.80
Rate for Payer: Monida First Choice Health	$42.68
Rate for Payer: Monida Montana Health Co-op	$41.80
Rate for Payer: Monida PacificSource	$41.80

HEMOGLOBIN

Facility

$44.00

Service Code	CPT 85018
Hospital Charge Code	8085018
Hospital Revenue Code	521
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare	$39.60
Rate for Payer: BCBS MT CHIP	$39.60
Rate for Payer: BCBS MT Closed Plan Network	$41.80
Rate for Payer: BCBS MT HealthLink	$39.60
Rate for Payer: BCBS MT Medicare	$39.60
Rate for Payer: BCBS MT POS	$41.80
Rate for Payer: BCBS MT Traditional	$44.00
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial	$41.80
Rate for Payer: Cigna Medicare	$39.60
Rate for Payer: Medicaid All Medicaid	$40.48
Rate for Payer: Medicare All Medicare	$30.80
Rate for Payer: Monida Allegiance	$41.80
Rate for Payer: Monida First Choice Health	$42.68
Rate for Payer: Monida Montana Health Co-op	$41.80
Rate for Payer: Monida PacificSource	$41.80

HEMOGLOBIN A1C

Facility

$105.00

Service Code	CPT 83036
Hospital Charge Code	4083036
Hospital Revenue Code	300
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$99.75
Rate for Payer: Aetna Medicare	$94.50
Rate for Payer: BCBS MT CHIP	$94.50
Rate for Payer: BCBS MT Closed Plan Network	$99.75
Rate for Payer: BCBS MT HealthLink	$94.50
Rate for Payer: BCBS MT Medicare	$94.50
Rate for Payer: BCBS MT POS	$99.75
Rate for Payer: BCBS MT Traditional	$105.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna Commercial	$99.75
Rate for Payer: Cigna Medicare	$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

HEMOGLOBIN A1C

Facility

$105.00

Service Code	CPT 83036
Hospital Charge Code	4083036
Hospital Revenue Code	300
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$99.75
Rate for Payer: Aetna Medicare	$94.50
Rate for Payer: BCBS MT CHIP	$94.50
Rate for Payer: BCBS MT Closed Plan Network	$99.75
Rate for Payer: BCBS MT HealthLink	$94.50
Rate for Payer: BCBS MT Medicare	$94.50
Rate for Payer: BCBS MT POS	$99.75
Rate for Payer: BCBS MT Traditional	$105.00
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna Commercial	$99.75
Rate for Payer: Cigna Medicare	$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

HEMOGLOBIN, BLOOD

Facility

$43.00

Service Code	CPT 85018
Hospital Charge Code	4085018
Hospital Revenue Code	305
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare	$38.70
Rate for Payer: BCBS MT CHIP	$38.70
Rate for Payer: BCBS MT Closed Plan Network	$40.85
Rate for Payer: BCBS MT HealthLink	$38.70
Rate for Payer: BCBS MT Medicare	$38.70
Rate for Payer: BCBS MT POS	$40.85
Rate for Payer: BCBS MT Traditional	$43.00
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial	$40.85
Rate for Payer: Cigna Medicare	$38.70
Rate for Payer: Medicaid All Medicaid	$39.56
Rate for Payer: Medicare All Medicare	$30.10
Rate for Payer: Monida Allegiance	$40.85
Rate for Payer: Monida First Choice Health	$41.71
Rate for Payer: Monida Montana Health Co-op	$40.85
Rate for Payer: Monida PacificSource	$40.85

HEMOGLOBIN, BLOOD

Facility

$43.00

Service Code	CPT 85018
Hospital Charge Code	4085018
Hospital Revenue Code	305
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare	$38.70
Rate for Payer: BCBS MT CHIP	$38.70
Rate for Payer: BCBS MT Closed Plan Network	$40.85
Rate for Payer: BCBS MT HealthLink	$38.70
Rate for Payer: BCBS MT Medicare	$38.70
Rate for Payer: BCBS MT POS	$40.85
Rate for Payer: BCBS MT Traditional	$43.00
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial	$40.85
Rate for Payer: Cigna Medicare	$38.70
Rate for Payer: Medicaid All Medicaid	$39.56
Rate for Payer: Medicare All Medicare	$30.10
Rate for Payer: Monida Allegiance	$40.85
Rate for Payer: Monida First Choice Health	$41.71
Rate for Payer: Monida Montana Health Co-op	$40.85
Rate for Payer: Monida PacificSource	$40.85

Know your out-of-pocket cost for care.

All Charges