Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

LAB BRUCELLA

Facility

$211.00

Service Code	CPT 86622
Hospital Charge Code	4086623
Hospital Revenue Code	300
Min. Negotiated Rate	$147.70
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$200.45
Rate for Payer: Aetna Medicare	$189.90
Rate for Payer: BCBS MT CHIP	$189.90
Rate for Payer: BCBS MT Closed Plan Network	$200.45
Rate for Payer: BCBS MT HealthLink	$189.90
Rate for Payer: BCBS MT Medicare	$189.90
Rate for Payer: BCBS MT POS	$200.45
Rate for Payer: BCBS MT Traditional	$211.00
Rate for Payer: Cash Price	$189.90
Rate for Payer: Cigna Commercial	$200.45
Rate for Payer: Cigna Medicare	$189.90
Rate for Payer: Medicaid All Medicaid	$194.12
Rate for Payer: Medicare All Medicare	$147.70
Rate for Payer: Monida Allegiance	$200.45
Rate for Payer: Monida First Choice Health	$204.67
Rate for Payer: Monida Montana Health Co-op	$200.45
Rate for Payer: Monida PacificSource	$200.45

LAB BRUCELLA

Facility

$211.00

Service Code	CPT 86622
Hospital Charge Code	4086623
Hospital Revenue Code	300
Min. Negotiated Rate	$147.70
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$200.45
Rate for Payer: Aetna Medicare	$189.90
Rate for Payer: BCBS MT CHIP	$189.90
Rate for Payer: BCBS MT Closed Plan Network	$200.45
Rate for Payer: BCBS MT HealthLink	$189.90
Rate for Payer: BCBS MT Medicare	$189.90
Rate for Payer: BCBS MT POS	$200.45
Rate for Payer: BCBS MT Traditional	$211.00
Rate for Payer: Cash Price	$189.90
Rate for Payer: Cigna Commercial	$200.45
Rate for Payer: Cigna Medicare	$189.90
Rate for Payer: Medicaid All Medicaid	$194.12
Rate for Payer: Medicare All Medicare	$147.70
Rate for Payer: Monida Allegiance	$200.45
Rate for Payer: Monida First Choice Health	$204.67
Rate for Payer: Monida Montana Health Co-op	$200.45
Rate for Payer: Monida PacificSource	$200.45

LAB CADMIUM

Facility

$84.00

Service Code	CPT 82300
Hospital Charge Code	4082300
Hospital Revenue Code	301
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare	$75.60
Rate for Payer: BCBS MT CHIP	$75.60
Rate for Payer: BCBS MT Closed Plan Network	$79.80
Rate for Payer: BCBS MT HealthLink	$75.60
Rate for Payer: BCBS MT Medicare	$75.60
Rate for Payer: BCBS MT POS	$79.80
Rate for Payer: BCBS MT Traditional	$84.00
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cigna Commercial	$79.80
Rate for Payer: Cigna Medicare	$75.60
Rate for Payer: Medicaid All Medicaid	$77.28
Rate for Payer: Medicare All Medicare	$58.80
Rate for Payer: Monida Allegiance	$79.80
Rate for Payer: Monida First Choice Health	$81.48
Rate for Payer: Monida Montana Health Co-op	$79.80
Rate for Payer: Monida PacificSource	$79.80

LAB CADMIUM

Facility

$84.00

Service Code	CPT 82300
Hospital Charge Code	4082300
Hospital Revenue Code	301
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare	$75.60
Rate for Payer: BCBS MT CHIP	$75.60
Rate for Payer: BCBS MT Closed Plan Network	$79.80
Rate for Payer: BCBS MT HealthLink	$75.60
Rate for Payer: BCBS MT Medicare	$75.60
Rate for Payer: BCBS MT POS	$79.80
Rate for Payer: BCBS MT Traditional	$84.00
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cigna Commercial	$79.80
Rate for Payer: Cigna Medicare	$75.60
Rate for Payer: Medicaid All Medicaid	$77.28
Rate for Payer: Medicare All Medicare	$58.80
Rate for Payer: Monida Allegiance	$79.80
Rate for Payer: Monida First Choice Health	$81.48
Rate for Payer: Monida Montana Health Co-op	$79.80
Rate for Payer: Monida PacificSource	$79.80

LAB CANDIDA ALBICANS IGE

Facility

$56.00

Service Code	CPT 86003
Hospital Charge Code	4000316
Hospital Revenue Code	300
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare	$50.40
Rate for Payer: BCBS MT CHIP	$50.40
Rate for Payer: BCBS MT Closed Plan Network	$53.20
Rate for Payer: BCBS MT HealthLink	$50.40
Rate for Payer: BCBS MT Medicare	$50.40
Rate for Payer: BCBS MT POS	$53.20
Rate for Payer: BCBS MT Traditional	$56.00
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna Commercial	$53.20
Rate for Payer: Cigna Medicare	$50.40
Rate for Payer: Medicaid All Medicaid	$51.52
Rate for Payer: Medicare All Medicare	$39.20
Rate for Payer: Monida Allegiance	$53.20
Rate for Payer: Monida First Choice Health	$54.32
Rate for Payer: Monida Montana Health Co-op	$53.20
Rate for Payer: Monida PacificSource	$53.20

LAB CANDIDA ALBICANS IGE

Facility

$56.00

Service Code	CPT 86003
Hospital Charge Code	4000316
Hospital Revenue Code	300
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare	$50.40
Rate for Payer: BCBS MT CHIP	$50.40
Rate for Payer: BCBS MT Closed Plan Network	$53.20
Rate for Payer: BCBS MT HealthLink	$50.40
Rate for Payer: BCBS MT Medicare	$50.40
Rate for Payer: BCBS MT POS	$53.20
Rate for Payer: BCBS MT Traditional	$56.00
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cigna Commercial	$53.20
Rate for Payer: Cigna Medicare	$50.40
Rate for Payer: Medicaid All Medicaid	$51.52
Rate for Payer: Medicare All Medicare	$39.20
Rate for Payer: Monida Allegiance	$53.20
Rate for Payer: Monida First Choice Health	$54.32
Rate for Payer: Monida Montana Health Co-op	$53.20
Rate for Payer: Monida PacificSource	$53.20

LAB CANDIDA SPECIES DIR 1

Facility

$125.00

Service Code	CPT 87480
Hospital Charge Code	4087480
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 CANDIDA SPECIES DIR 1

Facility

$125.00

Service Code	CPT 87480
Hospital Charge Code	4087480
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 CARBON MONOXIDE

Facility

$81.00

Service Code	CPT 82375
Hospital Charge Code	4082375
Hospital Revenue Code	301
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: Aetna Medicare	$72.90
Rate for Payer: BCBS MT CHIP	$72.90
Rate for Payer: BCBS MT Closed Plan Network	$76.95
Rate for Payer: BCBS MT HealthLink	$72.90
Rate for Payer: BCBS MT Medicare	$72.90
Rate for Payer: BCBS MT POS	$76.95
Rate for Payer: BCBS MT Traditional	$81.00
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial	$76.95
Rate for Payer: Cigna Medicare	$72.90
Rate for Payer: Medicaid All Medicaid	$74.52
Rate for Payer: Medicare All Medicare	$56.70
Rate for Payer: Monida Allegiance	$76.95
Rate for Payer: Monida First Choice Health	$78.57
Rate for Payer: Monida Montana Health Co-op	$76.95
Rate for Payer: Monida PacificSource	$76.95

LAB CARBON MONOXIDE

Facility

$81.00

Service Code	CPT 82375
Hospital Charge Code	4082375
Hospital Revenue Code	301
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: Aetna Medicare	$72.90
Rate for Payer: BCBS MT CHIP	$72.90
Rate for Payer: BCBS MT Closed Plan Network	$76.95
Rate for Payer: BCBS MT HealthLink	$72.90
Rate for Payer: BCBS MT Medicare	$72.90
Rate for Payer: BCBS MT POS	$76.95
Rate for Payer: BCBS MT Traditional	$81.00
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial	$76.95
Rate for Payer: Cigna Medicare	$72.90
Rate for Payer: Medicaid All Medicaid	$74.52
Rate for Payer: Medicare All Medicare	$56.70
Rate for Payer: Monida Allegiance	$76.95
Rate for Payer: Monida First Choice Health	$78.57
Rate for Payer: Monida Montana Health Co-op	$76.95
Rate for Payer: Monida PacificSource	$76.95

LAB CATACHOLAMINES

Facility

$148.00

Service Code	CPT 82384
Hospital Charge Code	4082384
Hospital Revenue Code	300
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$148.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare	$133.20
Rate for Payer: BCBS MT CHIP	$133.20
Rate for Payer: BCBS MT Closed Plan Network	$140.60
Rate for Payer: BCBS MT HealthLink	$133.20
Rate for Payer: BCBS MT Medicare	$133.20
Rate for Payer: BCBS MT POS	$140.60
Rate for Payer: BCBS MT Traditional	$148.00
Rate for Payer: Cash Price	$133.20
Rate for Payer: Cigna Commercial	$140.60
Rate for Payer: Cigna Medicare	$133.20
Rate for Payer: Medicaid All Medicaid	$136.16
Rate for Payer: Medicare All Medicare	$103.60
Rate for Payer: Monida Allegiance	$140.60
Rate for Payer: Monida First Choice Health	$143.56
Rate for Payer: Monida Montana Health Co-op	$140.60
Rate for Payer: Monida PacificSource	$140.60

LAB CATACHOLAMINES

Facility

$148.00

Service Code	CPT 82384
Hospital Charge Code	4082384
Hospital Revenue Code	300
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$148.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare	$133.20
Rate for Payer: BCBS MT CHIP	$133.20
Rate for Payer: BCBS MT Closed Plan Network	$140.60
Rate for Payer: BCBS MT HealthLink	$133.20
Rate for Payer: BCBS MT Medicare	$133.20
Rate for Payer: BCBS MT POS	$140.60
Rate for Payer: BCBS MT Traditional	$148.00
Rate for Payer: Cash Price	$133.20
Rate for Payer: Cigna Commercial	$140.60
Rate for Payer: Cigna Medicare	$133.20
Rate for Payer: Medicaid All Medicaid	$136.16
Rate for Payer: Medicare All Medicare	$103.60
Rate for Payer: Monida Allegiance	$140.60
Rate for Payer: Monida First Choice Health	$143.56
Rate for Payer: Monida Montana Health Co-op	$140.60
Rate for Payer: Monida PacificSource	$140.60

LAB CEA

Facility

$135.00

Service Code	CPT 82378
Hospital Charge Code	4086151
Hospital Revenue Code	301
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 CEA

Facility

$135.00

Service Code	CPT 82378
Hospital Charge Code	4086151
Hospital Revenue Code	301
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 CFTR GENE COM VARIANTS

Facility

$649.00

Service Code	CPT 81220
Hospital Charge Code	4081220
Hospital Revenue Code	300
Min. Negotiated Rate	$454.30
Max. Negotiated Rate	$649.00
Rate for Payer: Aetna Commercial	$616.55
Rate for Payer: Aetna Medicare	$584.10
Rate for Payer: BCBS MT CHIP	$584.10
Rate for Payer: BCBS MT Closed Plan Network	$616.55
Rate for Payer: BCBS MT HealthLink	$584.10
Rate for Payer: BCBS MT Medicare	$584.10
Rate for Payer: BCBS MT POS	$616.55
Rate for Payer: BCBS MT Traditional	$649.00
Rate for Payer: Cash Price	$584.10
Rate for Payer: Cigna Commercial	$616.55
Rate for Payer: Cigna Medicare	$584.10
Rate for Payer: Medicaid All Medicaid	$597.08
Rate for Payer: Medicare All Medicare	$454.30
Rate for Payer: Monida Allegiance	$616.55
Rate for Payer: Monida First Choice Health	$629.53
Rate for Payer: Monida Montana Health Co-op	$616.55
Rate for Payer: Monida PacificSource	$616.55

LAB CFTR GENE COM VARIANTS

Facility

$649.00

Service Code	CPT 81220
Hospital Charge Code	4081220
Hospital Revenue Code	300
Min. Negotiated Rate	$454.30
Max. Negotiated Rate	$649.00
Rate for Payer: Aetna Commercial	$616.55
Rate for Payer: Aetna Medicare	$584.10
Rate for Payer: BCBS MT CHIP	$584.10
Rate for Payer: BCBS MT Closed Plan Network	$616.55
Rate for Payer: BCBS MT HealthLink	$584.10
Rate for Payer: BCBS MT Medicare	$584.10
Rate for Payer: BCBS MT POS	$616.55
Rate for Payer: BCBS MT Traditional	$649.00
Rate for Payer: Cash Price	$584.10
Rate for Payer: Cigna Commercial	$616.55
Rate for Payer: Cigna Medicare	$584.10
Rate for Payer: Medicaid All Medicaid	$597.08
Rate for Payer: Medicare All Medicare	$454.30
Rate for Payer: Monida Allegiance	$616.55
Rate for Payer: Monida First Choice Health	$629.53
Rate for Payer: Monida Montana Health Co-op	$616.55
Rate for Payer: Monida PacificSource	$616.55

LAB CHLAMYDIA PNEUMONIA

Facility

$87.00

Service Code	CPT 87486
Hospital Charge Code	4087486
Hospital Revenue Code	306
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$82.65
Rate for Payer: Aetna Medicare	$78.30
Rate for Payer: BCBS MT CHIP	$78.30
Rate for Payer: BCBS MT Closed Plan Network	$82.65
Rate for Payer: BCBS MT HealthLink	$78.30
Rate for Payer: BCBS MT Medicare	$78.30
Rate for Payer: BCBS MT POS	$82.65
Rate for Payer: BCBS MT Traditional	$87.00
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial	$82.65
Rate for Payer: Cigna Medicare	$78.30
Rate for Payer: Medicaid All Medicaid	$80.04
Rate for Payer: Medicare All Medicare	$60.90
Rate for Payer: Monida Allegiance	$82.65
Rate for Payer: Monida First Choice Health	$84.39
Rate for Payer: Monida Montana Health Co-op	$82.65
Rate for Payer: Monida PacificSource	$82.65

LAB CHLAMYDIA PNEUMONIA

Facility

$87.00

Service Code	CPT 87486
Hospital Charge Code	4087486
Hospital Revenue Code	306
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$82.65
Rate for Payer: Aetna Medicare	$78.30
Rate for Payer: BCBS MT CHIP	$78.30
Rate for Payer: BCBS MT Closed Plan Network	$82.65
Rate for Payer: BCBS MT HealthLink	$78.30
Rate for Payer: BCBS MT Medicare	$78.30
Rate for Payer: BCBS MT POS	$82.65
Rate for Payer: BCBS MT Traditional	$87.00
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial	$82.65
Rate for Payer: Cigna Medicare	$78.30
Rate for Payer: Medicaid All Medicaid	$80.04
Rate for Payer: Medicare All Medicare	$60.90
Rate for Payer: Monida Allegiance	$82.65
Rate for Payer: Monida First Choice Health	$84.39
Rate for Payer: Monida Montana Health Co-op	$82.65
Rate for Payer: Monida PacificSource	$82.65

LAB CHROMOGRANIN A

Facility

$94.00

Service Code	CPT 86316
Hospital Charge Code	4086316
Hospital Revenue Code	300
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare	$84.60
Rate for Payer: BCBS MT CHIP	$84.60
Rate for Payer: BCBS MT Closed Plan Network	$89.30
Rate for Payer: BCBS MT HealthLink	$84.60
Rate for Payer: BCBS MT Medicare	$84.60
Rate for Payer: BCBS MT POS	$89.30
Rate for Payer: BCBS MT Traditional	$94.00
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cigna Commercial	$89.30
Rate for Payer: Cigna Medicare	$84.60
Rate for Payer: Medicaid All Medicaid	$86.48
Rate for Payer: Medicare All Medicare	$65.80
Rate for Payer: Monida Allegiance	$89.30
Rate for Payer: Monida First Choice Health	$91.18
Rate for Payer: Monida Montana Health Co-op	$89.30
Rate for Payer: Monida PacificSource	$89.30

LAB CHROMOGRANIN A

Facility

$94.00

Service Code	CPT 86316
Hospital Charge Code	4086316
Hospital Revenue Code	300
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare	$84.60
Rate for Payer: BCBS MT CHIP	$84.60
Rate for Payer: BCBS MT Closed Plan Network	$89.30
Rate for Payer: BCBS MT HealthLink	$84.60
Rate for Payer: BCBS MT Medicare	$84.60
Rate for Payer: BCBS MT POS	$89.30
Rate for Payer: BCBS MT Traditional	$94.00
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cigna Commercial	$89.30
Rate for Payer: Cigna Medicare	$84.60
Rate for Payer: Medicaid All Medicaid	$86.48
Rate for Payer: Medicare All Medicare	$65.80
Rate for Payer: Monida Allegiance	$89.30
Rate for Payer: Monida First Choice Health	$91.18
Rate for Payer: Monida Montana Health Co-op	$89.30
Rate for Payer: Monida PacificSource	$89.30

LAB CHROMOSONE ROUTINE

Facility

$551.00

Service Code	CPT 88230
Hospital Charge Code	4088230
Hospital Revenue Code	301
Min. Negotiated Rate	$385.70
Max. Negotiated Rate	$551.00
Rate for Payer: Aetna Commercial	$523.45
Rate for Payer: Aetna Medicare	$495.90
Rate for Payer: BCBS MT CHIP	$495.90
Rate for Payer: BCBS MT Closed Plan Network	$523.45
Rate for Payer: BCBS MT HealthLink	$495.90
Rate for Payer: BCBS MT Medicare	$495.90
Rate for Payer: BCBS MT POS	$523.45
Rate for Payer: BCBS MT Traditional	$551.00
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cigna Commercial	$523.45
Rate for Payer: Cigna Medicare	$495.90
Rate for Payer: Medicaid All Medicaid	$506.92
Rate for Payer: Medicare All Medicare	$385.70
Rate for Payer: Monida Allegiance	$523.45
Rate for Payer: Monida First Choice Health	$534.47
Rate for Payer: Monida Montana Health Co-op	$523.45
Rate for Payer: Monida PacificSource	$523.45

LAB CHROMOSONE ROUTINE

Facility

$551.00

Service Code	CPT 88230
Hospital Charge Code	4088230
Hospital Revenue Code	301
Min. Negotiated Rate	$385.70
Max. Negotiated Rate	$551.00
Rate for Payer: Aetna Commercial	$523.45
Rate for Payer: Aetna Medicare	$495.90
Rate for Payer: BCBS MT CHIP	$495.90
Rate for Payer: BCBS MT Closed Plan Network	$523.45
Rate for Payer: BCBS MT HealthLink	$495.90
Rate for Payer: BCBS MT Medicare	$495.90
Rate for Payer: BCBS MT POS	$523.45
Rate for Payer: BCBS MT Traditional	$551.00
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cigna Commercial	$523.45
Rate for Payer: Cigna Medicare	$495.90
Rate for Payer: Medicaid All Medicaid	$506.92
Rate for Payer: Medicare All Medicare	$385.70
Rate for Payer: Monida Allegiance	$523.45
Rate for Payer: Monida First Choice Health	$534.47
Rate for Payer: Monida Montana Health Co-op	$523.45
Rate for Payer: Monida PacificSource	$523.45

LAB CITRATE

Facility

$135.00

Service Code	CPT 82507
Hospital Charge Code	4082507
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 CITRATE

Facility

$135.00

Service Code	CPT 82507
Hospital Charge Code	4082507
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 CK ISOENZYMES

Facility

$125.00

Service Code	CPT 82552
Hospital Charge Code	4082552
Hospital Revenue Code	301
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

Know your out-of-pocket cost for care.

All Charges