Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

LAB ANAEROBIC IDENTIFICATION

Facility

$67.00

Service Code	CPT 87076
Hospital Charge Code	4087076
Hospital Revenue Code	306
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare	$60.30
Rate for Payer: BCBS MT CHIP	$60.30
Rate for Payer: BCBS MT Closed Plan Network	$63.65
Rate for Payer: BCBS MT HealthLink	$60.30
Rate for Payer: BCBS MT Medicare	$60.30
Rate for Payer: BCBS MT POS	$63.65
Rate for Payer: BCBS MT Traditional	$67.00
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial	$63.65
Rate for Payer: Cigna Medicare	$60.30
Rate for Payer: Medicaid All Medicaid	$61.64
Rate for Payer: Medicare All Medicare	$46.90
Rate for Payer: Monida Allegiance	$63.65
Rate for Payer: Monida First Choice Health	$64.99
Rate for Payer: Monida Montana Health Co-op	$63.65
Rate for Payer: Monida PacificSource	$63.65

LAB ANCA ANTIBODY IDENTIFICATION

Facility

$145.00

Service Code	CPT 86021
Hospital Charge Code	4086021
Hospital Revenue Code	301
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$137.75
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS MT CHIP	$130.50
Rate for Payer: BCBS MT Closed Plan Network	$137.75
Rate for Payer: BCBS MT HealthLink	$130.50
Rate for Payer: BCBS MT Medicare	$130.50
Rate for Payer: BCBS MT POS	$137.75
Rate for Payer: BCBS MT Traditional	$145.00
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial	$137.75
Rate for Payer: Cigna Medicare	$130.50
Rate for Payer: Medicaid All Medicaid	$133.40
Rate for Payer: Medicare All Medicare	$101.50
Rate for Payer: Monida Allegiance	$137.75
Rate for Payer: Monida First Choice Health	$140.65
Rate for Payer: Monida Montana Health Co-op	$137.75
Rate for Payer: Monida PacificSource	$137.75

LAB ANCA ANTIBODY IDENTIFICATION

Facility

$145.00

Service Code	CPT 86021
Hospital Charge Code	4086021
Hospital Revenue Code	301
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$137.75
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS MT CHIP	$130.50
Rate for Payer: BCBS MT Closed Plan Network	$137.75
Rate for Payer: BCBS MT HealthLink	$130.50
Rate for Payer: BCBS MT Medicare	$130.50
Rate for Payer: BCBS MT POS	$137.75
Rate for Payer: BCBS MT Traditional	$145.00
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial	$137.75
Rate for Payer: Cigna Medicare	$130.50
Rate for Payer: Medicaid All Medicaid	$133.40
Rate for Payer: Medicare All Medicare	$101.50
Rate for Payer: Monida Allegiance	$137.75
Rate for Payer: Monida First Choice Health	$140.65
Rate for Payer: Monida Montana Health Co-op	$137.75
Rate for Payer: Monida PacificSource	$137.75

LAB ANDROSTENEDIONE

Facility

$390.00

Service Code	CPT 82157
Hospital Charge Code	4082157
Hospital Revenue Code	300
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare	$351.00
Rate for Payer: BCBS MT CHIP	$351.00
Rate for Payer: BCBS MT Closed Plan Network	$370.50
Rate for Payer: BCBS MT HealthLink	$351.00
Rate for Payer: BCBS MT Medicare	$351.00
Rate for Payer: BCBS MT POS	$370.50
Rate for Payer: BCBS MT Traditional	$390.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cigna Commercial	$370.50
Rate for Payer: Cigna Medicare	$351.00
Rate for Payer: Medicaid All Medicaid	$358.80
Rate for Payer: Medicare All Medicare	$273.00
Rate for Payer: Monida Allegiance	$370.50
Rate for Payer: Monida First Choice Health	$378.30
Rate for Payer: Monida Montana Health Co-op	$370.50
Rate for Payer: Monida PacificSource	$370.50

LAB ANDROSTENEDIONE

Facility

$390.00

Service Code	CPT 82157
Hospital Charge Code	4082157
Hospital Revenue Code	300
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare	$351.00
Rate for Payer: BCBS MT CHIP	$351.00
Rate for Payer: BCBS MT Closed Plan Network	$370.50
Rate for Payer: BCBS MT HealthLink	$351.00
Rate for Payer: BCBS MT Medicare	$351.00
Rate for Payer: BCBS MT POS	$370.50
Rate for Payer: BCBS MT Traditional	$390.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cigna Commercial	$370.50
Rate for Payer: Cigna Medicare	$351.00
Rate for Payer: Medicaid All Medicaid	$358.80
Rate for Payer: Medicare All Medicare	$273.00
Rate for Payer: Monida Allegiance	$370.50
Rate for Payer: Monida First Choice Health	$378.30
Rate for Payer: Monida Montana Health Co-op	$370.50
Rate for Payer: Monida PacificSource	$370.50

LAB ANTIBODY IDENTIFICATION

Facility

$187.00

Service Code	CPT 86870
Hospital Charge Code	4086870
Hospital Revenue Code	300
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$168.30
Rate for Payer: BCBS MT CHIP	$168.30
Rate for Payer: BCBS MT Closed Plan Network	$177.65
Rate for Payer: BCBS MT HealthLink	$168.30
Rate for Payer: BCBS MT Medicare	$168.30
Rate for Payer: BCBS MT POS	$177.65
Rate for Payer: BCBS MT Traditional	$187.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial	$177.65
Rate for Payer: Cigna Medicare	$168.30
Rate for Payer: Medicaid All Medicaid	$172.04
Rate for Payer: Medicare All Medicare	$130.90
Rate for Payer: Monida Allegiance	$177.65
Rate for Payer: Monida First Choice Health	$181.39
Rate for Payer: Monida Montana Health Co-op	$177.65
Rate for Payer: Monida PacificSource	$177.65

LAB ANTIBODY IDENTIFICATION

Facility

$187.00

Service Code	CPT 86870
Hospital Charge Code	4086870
Hospital Revenue Code	300
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$168.30
Rate for Payer: BCBS MT CHIP	$168.30
Rate for Payer: BCBS MT Closed Plan Network	$177.65
Rate for Payer: BCBS MT HealthLink	$168.30
Rate for Payer: BCBS MT Medicare	$168.30
Rate for Payer: BCBS MT POS	$177.65
Rate for Payer: BCBS MT Traditional	$187.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial	$177.65
Rate for Payer: Cigna Medicare	$168.30
Rate for Payer: Medicaid All Medicaid	$172.04
Rate for Payer: Medicare All Medicare	$130.90
Rate for Payer: Monida Allegiance	$177.65
Rate for Payer: Monida First Choice Health	$181.39
Rate for Payer: Monida Montana Health Co-op	$177.65
Rate for Payer: Monida PacificSource	$177.65

LAB ANTI IGE

Facility

$157.00

Service Code	CPT 83520
Hospital Charge Code	4035201
Hospital Revenue Code	300
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

LAB ANTI IGE

Facility

$157.00

Service Code	CPT 83520
Hospital Charge Code	4035201
Hospital Revenue Code	300
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

LAB ANTIPEROXIDASE AB

Facility

$72.00

Service Code	CPT 84432
Hospital Charge Code	4084432
Hospital Revenue Code	301
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

LAB ANTIPEROXIDASE AB

Facility

$72.00

Service Code	CPT 84432
Hospital Charge Code	4084432
Hospital Revenue Code	301
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

LAB ARSENIC

Facility

$78.00

Service Code	CPT 82175
Hospital Charge Code	4082175
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

LAB ARSENIC

Facility

$78.00

Service Code	CPT 82175
Hospital Charge Code	4082175
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

LAB ARTERIAL PUNCTURE

Facility

$89.00

Service Code	CPT 36600
Hospital Charge Code	4036600
Hospital Revenue Code	300
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

LAB ARTERIAL PUNCTURE

Facility

$89.00

Service Code	CPT 36600
Hospital Charge Code	4036600
Hospital Revenue Code	300
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

LAB ASPIRATE - CRYSTAL IDENTIFICATION

Facility

$60.00

Service Code	CPT 89060
Hospital Charge Code	4089060
Hospital Revenue Code	300
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

LAB ASPIRATE - CRYSTAL IDENTIFICATION

Facility

$60.00

Service Code	CPT 89060
Hospital Charge Code	4089060
Hospital Revenue Code	300
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

LAB BACTERIAL ID

Facility

$83.00

Service Code	CPT 87077
Hospital Charge Code	4087077
Hospital Revenue Code	306
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$78.85
Rate for Payer: Aetna Medicare	$74.70
Rate for Payer: BCBS MT CHIP	$74.70
Rate for Payer: BCBS MT Closed Plan Network	$78.85
Rate for Payer: BCBS MT HealthLink	$74.70
Rate for Payer: BCBS MT Medicare	$74.70
Rate for Payer: BCBS MT POS	$78.85
Rate for Payer: BCBS MT Traditional	$83.00
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cigna Commercial	$78.85
Rate for Payer: Cigna Medicare	$74.70
Rate for Payer: Medicaid All Medicaid	$76.36
Rate for Payer: Medicare All Medicare	$58.10
Rate for Payer: Monida Allegiance	$78.85
Rate for Payer: Monida First Choice Health	$80.51
Rate for Payer: Monida Montana Health Co-op	$78.85
Rate for Payer: Monida PacificSource	$78.85

LAB BACTERIAL ID

Facility

$83.00

Service Code	CPT 87077
Hospital Charge Code	4087077
Hospital Revenue Code	306
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$78.85
Rate for Payer: Aetna Medicare	$74.70
Rate for Payer: BCBS MT CHIP	$74.70
Rate for Payer: BCBS MT Closed Plan Network	$78.85
Rate for Payer: BCBS MT HealthLink	$74.70
Rate for Payer: BCBS MT Medicare	$74.70
Rate for Payer: BCBS MT POS	$78.85
Rate for Payer: BCBS MT Traditional	$83.00
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cigna Commercial	$78.85
Rate for Payer: Cigna Medicare	$74.70
Rate for Payer: Medicaid All Medicaid	$76.36
Rate for Payer: Medicare All Medicare	$58.10
Rate for Payer: Monida Allegiance	$78.85
Rate for Payer: Monida First Choice Health	$80.51
Rate for Payer: Monida Montana Health Co-op	$78.85
Rate for Payer: Monida PacificSource	$78.85

LAB BARTONELLA SEROLOGY

Facility

$149.00

Service Code	CPT 86256
Hospital Charge Code	4086256
Hospital Revenue Code	300
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$149.00
Rate for Payer: Aetna Commercial	$141.55
Rate for Payer: Aetna Medicare	$134.10
Rate for Payer: BCBS MT CHIP	$134.10
Rate for Payer: BCBS MT Closed Plan Network	$141.55
Rate for Payer: BCBS MT HealthLink	$134.10
Rate for Payer: BCBS MT Medicare	$134.10
Rate for Payer: BCBS MT POS	$141.55
Rate for Payer: BCBS MT Traditional	$149.00
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial	$141.55
Rate for Payer: Cigna Medicare	$134.10
Rate for Payer: Medicaid All Medicaid	$137.08
Rate for Payer: Medicare All Medicare	$104.30
Rate for Payer: Monida Allegiance	$141.55
Rate for Payer: Monida First Choice Health	$144.53
Rate for Payer: Monida Montana Health Co-op	$141.55
Rate for Payer: Monida PacificSource	$141.55

LAB BARTONELLA SEROLOGY

Facility

$149.00

Service Code	CPT 86256
Hospital Charge Code	4086256
Hospital Revenue Code	300
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$149.00
Rate for Payer: Aetna Commercial	$141.55
Rate for Payer: Aetna Medicare	$134.10
Rate for Payer: BCBS MT CHIP	$134.10
Rate for Payer: BCBS MT Closed Plan Network	$141.55
Rate for Payer: BCBS MT HealthLink	$134.10
Rate for Payer: BCBS MT Medicare	$134.10
Rate for Payer: BCBS MT POS	$141.55
Rate for Payer: BCBS MT Traditional	$149.00
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial	$141.55
Rate for Payer: Cigna Medicare	$134.10
Rate for Payer: Medicaid All Medicaid	$137.08
Rate for Payer: Medicare All Medicare	$104.30
Rate for Payer: Monida Allegiance	$141.55
Rate for Payer: Monida First Choice Health	$144.53
Rate for Payer: Monida Montana Health Co-op	$141.55
Rate for Payer: Monida PacificSource	$141.55

LAB BETA LACTAMASE

Facility

$52.00

Service Code	CPT 87185
Hospital Charge Code	4087185
Hospital Revenue Code	306
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare	$46.80
Rate for Payer: BCBS MT CHIP	$46.80
Rate for Payer: BCBS MT Closed Plan Network	$49.40
Rate for Payer: BCBS MT HealthLink	$46.80
Rate for Payer: BCBS MT Medicare	$46.80
Rate for Payer: BCBS MT POS	$49.40
Rate for Payer: BCBS MT Traditional	$52.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial	$49.40
Rate for Payer: Cigna Medicare	$46.80
Rate for Payer: Medicaid All Medicaid	$47.84
Rate for Payer: Medicare All Medicare	$36.40
Rate for Payer: Monida Allegiance	$49.40
Rate for Payer: Monida First Choice Health	$50.44
Rate for Payer: Monida Montana Health Co-op	$49.40
Rate for Payer: Monida PacificSource	$49.40

LAB BETA LACTAMASE

Facility

$52.00

Service Code	CPT 87185
Hospital Charge Code	4087185
Hospital Revenue Code	306
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare	$46.80
Rate for Payer: BCBS MT CHIP	$46.80
Rate for Payer: BCBS MT Closed Plan Network	$49.40
Rate for Payer: BCBS MT HealthLink	$46.80
Rate for Payer: BCBS MT Medicare	$46.80
Rate for Payer: BCBS MT POS	$49.40
Rate for Payer: BCBS MT Traditional	$52.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial	$49.40
Rate for Payer: Cigna Medicare	$46.80
Rate for Payer: Medicaid All Medicaid	$47.84
Rate for Payer: Medicare All Medicare	$36.40
Rate for Payer: Monida Allegiance	$49.40
Rate for Payer: Monida First Choice Health	$50.44
Rate for Payer: Monida Montana Health Co-op	$49.40
Rate for Payer: Monida PacificSource	$49.40

LAB BIOTINIDOSE

Facility

$78.00

Service Code	CPT 82261
Hospital Charge Code	4082261
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

LAB BIOTINIDOSE

Facility

$78.00

Service Code	CPT 82261
Hospital Charge Code	4082261
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

Know your out-of-pocket cost for care.

All Charges