Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

1,25-DIHYDROXYVITAMIN D (081091)

Facility

$89.00

Service Code	CPT 82652
Hospital Charge Code	4082652
Hospital Revenue Code	301
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$89.00
Rate for Payer: Aetna Commercial	$84.55
Rate for Payer: Aetna Medicare	$80.10
Rate for Payer: BCBS MT CHIP	$80.10
Rate for Payer: BCBS MT Closed Plan Network	$84.55
Rate for Payer: BCBS MT HealthLink	$80.10
Rate for Payer: BCBS MT Medicare	$80.10
Rate for Payer: BCBS MT POS	$84.55
Rate for Payer: BCBS MT Traditional	$89.00
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna Commercial	$84.55
Rate for Payer: Cigna Medicare	$80.10
Rate for Payer: Medicaid All Medicaid	$81.88
Rate for Payer: Medicare All Medicare	$62.30
Rate for Payer: Monida Allegiance	$84.55
Rate for Payer: Monida First Choice Health	$86.33
Rate for Payer: Monida Montana Health Co-op	$84.55
Rate for Payer: Monida PacificSource	$84.55

1,25-DIHYDROXYVITAMIN D (081091)

Facility

$89.00

Service Code	CPT 82652
Hospital Charge Code	4082652
Hospital Revenue Code	301
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$89.00
Rate for Payer: Aetna Commercial	$84.55
Rate for Payer: Aetna Medicare	$80.10
Rate for Payer: BCBS MT CHIP	$80.10
Rate for Payer: BCBS MT Closed Plan Network	$84.55
Rate for Payer: BCBS MT HealthLink	$80.10
Rate for Payer: BCBS MT Medicare	$80.10
Rate for Payer: BCBS MT POS	$84.55
Rate for Payer: BCBS MT Traditional	$89.00
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna Commercial	$84.55
Rate for Payer: Cigna Medicare	$80.10
Rate for Payer: Medicaid All Medicaid	$81.88
Rate for Payer: Medicare All Medicare	$62.30
Rate for Payer: Monida Allegiance	$84.55
Rate for Payer: Monida First Choice Health	$86.33
Rate for Payer: Monida Montana Health Co-op	$84.55
Rate for Payer: Monida PacificSource	$84.55

1-3 BETA D GLUCAN FUNGITELL

Facility

$210.00

Service Code	CPT 87449
Hospital Charge Code	4088078
Hospital Revenue Code	302
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

1-3 BETA D GLUCAN FUNGITELL

Facility

$210.00

Service Code	CPT 87449
Hospital Charge Code	4088078
Hospital Revenue Code	302
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

17-HYDROXYPROGESTERONE (070085)

Facility

$131.00

Service Code	CPT 83498
Hospital Charge Code	4083498
Hospital Revenue Code	300
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$131.00
Rate for Payer: Aetna Commercial	$124.45
Rate for Payer: Aetna Medicare	$117.90
Rate for Payer: BCBS MT CHIP	$117.90
Rate for Payer: BCBS MT Closed Plan Network	$124.45
Rate for Payer: BCBS MT HealthLink	$117.90
Rate for Payer: BCBS MT Medicare	$117.90
Rate for Payer: BCBS MT POS	$124.45
Rate for Payer: BCBS MT Traditional	$131.00
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cigna Commercial	$124.45
Rate for Payer: Cigna Medicare	$117.90
Rate for Payer: Medicaid All Medicaid	$120.52
Rate for Payer: Medicare All Medicare	$91.70
Rate for Payer: Monida Allegiance	$124.45
Rate for Payer: Monida First Choice Health	$127.07
Rate for Payer: Monida Montana Health Co-op	$124.45
Rate for Payer: Monida PacificSource	$124.45

17-HYDROXYPROGESTERONE (070085)

Facility

$131.00

Service Code	CPT 83498
Hospital Charge Code	4083498
Hospital Revenue Code	300
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$131.00
Rate for Payer: Aetna Commercial	$124.45
Rate for Payer: Aetna Medicare	$117.90
Rate for Payer: BCBS MT CHIP	$117.90
Rate for Payer: BCBS MT Closed Plan Network	$124.45
Rate for Payer: BCBS MT HealthLink	$117.90
Rate for Payer: BCBS MT Medicare	$117.90
Rate for Payer: BCBS MT POS	$124.45
Rate for Payer: BCBS MT Traditional	$131.00
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cigna Commercial	$124.45
Rate for Payer: Cigna Medicare	$117.90
Rate for Payer: Medicaid All Medicaid	$120.52
Rate for Payer: Medicare All Medicare	$91.70
Rate for Payer: Monida Allegiance	$124.45
Rate for Payer: Monida First Choice Health	$127.07
Rate for Payer: Monida Montana Health Co-op	$124.45
Rate for Payer: Monida PacificSource	$124.45

21 HYDROXYLASE AUTOANTIBODIES

Facility

$135.00

Service Code	CPT 83516
Hospital Charge Code	4088079
Hospital Revenue Code	302
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$128.25
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCBS MT CHIP	$121.50
Rate for Payer: BCBS MT Closed Plan Network	$128.25
Rate for Payer: BCBS MT HealthLink	$121.50
Rate for Payer: BCBS MT Medicare	$121.50
Rate for Payer: BCBS MT POS	$128.25
Rate for Payer: BCBS MT Traditional	$135.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial	$128.25
Rate for Payer: Cigna Medicare	$121.50
Rate for Payer: Medicaid All Medicaid	$124.20
Rate for Payer: Medicare All Medicare	$94.50
Rate for Payer: Monida Allegiance	$128.25
Rate for Payer: Monida First Choice Health	$130.95
Rate for Payer: Monida Montana Health Co-op	$128.25
Rate for Payer: Monida PacificSource	$128.25

21 HYDROXYLASE AUTOANTIBODIES

Facility

$135.00

Service Code	CPT 83516
Hospital Charge Code	4088079
Hospital Revenue Code	302
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$128.25
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCBS MT CHIP	$121.50
Rate for Payer: BCBS MT Closed Plan Network	$128.25
Rate for Payer: BCBS MT HealthLink	$121.50
Rate for Payer: BCBS MT Medicare	$121.50
Rate for Payer: BCBS MT POS	$128.25
Rate for Payer: BCBS MT Traditional	$135.00
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial	$128.25
Rate for Payer: Cigna Medicare	$121.50
Rate for Payer: Medicaid All Medicaid	$124.20
Rate for Payer: Medicare All Medicare	$94.50
Rate for Payer: Monida Allegiance	$128.25
Rate for Payer: Monida First Choice Health	$130.95
Rate for Payer: Monida Montana Health Co-op	$128.25
Rate for Payer: Monida PacificSource	$128.25

2-3 DINOR 11 BETA PROSTAGLANDIN F2 ALPHA

Facility

$142.00

Service Code	CPT 84150
Hospital Charge Code	4088012
Hospital Revenue Code	302
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$142.00
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare	$127.80
Rate for Payer: BCBS MT CHIP	$127.80
Rate for Payer: BCBS MT Closed Plan Network	$134.90
Rate for Payer: BCBS MT HealthLink	$127.80
Rate for Payer: BCBS MT Medicare	$127.80
Rate for Payer: BCBS MT POS	$134.90
Rate for Payer: BCBS MT Traditional	$142.00
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cigna Commercial	$134.90
Rate for Payer: Cigna Medicare	$127.80
Rate for Payer: Medicaid All Medicaid	$130.64
Rate for Payer: Medicare All Medicare	$99.40
Rate for Payer: Monida Allegiance	$134.90
Rate for Payer: Monida First Choice Health	$137.74
Rate for Payer: Monida Montana Health Co-op	$134.90
Rate for Payer: Monida PacificSource	$134.90

2-3 DINOR 11 BETA PROSTAGLANDIN F2 ALPHA

Facility

$142.00

Service Code	CPT 84150
Hospital Charge Code	4088012
Hospital Revenue Code	302
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$142.00
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare	$127.80
Rate for Payer: BCBS MT CHIP	$127.80
Rate for Payer: BCBS MT Closed Plan Network	$134.90
Rate for Payer: BCBS MT HealthLink	$127.80
Rate for Payer: BCBS MT Medicare	$127.80
Rate for Payer: BCBS MT POS	$134.90
Rate for Payer: BCBS MT Traditional	$142.00
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cigna Commercial	$134.90
Rate for Payer: Cigna Medicare	$127.80
Rate for Payer: Medicaid All Medicaid	$130.64
Rate for Payer: Medicare All Medicare	$99.40
Rate for Payer: Monida Allegiance	$134.90
Rate for Payer: Monida First Choice Health	$137.74
Rate for Payer: Monida Montana Health Co-op	$134.90
Rate for Payer: Monida PacificSource	$134.90

25-HYDROXYVITAMIN D2 AND D3 (BCL)

Facility

$79.00

Service Code	CPT 82306
Hospital Charge Code	4082306
Hospital Revenue Code	300
Min. Negotiated Rate	$55.30
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$75.05
Rate for Payer: Aetna Medicare	$71.10
Rate for Payer: BCBS MT CHIP	$71.10
Rate for Payer: BCBS MT Closed Plan Network	$75.05
Rate for Payer: BCBS MT HealthLink	$71.10
Rate for Payer: BCBS MT Medicare	$71.10
Rate for Payer: BCBS MT POS	$75.05
Rate for Payer: BCBS MT Traditional	$79.00
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cigna Commercial	$75.05
Rate for Payer: Cigna Medicare	$71.10
Rate for Payer: Medicaid All Medicaid	$72.68
Rate for Payer: Medicare All Medicare	$55.30
Rate for Payer: Monida Allegiance	$75.05
Rate for Payer: Monida First Choice Health	$76.63
Rate for Payer: Monida Montana Health Co-op	$75.05
Rate for Payer: Monida PacificSource	$75.05

25-HYDROXYVITAMIN D2 AND D3 (BCL)

Facility

$79.00

Service Code	CPT 82306
Hospital Charge Code	4082306
Hospital Revenue Code	300
Min. Negotiated Rate	$55.30
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$75.05
Rate for Payer: Aetna Medicare	$71.10
Rate for Payer: BCBS MT CHIP	$71.10
Rate for Payer: BCBS MT Closed Plan Network	$75.05
Rate for Payer: BCBS MT HealthLink	$71.10
Rate for Payer: BCBS MT Medicare	$71.10
Rate for Payer: BCBS MT POS	$75.05
Rate for Payer: BCBS MT Traditional	$79.00
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cigna Commercial	$75.05
Rate for Payer: Cigna Medicare	$71.10
Rate for Payer: Medicaid All Medicaid	$72.68
Rate for Payer: Medicare All Medicare	$55.30
Rate for Payer: Monida Allegiance	$75.05
Rate for Payer: Monida First Choice Health	$76.63
Rate for Payer: Monida Montana Health Co-op	$75.05
Rate for Payer: Monida PacificSource	$75.05

5-HIAA, 24 HOUR URINE (004069)

Facility

$29.00

Service Code	CPT 83497
Hospital Charge Code	4083497
Hospital Revenue Code	300
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna Commercial	$27.55
Rate for Payer: Aetna Medicare	$26.10
Rate for Payer: BCBS MT CHIP	$26.10
Rate for Payer: BCBS MT Closed Plan Network	$27.55
Rate for Payer: BCBS MT HealthLink	$26.10
Rate for Payer: BCBS MT Medicare	$26.10
Rate for Payer: BCBS MT POS	$27.55
Rate for Payer: BCBS MT Traditional	$29.00
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna Commercial	$27.55
Rate for Payer: Cigna Medicare	$26.10
Rate for Payer: Medicaid All Medicaid	$26.68
Rate for Payer: Medicare All Medicare	$20.30
Rate for Payer: Monida Allegiance	$27.55
Rate for Payer: Monida First Choice Health	$28.13
Rate for Payer: Monida Montana Health Co-op	$27.55
Rate for Payer: Monida PacificSource	$27.55

5-HIAA, 24 HOUR URINE (004069)

Facility

$29.00

Service Code	CPT 83497
Hospital Charge Code	4083497
Hospital Revenue Code	300
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna Commercial	$27.55
Rate for Payer: Aetna Medicare	$26.10
Rate for Payer: BCBS MT CHIP	$26.10
Rate for Payer: BCBS MT Closed Plan Network	$27.55
Rate for Payer: BCBS MT HealthLink	$26.10
Rate for Payer: BCBS MT Medicare	$26.10
Rate for Payer: BCBS MT POS	$27.55
Rate for Payer: BCBS MT Traditional	$29.00
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna Commercial	$27.55
Rate for Payer: Cigna Medicare	$26.10
Rate for Payer: Medicaid All Medicaid	$26.68
Rate for Payer: Medicare All Medicare	$20.30
Rate for Payer: Monida Allegiance	$27.55
Rate for Payer: Monida First Choice Health	$28.13
Rate for Payer: Monida Montana Health Co-op	$27.55
Rate for Payer: Monida PacificSource	$27.55

A1C LINEARITY KIT AFINION

Facility

$1,150.25

Hospital Charge Code	90197151
Hospital Revenue Code	270
Min. Negotiated Rate	$805.17
Max. Negotiated Rate	$1,150.25
Rate for Payer: Aetna Commercial	$1,092.74
Rate for Payer: Aetna Medicare	$1,035.22
Rate for Payer: BCBS MT CHIP	$1,035.22
Rate for Payer: BCBS MT Closed Plan Network	$1,092.74
Rate for Payer: BCBS MT HealthLink	$1,035.22
Rate for Payer: BCBS MT Medicare	$1,035.22
Rate for Payer: BCBS MT POS	$1,092.74
Rate for Payer: BCBS MT Traditional	$1,150.25
Rate for Payer: Cash Price	$1,035.23
Rate for Payer: Cigna Commercial	$1,092.74
Rate for Payer: Cigna Medicare	$1,035.22
Rate for Payer: Medicaid All Medicaid	$1,058.23
Rate for Payer: Medicare All Medicare	$805.17
Rate for Payer: Monida Allegiance	$1,092.74
Rate for Payer: Monida First Choice Health	$1,115.74
Rate for Payer: Monida Montana Health Co-op	$1,092.74
Rate for Payer: Monida PacificSource	$1,092.74

A1C LINEARITY KIT AFINION

Facility

$1,150.25

Hospital Charge Code	90197151
Hospital Revenue Code	270
Min. Negotiated Rate	$805.17
Max. Negotiated Rate	$1,150.25
Rate for Payer: Aetna Commercial	$1,092.74
Rate for Payer: Aetna Medicare	$1,035.22
Rate for Payer: BCBS MT CHIP	$1,035.22
Rate for Payer: BCBS MT Closed Plan Network	$1,092.74
Rate for Payer: BCBS MT HealthLink	$1,035.22
Rate for Payer: BCBS MT Medicare	$1,035.22
Rate for Payer: BCBS MT POS	$1,092.74
Rate for Payer: BCBS MT Traditional	$1,150.25
Rate for Payer: Cash Price	$1,035.23
Rate for Payer: Cigna Commercial	$1,092.74
Rate for Payer: Cigna Medicare	$1,035.22
Rate for Payer: Medicaid All Medicaid	$1,058.23
Rate for Payer: Medicare All Medicare	$805.17
Rate for Payer: Monida Allegiance	$1,092.74
Rate for Payer: Monida First Choice Health	$1,115.74
Rate for Payer: Monida Montana Health Co-op	$1,092.74
Rate for Payer: Monida PacificSource	$1,092.74

ABBOTT A1C POC TWIN

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	8198948
Hospital Revenue Code	310
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare	$54.00
Rate for Payer: BCBS MT CHIP	$54.00
Rate for Payer: BCBS MT Closed Plan Network	$57.00
Rate for Payer: BCBS MT HealthLink	$54.00
Rate for Payer: BCBS MT Medicare	$54.00
Rate for Payer: BCBS MT POS	$57.00
Rate for Payer: BCBS MT Traditional	$60.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: Cigna Medicare	$54.00
Rate for Payer: Medicaid All Medicaid	$55.20
Rate for Payer: Medicare All Medicare	$42.00
Rate for Payer: Monida Allegiance	$57.00
Rate for Payer: Monida First Choice Health	$58.20
Rate for Payer: Monida Montana Health Co-op	$57.00
Rate for Payer: Monida PacificSource	$57.00

ABBOTT A1C POC TWIN

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	8198948
Hospital Revenue Code	310
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare	$54.00
Rate for Payer: BCBS MT CHIP	$54.00
Rate for Payer: BCBS MT Closed Plan Network	$57.00
Rate for Payer: BCBS MT HealthLink	$54.00
Rate for Payer: BCBS MT Medicare	$54.00
Rate for Payer: BCBS MT POS	$57.00
Rate for Payer: BCBS MT Traditional	$60.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial	$57.00
Rate for Payer: Cigna Medicare	$54.00
Rate for Payer: Medicaid All Medicaid	$55.20
Rate for Payer: Medicare All Medicare	$42.00
Rate for Payer: Monida Allegiance	$57.00
Rate for Payer: Monida First Choice Health	$58.20
Rate for Payer: Monida Montana Health Co-op	$57.00
Rate for Payer: Monida PacificSource	$57.00

ABBOTT AFINION A1C KIT

Facility

$92.61

Hospital Charge Code	90197146
Hospital Revenue Code	270
Min. Negotiated Rate	$64.83
Max. Negotiated Rate	$92.61
Rate for Payer: Aetna Commercial	$87.98
Rate for Payer: Aetna Medicare	$83.35
Rate for Payer: BCBS MT CHIP	$83.35
Rate for Payer: BCBS MT Closed Plan Network	$87.98
Rate for Payer: BCBS MT HealthLink	$83.35
Rate for Payer: BCBS MT Medicare	$83.35
Rate for Payer: BCBS MT POS	$87.98
Rate for Payer: BCBS MT Traditional	$92.61
Rate for Payer: Cash Price	$83.35
Rate for Payer: Cigna Commercial	$87.98
Rate for Payer: Cigna Medicare	$83.35
Rate for Payer: Medicaid All Medicaid	$85.20
Rate for Payer: Medicare All Medicare	$64.83
Rate for Payer: Monida Allegiance	$87.98
Rate for Payer: Monida First Choice Health	$89.83
Rate for Payer: Monida Montana Health Co-op	$87.98
Rate for Payer: Monida PacificSource	$87.98

ABBOTT AFINION A1C KIT

Facility

$92.61

Hospital Charge Code	90197146
Hospital Revenue Code	270
Min. Negotiated Rate	$64.83
Max. Negotiated Rate	$92.61
Rate for Payer: Aetna Commercial	$87.98
Rate for Payer: Aetna Medicare	$83.35
Rate for Payer: BCBS MT CHIP	$83.35
Rate for Payer: BCBS MT Closed Plan Network	$87.98
Rate for Payer: BCBS MT HealthLink	$83.35
Rate for Payer: BCBS MT Medicare	$83.35
Rate for Payer: BCBS MT POS	$87.98
Rate for Payer: BCBS MT Traditional	$92.61
Rate for Payer: Cash Price	$83.35
Rate for Payer: Cigna Commercial	$87.98
Rate for Payer: Cigna Medicare	$83.35
Rate for Payer: Medicaid All Medicaid	$85.20
Rate for Payer: Medicare All Medicare	$64.83
Rate for Payer: Monida Allegiance	$87.98
Rate for Payer: Monida First Choice Health	$89.83
Rate for Payer: Monida Montana Health Co-op	$87.98
Rate for Payer: Monida PacificSource	$87.98

ABBOTT AFINION A1C QC

Facility

$60.61

Hospital Charge Code	90197148
Hospital Revenue Code	270
Min. Negotiated Rate	$42.43
Max. Negotiated Rate	$60.61
Rate for Payer: Aetna Commercial	$57.58
Rate for Payer: Aetna Medicare	$54.55
Rate for Payer: BCBS MT CHIP	$54.55
Rate for Payer: BCBS MT Closed Plan Network	$57.58
Rate for Payer: BCBS MT HealthLink	$54.55
Rate for Payer: BCBS MT Medicare	$54.55
Rate for Payer: BCBS MT POS	$57.58
Rate for Payer: BCBS MT Traditional	$60.61
Rate for Payer: Cash Price	$54.55
Rate for Payer: Cigna Commercial	$57.58
Rate for Payer: Cigna Medicare	$54.55
Rate for Payer: Medicaid All Medicaid	$55.76
Rate for Payer: Medicare All Medicare	$42.43
Rate for Payer: Monida Allegiance	$57.58
Rate for Payer: Monida First Choice Health	$58.79
Rate for Payer: Monida Montana Health Co-op	$57.58
Rate for Payer: Monida PacificSource	$57.58

ABBOTT AFINION A1C QC

Facility

$60.61

Hospital Charge Code	90197148
Hospital Revenue Code	270
Min. Negotiated Rate	$42.43
Max. Negotiated Rate	$60.61
Rate for Payer: Aetna Commercial	$57.58
Rate for Payer: Aetna Medicare	$54.55
Rate for Payer: BCBS MT CHIP	$54.55
Rate for Payer: BCBS MT Closed Plan Network	$57.58
Rate for Payer: BCBS MT HealthLink	$54.55
Rate for Payer: BCBS MT Medicare	$54.55
Rate for Payer: BCBS MT POS	$57.58
Rate for Payer: BCBS MT Traditional	$60.61
Rate for Payer: Cash Price	$54.55
Rate for Payer: Cigna Commercial	$57.58
Rate for Payer: Cigna Medicare	$54.55
Rate for Payer: Medicaid All Medicaid	$55.76
Rate for Payer: Medicare All Medicare	$42.43
Rate for Payer: Monida Allegiance	$57.58
Rate for Payer: Monida First Choice Health	$58.79
Rate for Payer: Monida Montana Health Co-op	$57.58
Rate for Payer: Monida PacificSource	$57.58

ABBOTT AFINION ANALYZER

Facility

$2,793.43

Hospital Charge Code	90197147
Hospital Revenue Code	270
Min. Negotiated Rate	$1,955.40
Max. Negotiated Rate	$2,793.43
Rate for Payer: Aetna Commercial	$2,653.76
Rate for Payer: Aetna Medicare	$2,514.09
Rate for Payer: BCBS MT CHIP	$2,514.09
Rate for Payer: BCBS MT Closed Plan Network	$2,653.76
Rate for Payer: BCBS MT HealthLink	$2,514.09
Rate for Payer: BCBS MT Medicare	$2,514.09
Rate for Payer: BCBS MT POS	$2,653.76
Rate for Payer: BCBS MT Traditional	$2,793.43
Rate for Payer: Cash Price	$2,514.09
Rate for Payer: Cigna Commercial	$2,653.76
Rate for Payer: Cigna Medicare	$2,514.09
Rate for Payer: Medicaid All Medicaid	$2,569.96
Rate for Payer: Medicare All Medicare	$1,955.40
Rate for Payer: Monida Allegiance	$2,653.76
Rate for Payer: Monida First Choice Health	$2,709.63
Rate for Payer: Monida Montana Health Co-op	$2,653.76
Rate for Payer: Monida PacificSource	$2,653.76

ABBOTT AFINION ANALYZER

Facility

$2,793.43

Hospital Charge Code	90197147
Hospital Revenue Code	270
Min. Negotiated Rate	$1,955.40
Max. Negotiated Rate	$2,793.43
Rate for Payer: Aetna Commercial	$2,653.76
Rate for Payer: Aetna Medicare	$2,514.09
Rate for Payer: BCBS MT CHIP	$2,514.09
Rate for Payer: BCBS MT Closed Plan Network	$2,653.76
Rate for Payer: BCBS MT HealthLink	$2,514.09
Rate for Payer: BCBS MT Medicare	$2,514.09
Rate for Payer: BCBS MT POS	$2,653.76
Rate for Payer: BCBS MT Traditional	$2,793.43
Rate for Payer: Cash Price	$2,514.09
Rate for Payer: Cigna Commercial	$2,653.76
Rate for Payer: Cigna Medicare	$2,514.09
Rate for Payer: Medicaid All Medicaid	$2,569.96
Rate for Payer: Medicare All Medicare	$1,955.40
Rate for Payer: Monida Allegiance	$2,653.76
Rate for Payer: Monida First Choice Health	$2,709.63
Rate for Payer: Monida Montana Health Co-op	$2,653.76
Rate for Payer: Monida PacificSource	$2,653.76

ABBOTT FENTANYL QC

Facility

$55.46

Hospital Charge Code	90197150
Hospital Revenue Code	270
Min. Negotiated Rate	$38.82
Max. Negotiated Rate	$55.46
Rate for Payer: Aetna Commercial	$52.69
Rate for Payer: Aetna Medicare	$49.91
Rate for Payer: BCBS MT CHIP	$49.91
Rate for Payer: BCBS MT Closed Plan Network	$52.69
Rate for Payer: BCBS MT HealthLink	$49.91
Rate for Payer: BCBS MT Medicare	$49.91
Rate for Payer: BCBS MT POS	$52.69
Rate for Payer: BCBS MT Traditional	$55.46
Rate for Payer: Cash Price	$49.91
Rate for Payer: Cigna Commercial	$52.69
Rate for Payer: Cigna Medicare	$49.91
Rate for Payer: Medicaid All Medicaid	$51.02
Rate for Payer: Medicare All Medicare	$38.82
Rate for Payer: Monida Allegiance	$52.69
Rate for Payer: Monida First Choice Health	$53.80
Rate for Payer: Monida Montana Health Co-op	$52.69
Rate for Payer: Monida PacificSource	$52.69

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