Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

LAB GENERAL HEALTH PANEL

Facility

$318.00

Service Code	CPT 80050
Hospital Charge Code	4080050
Hospital Revenue Code	300
Min. Negotiated Rate	$222.60
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$302.10
Rate for Payer: Aetna Medicare	$286.20
Rate for Payer: BCBS MT CHIP	$286.20
Rate for Payer: BCBS MT Closed Plan Network	$302.10
Rate for Payer: BCBS MT HealthLink	$286.20
Rate for Payer: BCBS MT Medicare	$286.20
Rate for Payer: BCBS MT POS	$302.10
Rate for Payer: BCBS MT Traditional	$318.00
Rate for Payer: Cash Price	$286.20
Rate for Payer: Cigna Commercial	$302.10
Rate for Payer: Cigna Medicare	$286.20
Rate for Payer: Medicaid All Medicaid	$292.56
Rate for Payer: Medicare All Medicare	$222.60
Rate for Payer: Monida Allegiance	$302.10
Rate for Payer: Monida First Choice Health	$308.46
Rate for Payer: Monida Montana Health Co-op	$302.10
Rate for Payer: Monida PacificSource	$302.10

LAB GIARDIA LAMBLIA ANTIBODY

Facility

$103.00

Service Code	CPT 86674
Hospital Charge Code	4086674
Hospital Revenue Code	300
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$97.85
Rate for Payer: Aetna Medicare	$92.70
Rate for Payer: BCBS MT CHIP	$92.70
Rate for Payer: BCBS MT Closed Plan Network	$97.85
Rate for Payer: BCBS MT HealthLink	$92.70
Rate for Payer: BCBS MT Medicare	$92.70
Rate for Payer: BCBS MT POS	$97.85
Rate for Payer: BCBS MT Traditional	$103.00
Rate for Payer: Cash Price	$92.70
Rate for Payer: Cigna Commercial	$97.85
Rate for Payer: Cigna Medicare	$92.70
Rate for Payer: Medicaid All Medicaid	$94.76
Rate for Payer: Medicare All Medicare	$72.10
Rate for Payer: Monida Allegiance	$97.85
Rate for Payer: Monida First Choice Health	$99.91
Rate for Payer: Monida Montana Health Co-op	$97.85
Rate for Payer: Monida PacificSource	$97.85

LAB GIARDIA LAMBLIA ANTIBODY

Facility

$103.00

Service Code	CPT 86674
Hospital Charge Code	4086674
Hospital Revenue Code	300
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$103.00
Rate for Payer: Aetna Commercial	$97.85
Rate for Payer: Aetna Medicare	$92.70
Rate for Payer: BCBS MT CHIP	$92.70
Rate for Payer: BCBS MT Closed Plan Network	$97.85
Rate for Payer: BCBS MT HealthLink	$92.70
Rate for Payer: BCBS MT Medicare	$92.70
Rate for Payer: BCBS MT POS	$97.85
Rate for Payer: BCBS MT Traditional	$103.00
Rate for Payer: Cash Price	$92.70
Rate for Payer: Cigna Commercial	$97.85
Rate for Payer: Cigna Medicare	$92.70
Rate for Payer: Medicaid All Medicaid	$94.76
Rate for Payer: Medicare All Medicare	$72.10
Rate for Payer: Monida Allegiance	$97.85
Rate for Payer: Monida First Choice Health	$99.91
Rate for Payer: Monida Montana Health Co-op	$97.85
Rate for Payer: Monida PacificSource	$97.85

LAB GLUCOSE (WITH GLUCOLA) (OB)

Facility

$57.00

Service Code	CPT 82950
Hospital Charge Code	4082950
Hospital Revenue Code	301
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare	$51.30
Rate for Payer: BCBS MT CHIP	$51.30
Rate for Payer: BCBS MT Closed Plan Network	$54.15
Rate for Payer: BCBS MT HealthLink	$51.30
Rate for Payer: BCBS MT Medicare	$51.30
Rate for Payer: BCBS MT POS	$54.15
Rate for Payer: BCBS MT Traditional	$57.00
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cigna Commercial	$54.15
Rate for Payer: Cigna Medicare	$51.30
Rate for Payer: Medicaid All Medicaid	$52.44
Rate for Payer: Medicare All Medicare	$39.90
Rate for Payer: Monida Allegiance	$54.15
Rate for Payer: Monida First Choice Health	$55.29
Rate for Payer: Monida Montana Health Co-op	$54.15
Rate for Payer: Monida PacificSource	$54.15

LAB GLUCOSE (WITH GLUCOLA) (OB)

Facility

$57.00

Service Code	CPT 82950
Hospital Charge Code	4082950
Hospital Revenue Code	301
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare	$51.30
Rate for Payer: BCBS MT CHIP	$51.30
Rate for Payer: BCBS MT Closed Plan Network	$54.15
Rate for Payer: BCBS MT HealthLink	$51.30
Rate for Payer: BCBS MT Medicare	$51.30
Rate for Payer: BCBS MT POS	$54.15
Rate for Payer: BCBS MT Traditional	$57.00
Rate for Payer: Cash Price	$51.30
Rate for Payer: Cigna Commercial	$54.15
Rate for Payer: Cigna Medicare	$51.30
Rate for Payer: Medicaid All Medicaid	$52.44
Rate for Payer: Medicare All Medicare	$39.90
Rate for Payer: Monida Allegiance	$54.15
Rate for Payer: Monida First Choice Health	$55.29
Rate for Payer: Monida Montana Health Co-op	$54.15
Rate for Payer: Monida PacificSource	$54.15

LAB GROWTH HORMONE

Facility

$99.00

Service Code	CPT 83003
Hospital Charge Code	4083003
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare	$89.10
Rate for Payer: BCBS MT CHIP	$89.10
Rate for Payer: BCBS MT Closed Plan Network	$94.05
Rate for Payer: BCBS MT HealthLink	$89.10
Rate for Payer: BCBS MT Medicare	$89.10
Rate for Payer: BCBS MT POS	$94.05
Rate for Payer: BCBS MT Traditional	$99.00
Rate for Payer: Cash Price	$89.10
Rate for Payer: Cigna Commercial	$94.05
Rate for Payer: Cigna Medicare	$89.10
Rate for Payer: Medicaid All Medicaid	$91.08
Rate for Payer: Medicare All Medicare	$69.30
Rate for Payer: Monida Allegiance	$94.05
Rate for Payer: Monida First Choice Health	$96.03
Rate for Payer: Monida Montana Health Co-op	$94.05
Rate for Payer: Monida PacificSource	$94.05

LAB GROWTH HORMONE

Facility

$99.00

Service Code	CPT 83003
Hospital Charge Code	4083003
Hospital Revenue Code	301
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare	$89.10
Rate for Payer: BCBS MT CHIP	$89.10
Rate for Payer: BCBS MT Closed Plan Network	$94.05
Rate for Payer: BCBS MT HealthLink	$89.10
Rate for Payer: BCBS MT Medicare	$89.10
Rate for Payer: BCBS MT POS	$94.05
Rate for Payer: BCBS MT Traditional	$99.00
Rate for Payer: Cash Price	$89.10
Rate for Payer: Cigna Commercial	$94.05
Rate for Payer: Cigna Medicare	$89.10
Rate for Payer: Medicaid All Medicaid	$91.08
Rate for Payer: Medicare All Medicare	$69.30
Rate for Payer: Monida Allegiance	$94.05
Rate for Payer: Monida First Choice Health	$96.03
Rate for Payer: Monida Montana Health Co-op	$94.05
Rate for Payer: Monida PacificSource	$94.05

LAB HELIOBACTOR PYLORI

Facility

$92.00

Service Code	CPT 86677
Hospital Charge Code	4086677
Hospital Revenue Code	300
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare	$82.80
Rate for Payer: BCBS MT CHIP	$82.80
Rate for Payer: BCBS MT Closed Plan Network	$87.40
Rate for Payer: BCBS MT HealthLink	$82.80
Rate for Payer: BCBS MT Medicare	$82.80
Rate for Payer: BCBS MT POS	$87.40
Rate for Payer: BCBS MT Traditional	$92.00
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial	$87.40
Rate for Payer: Cigna Medicare	$82.80
Rate for Payer: Medicaid All Medicaid	$84.64
Rate for Payer: Medicare All Medicare	$64.40
Rate for Payer: Monida Allegiance	$87.40
Rate for Payer: Monida First Choice Health	$89.24
Rate for Payer: Monida Montana Health Co-op	$87.40
Rate for Payer: Monida PacificSource	$87.40

LAB HELIOBACTOR PYLORI

Facility

$92.00

Service Code	CPT 86677
Hospital Charge Code	4086677
Hospital Revenue Code	300
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare	$82.80
Rate for Payer: BCBS MT CHIP	$82.80
Rate for Payer: BCBS MT Closed Plan Network	$87.40
Rate for Payer: BCBS MT HealthLink	$82.80
Rate for Payer: BCBS MT Medicare	$82.80
Rate for Payer: BCBS MT POS	$87.40
Rate for Payer: BCBS MT Traditional	$92.00
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial	$87.40
Rate for Payer: Cigna Medicare	$82.80
Rate for Payer: Medicaid All Medicaid	$84.64
Rate for Payer: Medicare All Medicare	$64.40
Rate for Payer: Monida Allegiance	$87.40
Rate for Payer: Monida First Choice Health	$89.24
Rate for Payer: Monida Montana Health Co-op	$87.40
Rate for Payer: Monida PacificSource	$87.40

LAB HEMOGLOBINOPATHY EVALUATION

Facility

$208.00

Service Code	CPT 83021
Hospital Charge Code	4083021
Hospital Revenue Code	305
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare	$187.20
Rate for Payer: BCBS MT CHIP	$187.20
Rate for Payer: BCBS MT Closed Plan Network	$197.60
Rate for Payer: BCBS MT HealthLink	$187.20
Rate for Payer: BCBS MT Medicare	$187.20
Rate for Payer: BCBS MT POS	$197.60
Rate for Payer: BCBS MT Traditional	$208.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial	$197.60
Rate for Payer: Cigna Medicare	$187.20
Rate for Payer: Medicaid All Medicaid	$191.36
Rate for Payer: Medicare All Medicare	$145.60
Rate for Payer: Monida Allegiance	$197.60
Rate for Payer: Monida First Choice Health	$201.76
Rate for Payer: Monida Montana Health Co-op	$197.60
Rate for Payer: Monida PacificSource	$197.60

LAB HEMOGLOBINOPATHY EVALUATION

Facility

$208.00

Service Code	CPT 83021
Hospital Charge Code	4083021
Hospital Revenue Code	305
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare	$187.20
Rate for Payer: BCBS MT CHIP	$187.20
Rate for Payer: BCBS MT Closed Plan Network	$197.60
Rate for Payer: BCBS MT HealthLink	$187.20
Rate for Payer: BCBS MT Medicare	$187.20
Rate for Payer: BCBS MT POS	$197.60
Rate for Payer: BCBS MT Traditional	$208.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial	$197.60
Rate for Payer: Cigna Medicare	$187.20
Rate for Payer: Medicaid All Medicaid	$191.36
Rate for Payer: Medicare All Medicare	$145.60
Rate for Payer: Monida Allegiance	$197.60
Rate for Payer: Monida First Choice Health	$201.76
Rate for Payer: Monida Montana Health Co-op	$197.60
Rate for Payer: Monida PacificSource	$197.60

LAB HEPATITIS B SURFACE

Facility

$52.00

Service Code	CPT 86280
Hospital Charge Code	4086280
Hospital Revenue Code	300
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

LAB HEPATITIS B SURFACE

Facility

$52.00

Service Code	CPT 86280
Hospital Charge Code	4086280
Hospital Revenue Code	300
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

LAB HEPATITIS C VIRUS RNA,QT

Facility

$551.00

Service Code	CPT 87902
Hospital Charge Code	4087902
Hospital Revenue Code	300
Min. Negotiated Rate	$385.70
Max. Negotiated Rate	$551.00
Rate for Payer: Aetna Commercial	$523.45
Rate for Payer: Aetna Medicare	$495.90
Rate for Payer: BCBS MT CHIP	$495.90
Rate for Payer: BCBS MT Closed Plan Network	$523.45
Rate for Payer: BCBS MT HealthLink	$495.90
Rate for Payer: BCBS MT Medicare	$495.90
Rate for Payer: BCBS MT POS	$523.45
Rate for Payer: BCBS MT Traditional	$551.00
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cigna Commercial	$523.45
Rate for Payer: Cigna Medicare	$495.90
Rate for Payer: Medicaid All Medicaid	$506.92
Rate for Payer: Medicare All Medicare	$385.70
Rate for Payer: Monida Allegiance	$523.45
Rate for Payer: Monida First Choice Health	$534.47
Rate for Payer: Monida Montana Health Co-op	$523.45
Rate for Payer: Monida PacificSource	$523.45

LAB HEPATITIS C VIRUS RNA,QT

Facility

$551.00

Service Code	CPT 87902
Hospital Charge Code	4087902
Hospital Revenue Code	300
Min. Negotiated Rate	$385.70
Max. Negotiated Rate	$551.00
Rate for Payer: Aetna Commercial	$523.45
Rate for Payer: Aetna Medicare	$495.90
Rate for Payer: BCBS MT CHIP	$495.90
Rate for Payer: BCBS MT Closed Plan Network	$523.45
Rate for Payer: BCBS MT HealthLink	$495.90
Rate for Payer: BCBS MT Medicare	$495.90
Rate for Payer: BCBS MT POS	$523.45
Rate for Payer: BCBS MT Traditional	$551.00
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cigna Commercial	$523.45
Rate for Payer: Cigna Medicare	$495.90
Rate for Payer: Medicaid All Medicaid	$506.92
Rate for Payer: Medicare All Medicare	$385.70
Rate for Payer: Monida Allegiance	$523.45
Rate for Payer: Monida First Choice Health	$534.47
Rate for Payer: Monida Montana Health Co-op	$523.45
Rate for Payer: Monida PacificSource	$523.45

LAB HIV-1

Facility

$97.00

Service Code	CPT 86701
Hospital Charge Code	4086701
Hospital Revenue Code	300
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$97.00
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare	$87.30
Rate for Payer: BCBS MT CHIP	$87.30
Rate for Payer: BCBS MT Closed Plan Network	$92.15
Rate for Payer: BCBS MT HealthLink	$87.30
Rate for Payer: BCBS MT Medicare	$87.30
Rate for Payer: BCBS MT POS	$92.15
Rate for Payer: BCBS MT Traditional	$97.00
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna Commercial	$92.15
Rate for Payer: Cigna Medicare	$87.30
Rate for Payer: Medicaid All Medicaid	$89.24
Rate for Payer: Medicare All Medicare	$67.90
Rate for Payer: Monida Allegiance	$92.15
Rate for Payer: Monida First Choice Health	$94.09
Rate for Payer: Monida Montana Health Co-op	$92.15
Rate for Payer: Monida PacificSource	$92.15

LAB HIV-1

Facility

$97.00

Service Code	CPT 86701
Hospital Charge Code	4086701
Hospital Revenue Code	300
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$97.00
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare	$87.30
Rate for Payer: BCBS MT CHIP	$87.30
Rate for Payer: BCBS MT Closed Plan Network	$92.15
Rate for Payer: BCBS MT HealthLink	$87.30
Rate for Payer: BCBS MT Medicare	$87.30
Rate for Payer: BCBS MT POS	$92.15
Rate for Payer: BCBS MT Traditional	$97.00
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna Commercial	$92.15
Rate for Payer: Cigna Medicare	$87.30
Rate for Payer: Medicaid All Medicaid	$89.24
Rate for Payer: Medicare All Medicare	$67.90
Rate for Payer: Monida Allegiance	$92.15
Rate for Payer: Monida First Choice Health	$94.09
Rate for Payer: Monida Montana Health Co-op	$92.15
Rate for Payer: Monida PacificSource	$92.15

LAB HIV-1/2 RAPID

Facility

$78.00

Service Code	CPT 86703
Hospital Charge Code	4086703
Hospital Revenue Code	300
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

LAB HIV-1/2 RAPID

Facility

$78.00

Service Code	CPT 86703
Hospital Charge Code	4086703
Hospital Revenue Code	300
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

LAB HIV-1 GENOTYPE

Facility

$770.00

Service Code	CPT 87901
Hospital Charge Code	4087901
Hospital Revenue Code	306
Min. Negotiated Rate	$539.00
Max. Negotiated Rate	$770.00
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare	$693.00
Rate for Payer: BCBS MT CHIP	$693.00
Rate for Payer: BCBS MT Closed Plan Network	$731.50
Rate for Payer: BCBS MT HealthLink	$693.00
Rate for Payer: BCBS MT Medicare	$693.00
Rate for Payer: BCBS MT POS	$731.50
Rate for Payer: BCBS MT Traditional	$770.00
Rate for Payer: Cash Price	$693.00
Rate for Payer: Cigna Commercial	$731.50
Rate for Payer: Cigna Medicare	$693.00
Rate for Payer: Medicaid All Medicaid	$708.40
Rate for Payer: Medicare All Medicare	$539.00
Rate for Payer: Monida Allegiance	$731.50
Rate for Payer: Monida First Choice Health	$746.90
Rate for Payer: Monida Montana Health Co-op	$731.50
Rate for Payer: Monida PacificSource	$731.50

LAB HIV-1 GENOTYPE

Facility

$770.00

Service Code	CPT 87901
Hospital Charge Code	4087901
Hospital Revenue Code	306
Min. Negotiated Rate	$539.00
Max. Negotiated Rate	$770.00
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare	$693.00
Rate for Payer: BCBS MT CHIP	$693.00
Rate for Payer: BCBS MT Closed Plan Network	$731.50
Rate for Payer: BCBS MT HealthLink	$693.00
Rate for Payer: BCBS MT Medicare	$693.00
Rate for Payer: BCBS MT POS	$731.50
Rate for Payer: BCBS MT Traditional	$770.00
Rate for Payer: Cash Price	$693.00
Rate for Payer: Cigna Commercial	$731.50
Rate for Payer: Cigna Medicare	$693.00
Rate for Payer: Medicaid All Medicaid	$708.40
Rate for Payer: Medicare All Medicare	$539.00
Rate for Payer: Monida Allegiance	$731.50
Rate for Payer: Monida First Choice Health	$746.90
Rate for Payer: Monida Montana Health Co-op	$731.50
Rate for Payer: Monida PacificSource	$731.50

LAB HIV-2

Facility

$187.00

Service Code	CPT 86702
Hospital Charge Code	4086702
Hospital Revenue Code	300
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$168.30
Rate for Payer: BCBS MT CHIP	$168.30
Rate for Payer: BCBS MT Closed Plan Network	$177.65
Rate for Payer: BCBS MT HealthLink	$168.30
Rate for Payer: BCBS MT Medicare	$168.30
Rate for Payer: BCBS MT POS	$177.65
Rate for Payer: BCBS MT Traditional	$187.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial	$177.65
Rate for Payer: Cigna Medicare	$168.30
Rate for Payer: Medicaid All Medicaid	$172.04
Rate for Payer: Medicare All Medicare	$130.90
Rate for Payer: Monida Allegiance	$177.65
Rate for Payer: Monida First Choice Health	$181.39
Rate for Payer: Monida Montana Health Co-op	$177.65
Rate for Payer: Monida PacificSource	$177.65

LAB HIV-2

Facility

$187.00

Service Code	CPT 86702
Hospital Charge Code	4086702
Hospital Revenue Code	300
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$168.30
Rate for Payer: BCBS MT CHIP	$168.30
Rate for Payer: BCBS MT Closed Plan Network	$177.65
Rate for Payer: BCBS MT HealthLink	$168.30
Rate for Payer: BCBS MT Medicare	$168.30
Rate for Payer: BCBS MT POS	$177.65
Rate for Payer: BCBS MT Traditional	$187.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial	$177.65
Rate for Payer: Cigna Medicare	$168.30
Rate for Payer: Medicaid All Medicaid	$172.04
Rate for Payer: Medicare All Medicare	$130.90
Rate for Payer: Monida Allegiance	$177.65
Rate for Payer: Monida First Choice Health	$181.39
Rate for Payer: Monida Montana Health Co-op	$177.65
Rate for Payer: Monida PacificSource	$177.65

LAB HOMOCYSTEINE CARDIO

Facility

$210.00

Service Code	CPT 33030
Hospital Charge Code	4033090
Hospital Revenue Code	301
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare	$189.00
Rate for Payer: BCBS MT CHIP	$189.00
Rate for Payer: BCBS MT Closed Plan Network	$199.50
Rate for Payer: BCBS MT HealthLink	$189.00
Rate for Payer: BCBS MT Medicare	$189.00
Rate for Payer: BCBS MT POS	$199.50
Rate for Payer: BCBS MT Traditional	$210.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: Cigna Medicare	$189.00
Rate for Payer: Medicaid All Medicaid	$193.20
Rate for Payer: Medicare All Medicare	$147.00
Rate for Payer: Monida Allegiance	$199.50
Rate for Payer: Monida First Choice Health	$203.70
Rate for Payer: Monida Montana Health Co-op	$199.50
Rate for Payer: Monida PacificSource	$199.50

LAB HOMOCYSTEINE CARDIO

Facility

$210.00

Service Code	CPT 33030
Hospital Charge Code	4033090
Hospital Revenue Code	301
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare	$189.00
Rate for Payer: BCBS MT CHIP	$189.00
Rate for Payer: BCBS MT Closed Plan Network	$199.50
Rate for Payer: BCBS MT HealthLink	$189.00
Rate for Payer: BCBS MT Medicare	$189.00
Rate for Payer: BCBS MT POS	$199.50
Rate for Payer: BCBS MT Traditional	$210.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: Cigna Medicare	$189.00
Rate for Payer: Medicaid All Medicaid	$193.20
Rate for Payer: Medicare All Medicare	$147.00
Rate for Payer: Monida Allegiance	$199.50
Rate for Payer: Monida First Choice Health	$203.70
Rate for Payer: Monida Montana Health Co-op	$199.50
Rate for Payer: Monida PacificSource	$199.50

Know your out-of-pocket cost for care.

All Charges