Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PARING/CUTTING 2-4 LESION CORN/CALL

Facility

$191.00

Service Code	CPT 11056
Hospital Charge Code	8011056
Hospital Revenue Code	521
Min. Negotiated Rate	$133.70
Max. Negotiated Rate	$191.00
Rate for Payer: Aetna Commercial	$181.45
Rate for Payer: Aetna Medicare	$171.90
Rate for Payer: BCBS MT CHIP	$171.90
Rate for Payer: BCBS MT Closed Plan Network	$181.45
Rate for Payer: BCBS MT HealthLink	$171.90
Rate for Payer: BCBS MT Medicare	$171.90
Rate for Payer: BCBS MT POS	$181.45
Rate for Payer: BCBS MT Traditional	$191.00
Rate for Payer: Cash Price	$171.90
Rate for Payer: Cigna Commercial	$181.45
Rate for Payer: Cigna Medicare	$171.90
Rate for Payer: Medicaid All Medicaid	$175.72
Rate for Payer: Medicare All Medicare	$133.70
Rate for Payer: Monida Allegiance	$181.45
Rate for Payer: Monida First Choice Health	$185.27
Rate for Payer: Monida Montana Health Co-op	$181.45
Rate for Payer: Monida PacificSource	$181.45

PARING/CUTTING >4 LESIONS CORN/CALLUS

Facility

$220.00

Service Code	CPT 11057
Hospital Charge Code	8011057
Hospital Revenue Code	521
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare	$198.00
Rate for Payer: BCBS MT CHIP	$198.00
Rate for Payer: BCBS MT Closed Plan Network	$209.00
Rate for Payer: BCBS MT HealthLink	$198.00
Rate for Payer: BCBS MT Medicare	$198.00
Rate for Payer: BCBS MT POS	$209.00
Rate for Payer: BCBS MT Traditional	$220.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare	$198.00
Rate for Payer: Medicaid All Medicaid	$202.40
Rate for Payer: Medicare All Medicare	$154.00
Rate for Payer: Monida Allegiance	$209.00
Rate for Payer: Monida First Choice Health	$213.40
Rate for Payer: Monida Montana Health Co-op	$209.00
Rate for Payer: Monida PacificSource	$209.00

PARING/CUTTING >4 LESIONS CORN/CALLUS

Facility

$220.00

Service Code	CPT 11057
Hospital Charge Code	8011057
Hospital Revenue Code	521
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare	$198.00
Rate for Payer: BCBS MT CHIP	$198.00
Rate for Payer: BCBS MT Closed Plan Network	$209.00
Rate for Payer: BCBS MT HealthLink	$198.00
Rate for Payer: BCBS MT Medicare	$198.00
Rate for Payer: BCBS MT POS	$209.00
Rate for Payer: BCBS MT Traditional	$220.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare	$198.00
Rate for Payer: Medicaid All Medicaid	$202.40
Rate for Payer: Medicare All Medicare	$154.00
Rate for Payer: Monida Allegiance	$209.00
Rate for Payer: Monida First Choice Health	$213.40
Rate for Payer: Monida Montana Health Co-op	$209.00
Rate for Payer: Monida PacificSource	$209.00

PARING/CUTTING SINGLE LESION CORN/CALLUS

Facility

$176.00

Service Code	CPT 11055
Hospital Charge Code	8011055
Hospital Revenue Code	521
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$176.00
Rate for Payer: Aetna Commercial	$167.20
Rate for Payer: Aetna Medicare	$158.40
Rate for Payer: BCBS MT CHIP	$158.40
Rate for Payer: BCBS MT Closed Plan Network	$167.20
Rate for Payer: BCBS MT HealthLink	$158.40
Rate for Payer: BCBS MT Medicare	$158.40
Rate for Payer: BCBS MT POS	$167.20
Rate for Payer: BCBS MT Traditional	$176.00
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cigna Commercial	$167.20
Rate for Payer: Cigna Medicare	$158.40
Rate for Payer: Medicaid All Medicaid	$161.92
Rate for Payer: Medicare All Medicare	$123.20
Rate for Payer: Monida Allegiance	$167.20
Rate for Payer: Monida First Choice Health	$170.72
Rate for Payer: Monida Montana Health Co-op	$167.20
Rate for Payer: Monida PacificSource	$167.20

PARING/CUTTING SINGLE LESION CORN/CALLUS

Facility

$176.00

Service Code	CPT 11055
Hospital Charge Code	8011055
Hospital Revenue Code	521
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$176.00
Rate for Payer: Aetna Commercial	$167.20
Rate for Payer: Aetna Medicare	$158.40
Rate for Payer: BCBS MT CHIP	$158.40
Rate for Payer: BCBS MT Closed Plan Network	$167.20
Rate for Payer: BCBS MT HealthLink	$158.40
Rate for Payer: BCBS MT Medicare	$158.40
Rate for Payer: BCBS MT POS	$167.20
Rate for Payer: BCBS MT Traditional	$176.00
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cigna Commercial	$167.20
Rate for Payer: Cigna Medicare	$158.40
Rate for Payer: Medicaid All Medicaid	$161.92
Rate for Payer: Medicare All Medicare	$123.20
Rate for Payer: Monida Allegiance	$167.20
Rate for Payer: Monida First Choice Health	$170.72
Rate for Payer: Monida Montana Health Co-op	$167.20
Rate for Payer: Monida PacificSource	$167.20

PAROXETINE TAB [20 MG] NF

Facility

$9.00

Service Code	HCPCS J8499
Hospital Charge Code	3000378
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare	$8.10
Rate for Payer: BCBS MT CHIP	$8.10
Rate for Payer: BCBS MT Closed Plan Network	$8.55
Rate for Payer: BCBS MT HealthLink	$8.10
Rate for Payer: BCBS MT Medicare	$8.10
Rate for Payer: BCBS MT POS	$8.55
Rate for Payer: BCBS MT Traditional	$9.00
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cigna Commercial	$8.55
Rate for Payer: Cigna Medicare	$8.10
Rate for Payer: Medicaid All Medicaid	$8.28
Rate for Payer: Medicare All Medicare	$6.30
Rate for Payer: Monida Allegiance	$8.55
Rate for Payer: Monida First Choice Health	$8.73
Rate for Payer: Monida Montana Health Co-op	$8.55
Rate for Payer: Monida PacificSource	$8.55

PAROXETINE TAB [20 MG] NF

Facility

$9.00

Service Code	HCPCS J8499
Hospital Charge Code	3000378
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare	$8.10
Rate for Payer: BCBS MT CHIP	$8.10
Rate for Payer: BCBS MT Closed Plan Network	$8.55
Rate for Payer: BCBS MT HealthLink	$8.10
Rate for Payer: BCBS MT Medicare	$8.10
Rate for Payer: BCBS MT POS	$8.55
Rate for Payer: BCBS MT Traditional	$9.00
Rate for Payer: Cash Price	$8.10
Rate for Payer: Cigna Commercial	$8.55
Rate for Payer: Cigna Medicare	$8.10
Rate for Payer: Medicaid All Medicaid	$8.28
Rate for Payer: Medicare All Medicare	$6.30
Rate for Payer: Monida Allegiance	$8.55
Rate for Payer: Monida First Choice Health	$8.73
Rate for Payer: Monida Montana Health Co-op	$8.55
Rate for Payer: Monida PacificSource	$8.55

PARVOVIRUS PCR

Facility

$280.00

Service Code	CPT 87798
Hospital Charge Code	4087940
Hospital Revenue Code	300
Min. Negotiated Rate	$196.00
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare	$252.00
Rate for Payer: BCBS MT CHIP	$252.00
Rate for Payer: BCBS MT Closed Plan Network	$266.00
Rate for Payer: BCBS MT HealthLink	$252.00
Rate for Payer: BCBS MT Medicare	$252.00
Rate for Payer: BCBS MT POS	$266.00
Rate for Payer: BCBS MT Traditional	$280.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cigna Commercial	$266.00
Rate for Payer: Cigna Medicare	$252.00
Rate for Payer: Medicaid All Medicaid	$257.60
Rate for Payer: Medicare All Medicare	$196.00
Rate for Payer: Monida Allegiance	$266.00
Rate for Payer: Monida First Choice Health	$271.60
Rate for Payer: Monida Montana Health Co-op	$266.00
Rate for Payer: Monida PacificSource	$266.00

PARVOVIRUS PCR

Facility

$280.00

Service Code	CPT 87798
Hospital Charge Code	4087940
Hospital Revenue Code	300
Min. Negotiated Rate	$196.00
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare	$252.00
Rate for Payer: BCBS MT CHIP	$252.00
Rate for Payer: BCBS MT Closed Plan Network	$266.00
Rate for Payer: BCBS MT HealthLink	$252.00
Rate for Payer: BCBS MT Medicare	$252.00
Rate for Payer: BCBS MT POS	$266.00
Rate for Payer: BCBS MT Traditional	$280.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cigna Commercial	$266.00
Rate for Payer: Cigna Medicare	$252.00
Rate for Payer: Medicaid All Medicaid	$257.60
Rate for Payer: Medicare All Medicare	$196.00
Rate for Payer: Monida Allegiance	$266.00
Rate for Payer: Monida First Choice Health	$271.60
Rate for Payer: Monida Montana Health Co-op	$266.00
Rate for Payer: Monida PacificSource	$266.00

PATELLA STRAP LG

Facility

$46.00

Hospital Charge Code	2893456
Hospital Revenue Code	290
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare	$41.40
Rate for Payer: BCBS MT CHIP	$41.40
Rate for Payer: BCBS MT Closed Plan Network	$43.70
Rate for Payer: BCBS MT HealthLink	$41.40
Rate for Payer: BCBS MT Medicare	$41.40
Rate for Payer: BCBS MT POS	$43.70
Rate for Payer: BCBS MT Traditional	$46.00
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cigna Commercial	$43.70
Rate for Payer: Cigna Medicare	$41.40
Rate for Payer: Medicaid All Medicaid	$42.32
Rate for Payer: Medicare All Medicare	$32.20
Rate for Payer: Monida Allegiance	$43.70
Rate for Payer: Monida First Choice Health	$44.62
Rate for Payer: Monida Montana Health Co-op	$43.70
Rate for Payer: Monida PacificSource	$43.70

PATELLA STRAP LG

Facility

$46.00

Hospital Charge Code	2893456
Hospital Revenue Code	290
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare	$41.40
Rate for Payer: BCBS MT CHIP	$41.40
Rate for Payer: BCBS MT Closed Plan Network	$43.70
Rate for Payer: BCBS MT HealthLink	$41.40
Rate for Payer: BCBS MT Medicare	$41.40
Rate for Payer: BCBS MT POS	$43.70
Rate for Payer: BCBS MT Traditional	$46.00
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cigna Commercial	$43.70
Rate for Payer: Cigna Medicare	$41.40
Rate for Payer: Medicaid All Medicaid	$42.32
Rate for Payer: Medicare All Medicare	$32.20
Rate for Payer: Monida Allegiance	$43.70
Rate for Payer: Monida First Choice Health	$44.62
Rate for Payer: Monida Montana Health Co-op	$43.70
Rate for Payer: Monida PacificSource	$43.70

PATELLA STRAP MED

Facility

$54.00

Hospital Charge Code	2840155
Hospital Revenue Code	270
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

PATELLA STRAP MED

Facility

$54.00

Hospital Charge Code	2840155
Hospital Revenue Code	270
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

PATHFAST D-DIMER(60TESTS/BX) D/S

Facility

$620.10

Hospital Charge Code	90197025
Hospital Revenue Code	270
Min. Negotiated Rate	$434.07
Max. Negotiated Rate	$620.10
Rate for Payer: Aetna Commercial	$589.10
Rate for Payer: Aetna Medicare	$558.09
Rate for Payer: BCBS MT CHIP	$558.09
Rate for Payer: BCBS MT Closed Plan Network	$589.10
Rate for Payer: BCBS MT HealthLink	$558.09
Rate for Payer: BCBS MT Medicare	$558.09
Rate for Payer: BCBS MT POS	$589.10
Rate for Payer: BCBS MT Traditional	$620.10
Rate for Payer: Cash Price	$558.09
Rate for Payer: Cigna Commercial	$589.10
Rate for Payer: Cigna Medicare	$558.09
Rate for Payer: Medicaid All Medicaid	$570.49
Rate for Payer: Medicare All Medicare	$434.07
Rate for Payer: Monida Allegiance	$589.10
Rate for Payer: Monida First Choice Health	$601.50
Rate for Payer: Monida Montana Health Co-op	$589.10
Rate for Payer: Monida PacificSource	$589.10

PATHFAST D-DIMER(60TESTS/BX) D/S

Facility

$620.10

Hospital Charge Code	90197025
Hospital Revenue Code	270
Min. Negotiated Rate	$434.07
Max. Negotiated Rate	$620.10
Rate for Payer: Aetna Commercial	$589.10
Rate for Payer: Aetna Medicare	$558.09
Rate for Payer: BCBS MT CHIP	$558.09
Rate for Payer: BCBS MT Closed Plan Network	$589.10
Rate for Payer: BCBS MT HealthLink	$558.09
Rate for Payer: BCBS MT Medicare	$558.09
Rate for Payer: BCBS MT POS	$589.10
Rate for Payer: BCBS MT Traditional	$620.10
Rate for Payer: Cash Price	$558.09
Rate for Payer: Cigna Commercial	$589.10
Rate for Payer: Cigna Medicare	$558.09
Rate for Payer: Medicaid All Medicaid	$570.49
Rate for Payer: Medicare All Medicare	$434.07
Rate for Payer: Monida Allegiance	$589.10
Rate for Payer: Monida First Choice Health	$601.50
Rate for Payer: Monida Montana Health Co-op	$589.10
Rate for Payer: Monida PacificSource	$589.10

PATHFAST HI SENS TROPONIN

Facility

$2,392.38

Hospital Charge Code	90197157
Hospital Revenue Code	270
Min. Negotiated Rate	$1,674.67
Max. Negotiated Rate	$2,392.38
Rate for Payer: Aetna Commercial	$2,272.76
Rate for Payer: Aetna Medicare	$2,153.14
Rate for Payer: BCBS MT CHIP	$2,153.14
Rate for Payer: BCBS MT Closed Plan Network	$2,272.76
Rate for Payer: BCBS MT HealthLink	$2,153.14
Rate for Payer: BCBS MT Medicare	$2,153.14
Rate for Payer: BCBS MT POS	$2,272.76
Rate for Payer: BCBS MT Traditional	$2,392.38
Rate for Payer: Cash Price	$2,153.14
Rate for Payer: Cigna Commercial	$2,272.76
Rate for Payer: Cigna Medicare	$2,153.14
Rate for Payer: Medicaid All Medicaid	$2,200.99
Rate for Payer: Medicare All Medicare	$1,674.67
Rate for Payer: Monida Allegiance	$2,272.76
Rate for Payer: Monida First Choice Health	$2,320.61
Rate for Payer: Monida Montana Health Co-op	$2,272.76
Rate for Payer: Monida PacificSource	$2,272.76

PATHFAST HI SENS TROPONIN

Facility

$2,392.38

Hospital Charge Code	90197157
Hospital Revenue Code	270
Min. Negotiated Rate	$1,674.67
Max. Negotiated Rate	$2,392.38
Rate for Payer: Aetna Commercial	$2,272.76
Rate for Payer: Aetna Medicare	$2,153.14
Rate for Payer: BCBS MT CHIP	$2,153.14
Rate for Payer: BCBS MT Closed Plan Network	$2,272.76
Rate for Payer: BCBS MT HealthLink	$2,153.14
Rate for Payer: BCBS MT Medicare	$2,153.14
Rate for Payer: BCBS MT POS	$2,272.76
Rate for Payer: BCBS MT Traditional	$2,392.38
Rate for Payer: Cash Price	$2,153.14
Rate for Payer: Cigna Commercial	$2,272.76
Rate for Payer: Cigna Medicare	$2,153.14
Rate for Payer: Medicaid All Medicaid	$2,200.99
Rate for Payer: Medicare All Medicare	$1,674.67
Rate for Payer: Monida Allegiance	$2,272.76
Rate for Payer: Monida First Choice Health	$2,320.61
Rate for Payer: Monida Montana Health Co-op	$2,272.76
Rate for Payer: Monida PacificSource	$2,272.76

PATHFAST NTPROBNP(60TESTS/BX) D/S

Facility

$1,584.74

Hospital Charge Code	90197024
Hospital Revenue Code	270
Min. Negotiated Rate	$1,109.32
Max. Negotiated Rate	$1,584.74
Rate for Payer: Aetna Commercial	$1,505.50
Rate for Payer: Aetna Medicare	$1,426.27
Rate for Payer: BCBS MT CHIP	$1,426.27
Rate for Payer: BCBS MT Closed Plan Network	$1,505.50
Rate for Payer: BCBS MT HealthLink	$1,426.27
Rate for Payer: BCBS MT Medicare	$1,426.27
Rate for Payer: BCBS MT POS	$1,505.50
Rate for Payer: BCBS MT Traditional	$1,584.74
Rate for Payer: Cash Price	$1,426.27
Rate for Payer: Cigna Commercial	$1,505.50
Rate for Payer: Cigna Medicare	$1,426.27
Rate for Payer: Medicaid All Medicaid	$1,457.96
Rate for Payer: Medicare All Medicare	$1,109.32
Rate for Payer: Monida Allegiance	$1,505.50
Rate for Payer: Monida First Choice Health	$1,537.20
Rate for Payer: Monida Montana Health Co-op	$1,505.50
Rate for Payer: Monida PacificSource	$1,505.50

PATHFAST NTPROBNP(60TESTS/BX) D/S

Facility

$1,584.74

Hospital Charge Code	90197024
Hospital Revenue Code	270
Min. Negotiated Rate	$1,109.32
Max. Negotiated Rate	$1,584.74
Rate for Payer: Aetna Commercial	$1,505.50
Rate for Payer: Aetna Medicare	$1,426.27
Rate for Payer: BCBS MT CHIP	$1,426.27
Rate for Payer: BCBS MT Closed Plan Network	$1,505.50
Rate for Payer: BCBS MT HealthLink	$1,426.27
Rate for Payer: BCBS MT Medicare	$1,426.27
Rate for Payer: BCBS MT POS	$1,505.50
Rate for Payer: BCBS MT Traditional	$1,584.74
Rate for Payer: Cash Price	$1,426.27
Rate for Payer: Cigna Commercial	$1,505.50
Rate for Payer: Cigna Medicare	$1,426.27
Rate for Payer: Medicaid All Medicaid	$1,457.96
Rate for Payer: Medicare All Medicare	$1,109.32
Rate for Payer: Monida Allegiance	$1,505.50
Rate for Payer: Monida First Choice Health	$1,537.20
Rate for Payer: Monida Montana Health Co-op	$1,505.50
Rate for Payer: Monida PacificSource	$1,505.50

PATHFAST SERVICE CONTRACT

Facility

$3,995.00

Hospital Charge Code	90197126
Hospital Revenue Code	270
Min. Negotiated Rate	$2,796.50
Max. Negotiated Rate	$3,995.00
Rate for Payer: Aetna Commercial	$3,795.25
Rate for Payer: Aetna Medicare	$3,595.50
Rate for Payer: BCBS MT CHIP	$3,595.50
Rate for Payer: BCBS MT Closed Plan Network	$3,795.25
Rate for Payer: BCBS MT HealthLink	$3,595.50
Rate for Payer: BCBS MT Medicare	$3,595.50
Rate for Payer: BCBS MT POS	$3,795.25
Rate for Payer: BCBS MT Traditional	$3,995.00
Rate for Payer: Cash Price	$3,595.50
Rate for Payer: Cigna Commercial	$3,795.25
Rate for Payer: Cigna Medicare	$3,595.50
Rate for Payer: Medicaid All Medicaid	$3,675.40
Rate for Payer: Medicare All Medicare	$2,796.50
Rate for Payer: Monida Allegiance	$3,795.25
Rate for Payer: Monida First Choice Health	$3,875.15
Rate for Payer: Monida Montana Health Co-op	$3,795.25
Rate for Payer: Monida PacificSource	$3,795.25

PATHFAST SERVICE CONTRACT

Facility

$3,995.00

Hospital Charge Code	90197126
Hospital Revenue Code	270
Min. Negotiated Rate	$2,796.50
Max. Negotiated Rate	$3,995.00
Rate for Payer: Aetna Commercial	$3,795.25
Rate for Payer: Aetna Medicare	$3,595.50
Rate for Payer: BCBS MT CHIP	$3,595.50
Rate for Payer: BCBS MT Closed Plan Network	$3,795.25
Rate for Payer: BCBS MT HealthLink	$3,595.50
Rate for Payer: BCBS MT Medicare	$3,595.50
Rate for Payer: BCBS MT POS	$3,795.25
Rate for Payer: BCBS MT Traditional	$3,995.00
Rate for Payer: Cash Price	$3,595.50
Rate for Payer: Cigna Commercial	$3,795.25
Rate for Payer: Cigna Medicare	$3,595.50
Rate for Payer: Medicaid All Medicaid	$3,675.40
Rate for Payer: Medicare All Medicare	$2,796.50
Rate for Payer: Monida Allegiance	$3,795.25
Rate for Payer: Monida First Choice Health	$3,875.15
Rate for Payer: Monida Montana Health Co-op	$3,795.25
Rate for Payer: Monida PacificSource	$3,795.25

PATHOLOGY EXAM HIGH

Facility

$221.15

Service Code	CPT 88307
Hospital Charge Code	4087932
Hospital Revenue Code	310
Min. Negotiated Rate	$154.81
Max. Negotiated Rate	$221.15
Rate for Payer: Aetna Commercial	$210.09
Rate for Payer: Aetna Medicare	$199.03
Rate for Payer: BCBS MT CHIP	$199.03
Rate for Payer: BCBS MT Closed Plan Network	$210.09
Rate for Payer: BCBS MT HealthLink	$199.03
Rate for Payer: BCBS MT Medicare	$199.03
Rate for Payer: BCBS MT POS	$210.09
Rate for Payer: BCBS MT Traditional	$221.15
Rate for Payer: Cash Price	$199.04
Rate for Payer: Cigna Commercial	$210.09
Rate for Payer: Cigna Medicare	$199.03
Rate for Payer: Medicaid All Medicaid	$203.46
Rate for Payer: Medicare All Medicare	$154.81
Rate for Payer: Monida Allegiance	$210.09
Rate for Payer: Monida First Choice Health	$214.52
Rate for Payer: Monida Montana Health Co-op	$210.09
Rate for Payer: Monida PacificSource	$210.09

PATHOLOGY EXAM HIGH

Facility

$221.15

Service Code	CPT 88307
Hospital Charge Code	4087932
Hospital Revenue Code	310
Min. Negotiated Rate	$154.81
Max. Negotiated Rate	$221.15
Rate for Payer: Aetna Commercial	$210.09
Rate for Payer: Aetna Medicare	$199.03
Rate for Payer: BCBS MT CHIP	$199.03
Rate for Payer: BCBS MT Closed Plan Network	$210.09
Rate for Payer: BCBS MT HealthLink	$199.03
Rate for Payer: BCBS MT Medicare	$199.03
Rate for Payer: BCBS MT POS	$210.09
Rate for Payer: BCBS MT Traditional	$221.15
Rate for Payer: Cash Price	$199.04
Rate for Payer: Cigna Commercial	$210.09
Rate for Payer: Cigna Medicare	$199.03
Rate for Payer: Medicaid All Medicaid	$203.46
Rate for Payer: Medicare All Medicare	$154.81
Rate for Payer: Monida Allegiance	$210.09
Rate for Payer: Monida First Choice Health	$214.52
Rate for Payer: Monida Montana Health Co-op	$210.09
Rate for Payer: Monida PacificSource	$210.09

PATHOLOGY EXAM LOW

Facility

$106.20

Service Code	CPT 88304
Hospital Charge Code	4087930
Hospital Revenue Code	310
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna Commercial	$100.89
Rate for Payer: Aetna Medicare	$95.58
Rate for Payer: BCBS MT CHIP	$95.58
Rate for Payer: BCBS MT Closed Plan Network	$100.89
Rate for Payer: BCBS MT HealthLink	$95.58
Rate for Payer: BCBS MT Medicare	$95.58
Rate for Payer: BCBS MT POS	$100.89
Rate for Payer: BCBS MT Traditional	$106.20
Rate for Payer: Cash Price	$95.58
Rate for Payer: Cigna Commercial	$100.89
Rate for Payer: Cigna Medicare	$95.58
Rate for Payer: Medicaid All Medicaid	$97.70
Rate for Payer: Medicare All Medicare	$74.34
Rate for Payer: Monida Allegiance	$100.89
Rate for Payer: Monida First Choice Health	$103.01
Rate for Payer: Monida Montana Health Co-op	$100.89
Rate for Payer: Monida PacificSource	$100.89

PATHOLOGY EXAM LOW

Facility

$106.20

Service Code	CPT 88304
Hospital Charge Code	4087930
Hospital Revenue Code	310
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna Commercial	$100.89
Rate for Payer: Aetna Medicare	$95.58
Rate for Payer: BCBS MT CHIP	$95.58
Rate for Payer: BCBS MT Closed Plan Network	$100.89
Rate for Payer: BCBS MT HealthLink	$95.58
Rate for Payer: BCBS MT Medicare	$95.58
Rate for Payer: BCBS MT POS	$100.89
Rate for Payer: BCBS MT Traditional	$106.20
Rate for Payer: Cash Price	$95.58
Rate for Payer: Cigna Commercial	$100.89
Rate for Payer: Cigna Medicare	$95.58
Rate for Payer: Medicaid All Medicaid	$97.70
Rate for Payer: Medicare All Medicare	$74.34
Rate for Payer: Monida Allegiance	$100.89
Rate for Payer: Monida First Choice Health	$103.01
Rate for Payer: Monida Montana Health Co-op	$100.89
Rate for Payer: Monida PacificSource	$100.89

Know your out-of-pocket cost for care.

All Charges