Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

LAB SYNOVIAL FLUID GLUCOSE

Facility

$46.00

Service Code	HCPCS 82945
Hospital Charge Code	4082945
Hospital Revenue Code	301
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

LAB SYNOVIAL FLUID GLUCOSE

Facility

$46.00

Service Code	HCPCS 82945
Hospital Charge Code	4082945
Hospital Revenue Code	301
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

LAB SYNOVIAL FLUID PROTEIN

Facility

$49.00

Service Code	HCPCS 84157
Hospital Charge Code	4084157
Hospital Revenue Code	301
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: BCBS MT CHIP	$44.10
Rate for Payer: BCBS MT Closed Plan Network	$46.55
Rate for Payer: BCBS MT HealthLink	$44.10
Rate for Payer: BCBS MT Medicare	$44.10
Rate for Payer: BCBS MT POS	$46.55
Rate for Payer: BCBS MT Traditional	$49.00
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cigna Commercial	$46.55
Rate for Payer: Cigna Medicare	$44.10
Rate for Payer: Medicaid All Medicaid	$45.08
Rate for Payer: Medicare All Medicare	$34.30
Rate for Payer: Monida Allegiance	$46.55
Rate for Payer: Monida First Choice Health	$47.53
Rate for Payer: Monida Montana Health Co-op	$46.55
Rate for Payer: Monida PacificSource	$46.55

LAB SYNOVIAL FLUID PROTEIN

Facility

$49.00

Service Code	HCPCS 84157
Hospital Charge Code	4084157
Hospital Revenue Code	301
Min. Negotiated Rate	$34.30
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: BCBS MT CHIP	$44.10
Rate for Payer: BCBS MT Closed Plan Network	$46.55
Rate for Payer: BCBS MT HealthLink	$44.10
Rate for Payer: BCBS MT Medicare	$44.10
Rate for Payer: BCBS MT POS	$46.55
Rate for Payer: BCBS MT Traditional	$49.00
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cigna Commercial	$46.55
Rate for Payer: Cigna Medicare	$44.10
Rate for Payer: Medicaid All Medicaid	$45.08
Rate for Payer: Medicare All Medicare	$34.30
Rate for Payer: Monida Allegiance	$46.55
Rate for Payer: Monida First Choice Health	$47.53
Rate for Payer: Monida Montana Health Co-op	$46.55
Rate for Payer: Monida PacificSource	$46.55

LAB THEOPHYLLINE

Facility

$104.00

Service Code	HCPCS 80198
Hospital Charge Code	4080198
Hospital Revenue Code	300
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare	$93.60
Rate for Payer: BCBS MT CHIP	$93.60
Rate for Payer: BCBS MT Closed Plan Network	$98.80
Rate for Payer: BCBS MT HealthLink	$93.60
Rate for Payer: BCBS MT Medicare	$93.60
Rate for Payer: BCBS MT POS	$98.80
Rate for Payer: BCBS MT Traditional	$104.00
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial	$98.80
Rate for Payer: Cigna Medicare	$93.60
Rate for Payer: Medicaid All Medicaid	$95.68
Rate for Payer: Medicare All Medicare	$72.80
Rate for Payer: Monida Allegiance	$98.80
Rate for Payer: Monida First Choice Health	$100.88
Rate for Payer: Monida Montana Health Co-op	$98.80
Rate for Payer: Monida PacificSource	$98.80

LAB THEOPHYLLINE

Facility

$104.00

Service Code	HCPCS 80198
Hospital Charge Code	4080198
Hospital Revenue Code	300
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare	$93.60
Rate for Payer: BCBS MT CHIP	$93.60
Rate for Payer: BCBS MT Closed Plan Network	$98.80
Rate for Payer: BCBS MT HealthLink	$93.60
Rate for Payer: BCBS MT Medicare	$93.60
Rate for Payer: BCBS MT POS	$98.80
Rate for Payer: BCBS MT Traditional	$104.00
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial	$98.80
Rate for Payer: Cigna Medicare	$93.60
Rate for Payer: Medicaid All Medicaid	$95.68
Rate for Payer: Medicare All Medicare	$72.80
Rate for Payer: Monida Allegiance	$98.80
Rate for Payer: Monida First Choice Health	$100.88
Rate for Payer: Monida Montana Health Co-op	$98.80
Rate for Payer: Monida PacificSource	$98.80

LAB THYROID STIMULATION IMMUNOGLOBULIN

Facility

$344.00

Service Code	HCPCS 84445
Hospital Charge Code	4084445
Hospital Revenue Code	301
Min. Negotiated Rate	$240.80
Max. Negotiated Rate	$344.00
Rate for Payer: Aetna Commercial	$326.80
Rate for Payer: Aetna Medicare	$309.60
Rate for Payer: BCBS MT CHIP	$309.60
Rate for Payer: BCBS MT Closed Plan Network	$326.80
Rate for Payer: BCBS MT HealthLink	$309.60
Rate for Payer: BCBS MT Medicare	$309.60
Rate for Payer: BCBS MT POS	$326.80
Rate for Payer: BCBS MT Traditional	$344.00
Rate for Payer: Cash Price	$309.60
Rate for Payer: Cigna Commercial	$326.80
Rate for Payer: Cigna Medicare	$309.60
Rate for Payer: Medicaid All Medicaid	$316.48
Rate for Payer: Medicare All Medicare	$240.80
Rate for Payer: Monida Allegiance	$326.80
Rate for Payer: Monida First Choice Health	$333.68
Rate for Payer: Monida Montana Health Co-op	$326.80
Rate for Payer: Monida PacificSource	$326.80

LAB THYROID STIMULATION IMMUNOGLOBULIN

Facility

$344.00

Service Code	HCPCS 84445
Hospital Charge Code	4084445
Hospital Revenue Code	301
Min. Negotiated Rate	$240.80
Max. Negotiated Rate	$344.00
Rate for Payer: Aetna Commercial	$326.80
Rate for Payer: Aetna Medicare	$309.60
Rate for Payer: BCBS MT CHIP	$309.60
Rate for Payer: BCBS MT Closed Plan Network	$326.80
Rate for Payer: BCBS MT HealthLink	$309.60
Rate for Payer: BCBS MT Medicare	$309.60
Rate for Payer: BCBS MT POS	$326.80
Rate for Payer: BCBS MT Traditional	$344.00
Rate for Payer: Cash Price	$309.60
Rate for Payer: Cigna Commercial	$326.80
Rate for Payer: Cigna Medicare	$309.60
Rate for Payer: Medicaid All Medicaid	$316.48
Rate for Payer: Medicare All Medicare	$240.80
Rate for Payer: Monida Allegiance	$326.80
Rate for Payer: Monida First Choice Health	$333.68
Rate for Payer: Monida Montana Health Co-op	$326.80
Rate for Payer: Monida PacificSource	$326.80

LAB TICKBORNE DISEASE PANEL

Facility

$99.00

Service Code	HCPCS 86638
Hospital Charge Code	4086638
Hospital Revenue Code	300
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 TICKBORNE DISEASE PANEL

Facility

$99.00

Service Code	HCPCS 86638
Hospital Charge Code	4086638
Hospital Revenue Code	300
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 TOBRAMYCIN LEVEL

Facility

$112.00

Service Code	HCPCS 80200
Hospital Charge Code	4080200
Hospital Revenue Code	300
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare	$100.80
Rate for Payer: BCBS MT CHIP	$100.80
Rate for Payer: BCBS MT Closed Plan Network	$106.40
Rate for Payer: BCBS MT HealthLink	$100.80
Rate for Payer: BCBS MT Medicare	$100.80
Rate for Payer: BCBS MT POS	$106.40
Rate for Payer: BCBS MT Traditional	$112.00
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial	$106.40
Rate for Payer: Cigna Medicare	$100.80
Rate for Payer: Medicaid All Medicaid	$103.04
Rate for Payer: Medicare All Medicare	$78.40
Rate for Payer: Monida Allegiance	$106.40
Rate for Payer: Monida First Choice Health	$108.64
Rate for Payer: Monida Montana Health Co-op	$106.40
Rate for Payer: Monida PacificSource	$106.40

LAB TOBRAMYCIN LEVEL

Facility

$112.00

Service Code	HCPCS 80200
Hospital Charge Code	4080200
Hospital Revenue Code	300
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare	$100.80
Rate for Payer: BCBS MT CHIP	$100.80
Rate for Payer: BCBS MT Closed Plan Network	$106.40
Rate for Payer: BCBS MT HealthLink	$100.80
Rate for Payer: BCBS MT Medicare	$100.80
Rate for Payer: BCBS MT POS	$106.40
Rate for Payer: BCBS MT Traditional	$112.00
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial	$106.40
Rate for Payer: Cigna Medicare	$100.80
Rate for Payer: Medicaid All Medicaid	$103.04
Rate for Payer: Medicare All Medicare	$78.40
Rate for Payer: Monida Allegiance	$106.40
Rate for Payer: Monida First Choice Health	$108.64
Rate for Payer: Monida Montana Health Co-op	$106.40
Rate for Payer: Monida PacificSource	$106.40

LAB TOXOPLASMASIS

Facility

$104.00

Service Code	HCPCS 86777
Hospital Charge Code	4086777
Hospital Revenue Code	302
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare	$93.60
Rate for Payer: BCBS MT CHIP	$93.60
Rate for Payer: BCBS MT Closed Plan Network	$98.80
Rate for Payer: BCBS MT HealthLink	$93.60
Rate for Payer: BCBS MT Medicare	$93.60
Rate for Payer: BCBS MT POS	$98.80
Rate for Payer: BCBS MT Traditional	$104.00
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial	$98.80
Rate for Payer: Cigna Medicare	$93.60
Rate for Payer: Medicaid All Medicaid	$95.68
Rate for Payer: Medicare All Medicare	$72.80
Rate for Payer: Monida Allegiance	$98.80
Rate for Payer: Monida First Choice Health	$100.88
Rate for Payer: Monida Montana Health Co-op	$98.80
Rate for Payer: Monida PacificSource	$98.80

LAB TOXOPLASMASIS

Facility

$104.00

Service Code	HCPCS 86777
Hospital Charge Code	4086777
Hospital Revenue Code	302
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare	$93.60
Rate for Payer: BCBS MT CHIP	$93.60
Rate for Payer: BCBS MT Closed Plan Network	$98.80
Rate for Payer: BCBS MT HealthLink	$93.60
Rate for Payer: BCBS MT Medicare	$93.60
Rate for Payer: BCBS MT POS	$98.80
Rate for Payer: BCBS MT Traditional	$104.00
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial	$98.80
Rate for Payer: Cigna Medicare	$93.60
Rate for Payer: Medicaid All Medicaid	$95.68
Rate for Payer: Medicare All Medicare	$72.80
Rate for Payer: Monida Allegiance	$98.80
Rate for Payer: Monida First Choice Health	$100.88
Rate for Payer: Monida Montana Health Co-op	$98.80
Rate for Payer: Monida PacificSource	$98.80

LAB TOXOPLASMASIS IGM

Facility

$102.00

Service Code	HCPCS 86778
Hospital Charge Code	4086778
Hospital Revenue Code	302
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: BCBS MT CHIP	$91.80
Rate for Payer: BCBS MT Closed Plan Network	$96.90
Rate for Payer: BCBS MT HealthLink	$91.80
Rate for Payer: BCBS MT Medicare	$91.80
Rate for Payer: BCBS MT POS	$96.90
Rate for Payer: BCBS MT Traditional	$102.00
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial	$96.90
Rate for Payer: Cigna Medicare	$91.80
Rate for Payer: Medicaid All Medicaid	$93.84
Rate for Payer: Medicare All Medicare	$71.40
Rate for Payer: Monida Allegiance	$96.90
Rate for Payer: Monida First Choice Health	$98.94
Rate for Payer: Monida Montana Health Co-op	$96.90
Rate for Payer: Monida PacificSource	$96.90

LAB TOXOPLASMASIS IGM

Facility

$102.00

Service Code	HCPCS 86778
Hospital Charge Code	4086778
Hospital Revenue Code	302
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare	$91.80
Rate for Payer: BCBS MT CHIP	$91.80
Rate for Payer: BCBS MT Closed Plan Network	$96.90
Rate for Payer: BCBS MT HealthLink	$91.80
Rate for Payer: BCBS MT Medicare	$91.80
Rate for Payer: BCBS MT POS	$96.90
Rate for Payer: BCBS MT Traditional	$102.00
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial	$96.90
Rate for Payer: Cigna Medicare	$91.80
Rate for Payer: Medicaid All Medicaid	$93.84
Rate for Payer: Medicare All Medicare	$71.40
Rate for Payer: Monida Allegiance	$96.90
Rate for Payer: Monida First Choice Health	$98.94
Rate for Payer: Monida Montana Health Co-op	$96.90
Rate for Payer: Monida PacificSource	$96.90

LAB TPMT ENZYME ACTIVITY

Facility

$257.00

Service Code	HCPCS 82657
Hospital Charge Code	4082657
Hospital Revenue Code	300
Min. Negotiated Rate	$179.90
Max. Negotiated Rate	$257.00
Rate for Payer: Aetna Commercial	$244.15
Rate for Payer: Aetna Medicare	$231.30
Rate for Payer: BCBS MT CHIP	$231.30
Rate for Payer: BCBS MT Closed Plan Network	$244.15
Rate for Payer: BCBS MT HealthLink	$231.30
Rate for Payer: BCBS MT Medicare	$231.30
Rate for Payer: BCBS MT POS	$244.15
Rate for Payer: BCBS MT Traditional	$257.00
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cigna Commercial	$244.15
Rate for Payer: Cigna Medicare	$231.30
Rate for Payer: Medicaid All Medicaid	$236.44
Rate for Payer: Medicare All Medicare	$179.90
Rate for Payer: Monida Allegiance	$244.15
Rate for Payer: Monida First Choice Health	$249.29
Rate for Payer: Monida Montana Health Co-op	$244.15
Rate for Payer: Monida PacificSource	$244.15

LAB TPMT ENZYME ACTIVITY

Facility

$257.00

Service Code	HCPCS 82657
Hospital Charge Code	4082657
Hospital Revenue Code	300
Min. Negotiated Rate	$179.90
Max. Negotiated Rate	$257.00
Rate for Payer: Aetna Commercial	$244.15
Rate for Payer: Aetna Medicare	$231.30
Rate for Payer: BCBS MT CHIP	$231.30
Rate for Payer: BCBS MT Closed Plan Network	$244.15
Rate for Payer: BCBS MT HealthLink	$231.30
Rate for Payer: BCBS MT Medicare	$231.30
Rate for Payer: BCBS MT POS	$244.15
Rate for Payer: BCBS MT Traditional	$257.00
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cigna Commercial	$244.15
Rate for Payer: Cigna Medicare	$231.30
Rate for Payer: Medicaid All Medicaid	$236.44
Rate for Payer: Medicare All Medicare	$179.90
Rate for Payer: Monida Allegiance	$244.15
Rate for Payer: Monida First Choice Health	$249.29
Rate for Payer: Monida Montana Health Co-op	$244.15
Rate for Payer: Monida PacificSource	$244.15

LAB TRANXENE LEVELS

Facility

$135.00

Service Code	HCPCS 80346
Hospital Charge Code	4080346
Hospital Revenue Code	300
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

LAB TRANXENE LEVELS

Facility

$135.00

Service Code	HCPCS 80346
Hospital Charge Code	4080346
Hospital Revenue Code	300
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

LAB TRICHOMONAS VAGIN DIR

Facility

$125.00

Service Code	HCPCS 87660
Hospital Charge Code	4087660
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: BCBS MT CHIP	$112.50
Rate for Payer: BCBS MT Closed Plan Network	$118.75
Rate for Payer: BCBS MT HealthLink	$112.50
Rate for Payer: BCBS MT Medicare	$112.50
Rate for Payer: BCBS MT POS	$118.75
Rate for Payer: BCBS MT Traditional	$125.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: Cigna Medicare	$112.50
Rate for Payer: Medicaid All Medicaid	$115.00
Rate for Payer: Medicare All Medicare	$87.50
Rate for Payer: Monida Allegiance	$118.75
Rate for Payer: Monida First Choice Health	$121.25
Rate for Payer: Monida Montana Health Co-op	$118.75
Rate for Payer: Monida PacificSource	$118.75

LAB TRICHOMONAS VAGIN DIR

Facility

$125.00

Service Code	HCPCS 87660
Hospital Charge Code	4087660
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: BCBS MT CHIP	$112.50
Rate for Payer: BCBS MT Closed Plan Network	$118.75
Rate for Payer: BCBS MT HealthLink	$112.50
Rate for Payer: BCBS MT Medicare	$112.50
Rate for Payer: BCBS MT POS	$118.75
Rate for Payer: BCBS MT Traditional	$125.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: Cigna Medicare	$112.50
Rate for Payer: Medicaid All Medicaid	$115.00
Rate for Payer: Medicare All Medicare	$87.50
Rate for Payer: Monida Allegiance	$118.75
Rate for Payer: Monida First Choice Health	$121.25
Rate for Payer: Monida Montana Health Co-op	$118.75
Rate for Payer: Monida PacificSource	$118.75

LAB TROPONIN

Facility

$113.00

Service Code	HCPCS 84484
Hospital Charge Code	4084484
Hospital Revenue Code	301
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$107.35
Rate for Payer: Aetna Medicare	$101.70
Rate for Payer: BCBS MT CHIP	$101.70
Rate for Payer: BCBS MT Closed Plan Network	$107.35
Rate for Payer: BCBS MT HealthLink	$101.70
Rate for Payer: BCBS MT Medicare	$101.70
Rate for Payer: BCBS MT POS	$107.35
Rate for Payer: BCBS MT Traditional	$113.00
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial	$107.35
Rate for Payer: Cigna Medicare	$101.70
Rate for Payer: Medicaid All Medicaid	$103.96
Rate for Payer: Medicare All Medicare	$79.10
Rate for Payer: Monida Allegiance	$107.35
Rate for Payer: Monida First Choice Health	$109.61
Rate for Payer: Monida Montana Health Co-op	$107.35
Rate for Payer: Monida PacificSource	$107.35

LAB TROPONIN

Facility

$113.00

Service Code	HCPCS 84484
Hospital Charge Code	4084484
Hospital Revenue Code	301
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$107.35
Rate for Payer: Aetna Medicare	$101.70
Rate for Payer: BCBS MT CHIP	$101.70
Rate for Payer: BCBS MT Closed Plan Network	$107.35
Rate for Payer: BCBS MT HealthLink	$101.70
Rate for Payer: BCBS MT Medicare	$101.70
Rate for Payer: BCBS MT POS	$107.35
Rate for Payer: BCBS MT Traditional	$113.00
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial	$107.35
Rate for Payer: Cigna Medicare	$101.70
Rate for Payer: Medicaid All Medicaid	$103.96
Rate for Payer: Medicare All Medicare	$79.10
Rate for Payer: Monida Allegiance	$107.35
Rate for Payer: Monida First Choice Health	$109.61
Rate for Payer: Monida Montana Health Co-op	$107.35
Rate for Payer: Monida PacificSource	$107.35

LAB TSH RECETOR SITE AB

Facility

$182.00

Service Code	HCPCS 84235
Hospital Charge Code	4084235
Hospital Revenue Code	301
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$172.90
Rate for Payer: Aetna Medicare	$163.80
Rate for Payer: BCBS MT CHIP	$163.80
Rate for Payer: BCBS MT Closed Plan Network	$172.90
Rate for Payer: BCBS MT HealthLink	$163.80
Rate for Payer: BCBS MT Medicare	$163.80
Rate for Payer: BCBS MT POS	$172.90
Rate for Payer: BCBS MT Traditional	$182.00
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cigna Commercial	$172.90
Rate for Payer: Cigna Medicare	$163.80
Rate for Payer: Medicaid All Medicaid	$167.44
Rate for Payer: Medicare All Medicare	$127.40
Rate for Payer: Monida Allegiance	$172.90
Rate for Payer: Monida First Choice Health	$176.54
Rate for Payer: Monida Montana Health Co-op	$172.90
Rate for Payer: Monida PacificSource	$172.90

Know your out-of-pocket cost for care.

All Charges