Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

ID NOW SARS COV - TWIN BRIDGES

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	8198946
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW SARS COV - TWIN BRIDGES

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	8198946
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW STREP

Facility

$804.19

Hospital Charge Code	90197114
Hospital Revenue Code	270
Min. Negotiated Rate	$562.93
Max. Negotiated Rate	$804.19
Rate for Payer: Aetna Commercial	$763.98
Rate for Payer: Aetna Medicare	$723.77
Rate for Payer: BCBS MT CHIP	$723.77
Rate for Payer: BCBS MT Closed Plan Network	$763.98
Rate for Payer: BCBS MT HealthLink	$723.77
Rate for Payer: BCBS MT Medicare	$723.77
Rate for Payer: BCBS MT POS	$763.98
Rate for Payer: BCBS MT Traditional	$804.19
Rate for Payer: Cash Price	$723.77
Rate for Payer: Cigna Commercial	$763.98
Rate for Payer: Cigna Medicare	$723.77
Rate for Payer: Medicaid All Medicaid	$739.85
Rate for Payer: Medicare All Medicare	$562.93
Rate for Payer: Monida Allegiance	$763.98
Rate for Payer: Monida First Choice Health	$780.06
Rate for Payer: Monida Montana Health Co-op	$763.98
Rate for Payer: Monida PacificSource	$763.98

ID NOW STREP

Facility

$804.19

Hospital Charge Code	90197114
Hospital Revenue Code	270
Min. Negotiated Rate	$562.93
Max. Negotiated Rate	$804.19
Rate for Payer: Aetna Commercial	$763.98
Rate for Payer: Aetna Medicare	$723.77
Rate for Payer: BCBS MT CHIP	$723.77
Rate for Payer: BCBS MT Closed Plan Network	$763.98
Rate for Payer: BCBS MT HealthLink	$723.77
Rate for Payer: BCBS MT Medicare	$723.77
Rate for Payer: BCBS MT POS	$763.98
Rate for Payer: BCBS MT Traditional	$804.19
Rate for Payer: Cash Price	$723.77
Rate for Payer: Cigna Commercial	$763.98
Rate for Payer: Cigna Medicare	$723.77
Rate for Payer: Medicaid All Medicaid	$739.85
Rate for Payer: Medicare All Medicare	$562.93
Rate for Payer: Monida Allegiance	$763.98
Rate for Payer: Monida First Choice Health	$780.06
Rate for Payer: Monida Montana Health Co-op	$763.98
Rate for Payer: Monida PacificSource	$763.98

ID NOW STREP -ABBOTT

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	4087998
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW STREP -ABBOTT

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	4087998
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW STREP -RVMC

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	4087926
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW STREP -RVMC

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	4087926
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW STREP - TWIN BRIDGES

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	8198944
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

ID NOW STREP - TWIN BRIDGES

Facility

$130.00

Service Code	CPT 87651
Hospital Charge Code	8198944
Hospital Revenue Code	521
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

I D WOUND COMPLEX

Facility

$761.00

Service Code	CPT 10180
Hospital Charge Code	8010180
Hospital Revenue Code	521
Min. Negotiated Rate	$532.70
Max. Negotiated Rate	$761.00
Rate for Payer: Aetna Commercial	$722.95
Rate for Payer: Aetna Medicare	$684.90
Rate for Payer: BCBS MT CHIP	$684.90
Rate for Payer: BCBS MT Closed Plan Network	$722.95
Rate for Payer: BCBS MT HealthLink	$684.90
Rate for Payer: BCBS MT Medicare	$684.90
Rate for Payer: BCBS MT POS	$722.95
Rate for Payer: BCBS MT Traditional	$761.00
Rate for Payer: Cash Price	$684.90
Rate for Payer: Cigna Commercial	$722.95
Rate for Payer: Cigna Medicare	$684.90
Rate for Payer: Medicaid All Medicaid	$700.12
Rate for Payer: Medicare All Medicare	$532.70
Rate for Payer: Monida Allegiance	$722.95
Rate for Payer: Monida First Choice Health	$738.17
Rate for Payer: Monida Montana Health Co-op	$722.95
Rate for Payer: Monida PacificSource	$722.95

I D WOUND COMPLEX

Facility

$761.00

Service Code	CPT 10180
Hospital Charge Code	8010180
Hospital Revenue Code	521
Min. Negotiated Rate	$532.70
Max. Negotiated Rate	$761.00
Rate for Payer: Aetna Commercial	$722.95
Rate for Payer: Aetna Medicare	$684.90
Rate for Payer: BCBS MT CHIP	$684.90
Rate for Payer: BCBS MT Closed Plan Network	$722.95
Rate for Payer: BCBS MT HealthLink	$684.90
Rate for Payer: BCBS MT Medicare	$684.90
Rate for Payer: BCBS MT POS	$722.95
Rate for Payer: BCBS MT Traditional	$761.00
Rate for Payer: Cash Price	$684.90
Rate for Payer: Cigna Commercial	$722.95
Rate for Payer: Cigna Medicare	$684.90
Rate for Payer: Medicaid All Medicaid	$700.12
Rate for Payer: Medicare All Medicare	$532.70
Rate for Payer: Monida Allegiance	$722.95
Rate for Payer: Monida First Choice Health	$738.17
Rate for Payer: Monida Montana Health Co-op	$722.95
Rate for Payer: Monida PacificSource	$722.95

IFOB MAILER

Facility

$219.43

Hospital Charge Code	90197141
Hospital Revenue Code	270
Min. Negotiated Rate	$153.60
Max. Negotiated Rate	$219.43
Rate for Payer: Aetna Commercial	$208.46
Rate for Payer: Aetna Medicare	$197.49
Rate for Payer: BCBS MT CHIP	$197.49
Rate for Payer: BCBS MT Closed Plan Network	$208.46
Rate for Payer: BCBS MT HealthLink	$197.49
Rate for Payer: BCBS MT Medicare	$197.49
Rate for Payer: BCBS MT POS	$208.46
Rate for Payer: BCBS MT Traditional	$219.43
Rate for Payer: Cash Price	$197.49
Rate for Payer: Cigna Commercial	$208.46
Rate for Payer: Cigna Medicare	$197.49
Rate for Payer: Medicaid All Medicaid	$201.88
Rate for Payer: Medicare All Medicare	$153.60
Rate for Payer: Monida Allegiance	$208.46
Rate for Payer: Monida First Choice Health	$212.85
Rate for Payer: Monida Montana Health Co-op	$208.46
Rate for Payer: Monida PacificSource	$208.46

IFOB MAILER

Facility

$219.43

Hospital Charge Code	90197141
Hospital Revenue Code	270
Min. Negotiated Rate	$153.60
Max. Negotiated Rate	$219.43
Rate for Payer: Aetna Commercial	$208.46
Rate for Payer: Aetna Medicare	$197.49
Rate for Payer: BCBS MT CHIP	$197.49
Rate for Payer: BCBS MT Closed Plan Network	$208.46
Rate for Payer: BCBS MT HealthLink	$197.49
Rate for Payer: BCBS MT Medicare	$197.49
Rate for Payer: BCBS MT POS	$208.46
Rate for Payer: BCBS MT Traditional	$219.43
Rate for Payer: Cash Price	$197.49
Rate for Payer: Cigna Commercial	$208.46
Rate for Payer: Cigna Medicare	$197.49
Rate for Payer: Medicaid All Medicaid	$201.88
Rate for Payer: Medicare All Medicare	$153.60
Rate for Payer: Monida Allegiance	$208.46
Rate for Payer: Monida First Choice Health	$212.85
Rate for Payer: Monida Montana Health Co-op	$208.46
Rate for Payer: Monida PacificSource	$208.46

IFOB TEST CARTRIDGE

Facility

$134.07

Hospital Charge Code	90197140
Hospital Revenue Code	270
Min. Negotiated Rate	$93.85
Max. Negotiated Rate	$134.07
Rate for Payer: Aetna Commercial	$127.37
Rate for Payer: Aetna Medicare	$120.66
Rate for Payer: BCBS MT CHIP	$120.66
Rate for Payer: BCBS MT Closed Plan Network	$127.37
Rate for Payer: BCBS MT HealthLink	$120.66
Rate for Payer: BCBS MT Medicare	$120.66
Rate for Payer: BCBS MT POS	$127.37
Rate for Payer: BCBS MT Traditional	$134.07
Rate for Payer: Cash Price	$120.66
Rate for Payer: Cigna Commercial	$127.37
Rate for Payer: Cigna Medicare	$120.66
Rate for Payer: Medicaid All Medicaid	$123.34
Rate for Payer: Medicare All Medicare	$93.85
Rate for Payer: Monida Allegiance	$127.37
Rate for Payer: Monida First Choice Health	$130.05
Rate for Payer: Monida Montana Health Co-op	$127.37
Rate for Payer: Monida PacificSource	$127.37

IFOB TEST CARTRIDGE

Facility

$134.07

Hospital Charge Code	90197140
Hospital Revenue Code	270
Min. Negotiated Rate	$93.85
Max. Negotiated Rate	$134.07
Rate for Payer: Aetna Commercial	$127.37
Rate for Payer: Aetna Medicare	$120.66
Rate for Payer: BCBS MT CHIP	$120.66
Rate for Payer: BCBS MT Closed Plan Network	$127.37
Rate for Payer: BCBS MT HealthLink	$120.66
Rate for Payer: BCBS MT Medicare	$120.66
Rate for Payer: BCBS MT POS	$127.37
Rate for Payer: BCBS MT Traditional	$134.07
Rate for Payer: Cash Price	$120.66
Rate for Payer: Cigna Commercial	$127.37
Rate for Payer: Cigna Medicare	$120.66
Rate for Payer: Medicaid All Medicaid	$123.34
Rate for Payer: Medicare All Medicare	$93.85
Rate for Payer: Monida Allegiance	$127.37
Rate for Payer: Monida First Choice Health	$130.05
Rate for Payer: Monida Montana Health Co-op	$127.37
Rate for Payer: Monida PacificSource	$127.37

IGHV MUTATION ANAL BY SEQUEN(0040227

Facility

$580.00

Service Code	CPT 81263
Hospital Charge Code	4087995
Hospital Revenue Code	302
Min. Negotiated Rate	$406.00
Max. Negotiated Rate	$580.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare	$522.00
Rate for Payer: BCBS MT CHIP	$522.00
Rate for Payer: BCBS MT Closed Plan Network	$551.00
Rate for Payer: BCBS MT HealthLink	$522.00
Rate for Payer: BCBS MT Medicare	$522.00
Rate for Payer: BCBS MT POS	$551.00
Rate for Payer: BCBS MT Traditional	$580.00
Rate for Payer: Cash Price	$522.00
Rate for Payer: Cigna Commercial	$551.00
Rate for Payer: Cigna Medicare	$522.00
Rate for Payer: Medicaid All Medicaid	$533.60
Rate for Payer: Medicare All Medicare	$406.00
Rate for Payer: Monida Allegiance	$551.00
Rate for Payer: Monida First Choice Health	$562.60
Rate for Payer: Monida Montana Health Co-op	$551.00
Rate for Payer: Monida PacificSource	$551.00

IGHV MUTATION ANAL BY SEQUEN(0040227

Facility

$580.00

Service Code	CPT 81263
Hospital Charge Code	4087995
Hospital Revenue Code	302
Min. Negotiated Rate	$406.00
Max. Negotiated Rate	$580.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare	$522.00
Rate for Payer: BCBS MT CHIP	$522.00
Rate for Payer: BCBS MT Closed Plan Network	$551.00
Rate for Payer: BCBS MT HealthLink	$522.00
Rate for Payer: BCBS MT Medicare	$522.00
Rate for Payer: BCBS MT POS	$551.00
Rate for Payer: BCBS MT Traditional	$580.00
Rate for Payer: Cash Price	$522.00
Rate for Payer: Cigna Commercial	$551.00
Rate for Payer: Cigna Medicare	$522.00
Rate for Payer: Medicaid All Medicaid	$533.60
Rate for Payer: Medicare All Medicare	$406.00
Rate for Payer: Monida Allegiance	$551.00
Rate for Payer: Monida First Choice Health	$562.60
Rate for Payer: Monida Montana Health Co-op	$551.00
Rate for Payer: Monida PacificSource	$551.00

IMMATURE PLATELET FRACTION

Facility

$65.00

Service Code	CPT 85032
Hospital Charge Code	4088061
Hospital Revenue Code	302
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

IMMATURE PLATELET FRACTION

Facility

$65.00

Service Code	CPT 85032
Hospital Charge Code	4088061
Hospital Revenue Code	302
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$61.75
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS MT CHIP	$58.50
Rate for Payer: BCBS MT Closed Plan Network	$61.75
Rate for Payer: BCBS MT HealthLink	$58.50
Rate for Payer: BCBS MT Medicare	$58.50
Rate for Payer: BCBS MT POS	$61.75
Rate for Payer: BCBS MT Traditional	$65.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: Cigna Medicare	$58.50
Rate for Payer: Medicaid All Medicaid	$59.80
Rate for Payer: Medicare All Medicare	$45.50
Rate for Payer: Monida Allegiance	$61.75
Rate for Payer: Monida First Choice Health	$63.05
Rate for Payer: Monida Montana Health Co-op	$61.75
Rate for Payer: Monida PacificSource	$61.75

IMMUHOHISTO ANTB ADDL SLIDE

Facility

$191.00

Service Code	CPT 88341
Hospital Charge Code	8088341
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

IMMUHOHISTO ANTB ADDL SLIDE

Facility

$191.00

Service Code	CPT 88341
Hospital Charge Code	8088341
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

.IMMUNASSY ANALYTE NOT INF AB/AG 83516

Facility

$100.00

Service Code	CPT 83516
Hospital Charge Code	4035161
Hospital Revenue Code	301
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS MT CHIP	$90.00
Rate for Payer: BCBS MT Closed Plan Network	$95.00
Rate for Payer: BCBS MT HealthLink	$90.00
Rate for Payer: BCBS MT Medicare	$90.00
Rate for Payer: BCBS MT POS	$95.00
Rate for Payer: BCBS MT Traditional	$100.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: Cigna Medicare	$90.00
Rate for Payer: Medicaid All Medicaid	$92.00
Rate for Payer: Medicare All Medicare	$70.00
Rate for Payer: Monida Allegiance	$95.00
Rate for Payer: Monida First Choice Health	$97.00
Rate for Payer: Monida Montana Health Co-op	$95.00
Rate for Payer: Monida PacificSource	$95.00

.IMMUNASSY ANALYTE NOT INF AB/AG 83516

Facility

$100.00

Service Code	CPT 83516
Hospital Charge Code	4035161
Hospital Revenue Code	301
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS MT CHIP	$90.00
Rate for Payer: BCBS MT Closed Plan Network	$95.00
Rate for Payer: BCBS MT HealthLink	$90.00
Rate for Payer: BCBS MT Medicare	$90.00
Rate for Payer: BCBS MT POS	$95.00
Rate for Payer: BCBS MT Traditional	$100.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: Cigna Medicare	$90.00
Rate for Payer: Medicaid All Medicaid	$92.00
Rate for Payer: Medicare All Medicare	$70.00
Rate for Payer: Monida Allegiance	$95.00
Rate for Payer: Monida First Choice Health	$97.00
Rate for Payer: Monida Montana Health Co-op	$95.00
Rate for Payer: Monida PacificSource	$95.00

.IMMUNASSY ANLYT NOT INF AB/AG QUA 83520

Facility

$157.00

Service Code	CPT 83520
Hospital Charge Code	4083520
Hospital Revenue Code	301
Min. Negotiated Rate	$109.90
Max. Negotiated Rate	$157.00
Rate for Payer: Aetna Commercial	$149.15
Rate for Payer: Aetna Medicare	$141.30
Rate for Payer: BCBS MT CHIP	$141.30
Rate for Payer: BCBS MT Closed Plan Network	$149.15
Rate for Payer: BCBS MT HealthLink	$141.30
Rate for Payer: BCBS MT Medicare	$141.30
Rate for Payer: BCBS MT POS	$149.15
Rate for Payer: BCBS MT Traditional	$157.00
Rate for Payer: Cash Price	$141.30
Rate for Payer: Cigna Commercial	$149.15
Rate for Payer: Cigna Medicare	$141.30
Rate for Payer: Medicaid All Medicaid	$144.44
Rate for Payer: Medicare All Medicare	$109.90
Rate for Payer: Monida Allegiance	$149.15
Rate for Payer: Monida First Choice Health	$152.29
Rate for Payer: Monida Montana Health Co-op	$149.15
Rate for Payer: Monida PacificSource	$149.15

Know your out-of-pocket cost for care.

All Charges