Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

HAPTOGLOBIN (001628)

Facility

$68.00

Service Code	HCPCS 83010
Hospital Charge Code	4083010
Hospital Revenue Code	300
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare	$61.20
Rate for Payer: BCBS MT CHIP	$61.20
Rate for Payer: BCBS MT Closed Plan Network	$64.60
Rate for Payer: BCBS MT HealthLink	$61.20
Rate for Payer: BCBS MT Medicare	$61.20
Rate for Payer: BCBS MT POS	$64.60
Rate for Payer: BCBS MT Traditional	$68.00
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna Commercial	$64.60
Rate for Payer: Cigna Medicare	$61.20
Rate for Payer: Medicaid All Medicaid	$62.56
Rate for Payer: Medicare All Medicare	$47.60
Rate for Payer: Monida Allegiance	$64.60
Rate for Payer: Monida First Choice Health	$65.96
Rate for Payer: Monida Montana Health Co-op	$64.60
Rate for Payer: Monida PacificSource	$64.60

HARDY CARY BLAIR MEDIUM

Facility

$204.44

Hospital Charge Code	90197077
Hospital Revenue Code	270
Min. Negotiated Rate	$143.11
Max. Negotiated Rate	$204.44
Rate for Payer: Aetna Commercial	$194.22
Rate for Payer: Aetna Medicare	$184.00
Rate for Payer: BCBS MT CHIP	$184.00
Rate for Payer: BCBS MT Closed Plan Network	$194.22
Rate for Payer: BCBS MT HealthLink	$184.00
Rate for Payer: BCBS MT Medicare	$184.00
Rate for Payer: BCBS MT POS	$194.22
Rate for Payer: BCBS MT Traditional	$204.44
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna Commercial	$194.22
Rate for Payer: Cigna Medicare	$184.00
Rate for Payer: Medicaid All Medicaid	$188.08
Rate for Payer: Medicare All Medicare	$143.11
Rate for Payer: Monida Allegiance	$194.22
Rate for Payer: Monida First Choice Health	$198.31
Rate for Payer: Monida Montana Health Co-op	$194.22
Rate for Payer: Monida PacificSource	$194.22

HARDY CARY BLAIR MEDIUM

Facility

$204.44

Hospital Charge Code	90197077
Hospital Revenue Code	270
Min. Negotiated Rate	$143.11
Max. Negotiated Rate	$204.44
Rate for Payer: Aetna Commercial	$194.22
Rate for Payer: Aetna Medicare	$184.00
Rate for Payer: BCBS MT CHIP	$184.00
Rate for Payer: BCBS MT Closed Plan Network	$194.22
Rate for Payer: BCBS MT HealthLink	$184.00
Rate for Payer: BCBS MT Medicare	$184.00
Rate for Payer: BCBS MT POS	$194.22
Rate for Payer: BCBS MT Traditional	$204.44
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cigna Commercial	$194.22
Rate for Payer: Cigna Medicare	$184.00
Rate for Payer: Medicaid All Medicaid	$188.08
Rate for Payer: Medicare All Medicare	$143.11
Rate for Payer: Monida Allegiance	$194.22
Rate for Payer: Monida First Choice Health	$198.31
Rate for Payer: Monida Montana Health Co-op	$194.22
Rate for Payer: Monida PacificSource	$194.22

HCG, BETA, QUANTITATIVE (004416)

Facility

$72.00

Service Code	HCPCS 84702
Hospital Charge Code	4084702
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, BETA, QUANTITATIVE (004416)

Facility

$72.00

Service Code	HCPCS 84702
Hospital Charge Code	4084702
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, QUALITATIVE, SERUM

Facility

$103.00

Service Code	HCPCS 81025
Hospital Charge Code	4087896
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

HCG, QUALITATIVE, SERUM

Facility

$103.00

Service Code	HCPCS 81025
Hospital Charge Code	4087896
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

HCG, QUALITATIVE, URINE

Facility

$103.00

Service Code	HCPCS 81025
Hospital Charge Code	4081025
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

HCG, QUALITATIVE, URINE

Facility

$103.00

Service Code	HCPCS 81025
Hospital Charge Code	4081025
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

HCG, QUAL URINE CONFI

Facility

$103.00

Service Code	HCPCS 81025
Hospital Charge Code	4087904
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

HCG, QUAL URINE CONFI

Facility

$103.00

Service Code	HCPCS 81025
Hospital Charge Code	4087904
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

HCG QUANTITATIVE RVMC

Facility

$164.00

Service Code	HCPCS 84702
Hospital Charge Code	4087913
Hospital Revenue Code	301
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$164.00
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: Aetna Medicare	$147.60
Rate for Payer: BCBS MT CHIP	$147.60
Rate for Payer: BCBS MT Closed Plan Network	$155.80
Rate for Payer: BCBS MT HealthLink	$147.60
Rate for Payer: BCBS MT Medicare	$147.60
Rate for Payer: BCBS MT POS	$155.80
Rate for Payer: BCBS MT Traditional	$164.00
Rate for Payer: Cash Price	$147.60
Rate for Payer: Cigna Commercial	$155.80
Rate for Payer: Cigna Medicare	$147.60
Rate for Payer: Medicaid All Medicaid	$150.88
Rate for Payer: Medicare All Medicare	$114.80
Rate for Payer: Monida Allegiance	$155.80
Rate for Payer: Monida First Choice Health	$159.08
Rate for Payer: Monida Montana Health Co-op	$155.80
Rate for Payer: Monida PacificSource	$155.80

HCG QUANTITATIVE RVMC

Facility

$164.00

Service Code	HCPCS 84702
Hospital Charge Code	4087913
Hospital Revenue Code	301
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$164.00
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: Aetna Medicare	$147.60
Rate for Payer: BCBS MT CHIP	$147.60
Rate for Payer: BCBS MT Closed Plan Network	$155.80
Rate for Payer: BCBS MT HealthLink	$147.60
Rate for Payer: BCBS MT Medicare	$147.60
Rate for Payer: BCBS MT POS	$155.80
Rate for Payer: BCBS MT Traditional	$164.00
Rate for Payer: Cash Price	$147.60
Rate for Payer: Cigna Commercial	$155.80
Rate for Payer: Cigna Medicare	$147.60
Rate for Payer: Medicaid All Medicaid	$150.88
Rate for Payer: Medicare All Medicare	$114.80
Rate for Payer: Monida Allegiance	$155.80
Rate for Payer: Monida First Choice Health	$159.08
Rate for Payer: Monida Montana Health Co-op	$155.80
Rate for Payer: Monida PacificSource	$155.80

HCG, TUMOR MARKER (140450)

Facility

$72.00

Service Code	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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

Know your out-of-pocket cost for care.

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