Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

PAIN SEVERITY QUANTIFIED; NO PAIN PRESEN

Facility

$0.01

Service Code	CPT 1126F
Hospital Charge Code	8001126
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: BCBS MT CHIP	$0.01
Rate for Payer: BCBS MT Closed Plan Network	$0.01
Rate for Payer: BCBS MT HealthLink	$0.01
Rate for Payer: BCBS MT Medicare	$0.01
Rate for Payer: BCBS MT POS	$0.01
Rate for Payer: BCBS MT Traditional	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: Cigna Medicare	$0.01
Rate for Payer: Medicaid All Medicaid	$0.01
Rate for Payer: Medicare All Medicare	$0.01
Rate for Payer: Monida Allegiance	$0.01
Rate for Payer: Monida First Choice Health	$0.01
Rate for Payer: Monida Montana Health Co-op	$0.01
Rate for Payer: Monida PacificSource	$0.01

PAIN SEVERITY QUANTIFIED; PAIN PRESENT

Facility

$0.01

Service Code	CPT 1125F
Hospital Charge Code	8001125
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: BCBS MT CHIP	$0.01
Rate for Payer: BCBS MT Closed Plan Network	$0.01
Rate for Payer: BCBS MT HealthLink	$0.01
Rate for Payer: BCBS MT Medicare	$0.01
Rate for Payer: BCBS MT POS	$0.01
Rate for Payer: BCBS MT Traditional	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: Cigna Medicare	$0.01
Rate for Payer: Medicaid All Medicaid	$0.01
Rate for Payer: Medicare All Medicare	$0.01
Rate for Payer: Monida Allegiance	$0.01
Rate for Payer: Monida First Choice Health	$0.01
Rate for Payer: Monida Montana Health Co-op	$0.01
Rate for Payer: Monida PacificSource	$0.01

PAIN SEVERITY QUANTIFIED; PAIN PRESENT

Facility

$0.01

Service Code	CPT 1125F
Hospital Charge Code	8001125
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: BCBS MT CHIP	$0.01
Rate for Payer: BCBS MT Closed Plan Network	$0.01
Rate for Payer: BCBS MT HealthLink	$0.01
Rate for Payer: BCBS MT Medicare	$0.01
Rate for Payer: BCBS MT POS	$0.01
Rate for Payer: BCBS MT Traditional	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: Cigna Medicare	$0.01
Rate for Payer: Medicaid All Medicaid	$0.01
Rate for Payer: Medicare All Medicare	$0.01
Rate for Payer: Monida Allegiance	$0.01
Rate for Payer: Monida First Choice Health	$0.01
Rate for Payer: Monida Montana Health Co-op	$0.01
Rate for Payer: Monida PacificSource	$0.01

PANCREATIC ELASTASE

Facility

$242.00

Service Code	CPT 83520
Hospital Charge Code	4088034
Hospital Revenue Code	302
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare	$217.80
Rate for Payer: BCBS MT CHIP	$217.80
Rate for Payer: BCBS MT Closed Plan Network	$229.90
Rate for Payer: BCBS MT HealthLink	$217.80
Rate for Payer: BCBS MT Medicare	$217.80
Rate for Payer: BCBS MT POS	$229.90
Rate for Payer: BCBS MT Traditional	$242.00
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial	$229.90
Rate for Payer: Cigna Medicare	$217.80
Rate for Payer: Medicaid All Medicaid	$222.64
Rate for Payer: Medicare All Medicare	$169.40
Rate for Payer: Monida Allegiance	$229.90
Rate for Payer: Monida First Choice Health	$234.74
Rate for Payer: Monida Montana Health Co-op	$229.90
Rate for Payer: Monida PacificSource	$229.90

PANCREATIC ELASTASE

Facility

$242.00

Service Code	CPT 83520
Hospital Charge Code	4088034
Hospital Revenue Code	302
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare	$217.80
Rate for Payer: BCBS MT CHIP	$217.80
Rate for Payer: BCBS MT Closed Plan Network	$229.90
Rate for Payer: BCBS MT HealthLink	$217.80
Rate for Payer: BCBS MT Medicare	$217.80
Rate for Payer: BCBS MT POS	$229.90
Rate for Payer: BCBS MT Traditional	$242.00
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial	$229.90
Rate for Payer: Cigna Medicare	$217.80
Rate for Payer: Medicaid All Medicaid	$222.64
Rate for Payer: Medicare All Medicare	$169.40
Rate for Payer: Monida Allegiance	$229.90
Rate for Payer: Monida First Choice Health	$234.74
Rate for Payer: Monida Montana Health Co-op	$229.90
Rate for Payer: Monida PacificSource	$229.90

PANCREATIC ELASTASE1

Facility

$242.00

Service Code	CPT 83520
Hospital Charge Code	4088035
Hospital Revenue Code	300
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare	$217.80
Rate for Payer: BCBS MT CHIP	$217.80
Rate for Payer: BCBS MT Closed Plan Network	$229.90
Rate for Payer: BCBS MT HealthLink	$217.80
Rate for Payer: BCBS MT Medicare	$217.80
Rate for Payer: BCBS MT POS	$229.90
Rate for Payer: BCBS MT Traditional	$242.00
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial	$229.90
Rate for Payer: Cigna Medicare	$217.80
Rate for Payer: Medicaid All Medicaid	$222.64
Rate for Payer: Medicare All Medicare	$169.40
Rate for Payer: Monida Allegiance	$229.90
Rate for Payer: Monida First Choice Health	$234.74
Rate for Payer: Monida Montana Health Co-op	$229.90
Rate for Payer: Monida PacificSource	$229.90

PANCREATIC ELASTASE1

Facility

$242.00

Service Code	CPT 83520
Hospital Charge Code	4088035
Hospital Revenue Code	300
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare	$217.80
Rate for Payer: BCBS MT CHIP	$217.80
Rate for Payer: BCBS MT Closed Plan Network	$229.90
Rate for Payer: BCBS MT HealthLink	$217.80
Rate for Payer: BCBS MT Medicare	$217.80
Rate for Payer: BCBS MT POS	$229.90
Rate for Payer: BCBS MT Traditional	$242.00
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial	$229.90
Rate for Payer: Cigna Medicare	$217.80
Rate for Payer: Medicaid All Medicaid	$222.64
Rate for Payer: Medicare All Medicare	$169.40
Rate for Payer: Monida Allegiance	$229.90
Rate for Payer: Monida First Choice Health	$234.74
Rate for Payer: Monida Montana Health Co-op	$229.90
Rate for Payer: Monida PacificSource	$229.90

PANCREATIC ELASTASE, STOOL (123234)

Facility

$242.00

Service Code	CPT 82653
Hospital Charge Code	4082656
Hospital Revenue Code	301
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare	$217.80
Rate for Payer: BCBS MT CHIP	$217.80
Rate for Payer: BCBS MT Closed Plan Network	$229.90
Rate for Payer: BCBS MT HealthLink	$217.80
Rate for Payer: BCBS MT Medicare	$217.80
Rate for Payer: BCBS MT POS	$229.90
Rate for Payer: BCBS MT Traditional	$242.00
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial	$229.90
Rate for Payer: Cigna Medicare	$217.80
Rate for Payer: Medicaid All Medicaid	$222.64
Rate for Payer: Medicare All Medicare	$169.40
Rate for Payer: Monida Allegiance	$229.90
Rate for Payer: Monida First Choice Health	$234.74
Rate for Payer: Monida Montana Health Co-op	$229.90
Rate for Payer: Monida PacificSource	$229.90

PANCREATIC ELASTASE, STOOL (123234)

Facility

$242.00

Service Code	CPT 82653
Hospital Charge Code	4082656
Hospital Revenue Code	301
Min. Negotiated Rate	$169.40
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare	$217.80
Rate for Payer: BCBS MT CHIP	$217.80
Rate for Payer: BCBS MT Closed Plan Network	$229.90
Rate for Payer: BCBS MT HealthLink	$217.80
Rate for Payer: BCBS MT Medicare	$217.80
Rate for Payer: BCBS MT POS	$229.90
Rate for Payer: BCBS MT Traditional	$242.00
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial	$229.90
Rate for Payer: Cigna Medicare	$217.80
Rate for Payer: Medicaid All Medicaid	$222.64
Rate for Payer: Medicare All Medicare	$169.40
Rate for Payer: Monida Allegiance	$229.90
Rate for Payer: Monida First Choice Health	$234.74
Rate for Payer: Monida Montana Health Co-op	$229.90
Rate for Payer: Monida PacificSource	$229.90

PANCREAZE DR CAP [4200 UN] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3007723
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

PANCREAZE DR CAP [4200 UN] NF

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3007723
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

PANTOPRAZOLE INJ [40MG]

Facility

$20.00

Service Code	HCPCS J2470
Hospital Charge Code	3000376
Hospital Revenue Code	259
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS MT CHIP	$18.00
Rate for Payer: BCBS MT Closed Plan Network	$19.00
Rate for Payer: BCBS MT HealthLink	$18.00
Rate for Payer: BCBS MT Medicare	$18.00
Rate for Payer: BCBS MT POS	$19.00
Rate for Payer: BCBS MT Traditional	$20.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: Cigna Medicare	$18.00
Rate for Payer: Medicaid All Medicaid	$18.40
Rate for Payer: Medicare All Medicare	$14.00
Rate for Payer: Monida Allegiance	$19.00
Rate for Payer: Monida First Choice Health	$19.40
Rate for Payer: Monida Montana Health Co-op	$19.00
Rate for Payer: Monida PacificSource	$19.00

PANTOPRAZOLE INJ [40MG]

Facility

$20.00

Service Code	HCPCS J2470
Hospital Charge Code	3000376
Hospital Revenue Code	259
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS MT CHIP	$18.00
Rate for Payer: BCBS MT Closed Plan Network	$19.00
Rate for Payer: BCBS MT HealthLink	$18.00
Rate for Payer: BCBS MT Medicare	$18.00
Rate for Payer: BCBS MT POS	$19.00
Rate for Payer: BCBS MT Traditional	$20.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: Cigna Medicare	$18.00
Rate for Payer: Medicaid All Medicaid	$18.40
Rate for Payer: Medicare All Medicare	$14.00
Rate for Payer: Monida Allegiance	$19.00
Rate for Payer: Monida First Choice Health	$19.40
Rate for Payer: Monida Montana Health Co-op	$19.00
Rate for Payer: Monida PacificSource	$19.00

PANTOPRAZOLE TAB [40 MG]

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000377
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

PANTOPRAZOLE TAB [40 MG]

Facility

$8.00

Service Code	HCPCS J8499
Hospital Charge Code	3000377
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare	$7.20
Rate for Payer: BCBS MT CHIP	$7.20
Rate for Payer: BCBS MT Closed Plan Network	$7.60
Rate for Payer: BCBS MT HealthLink	$7.20
Rate for Payer: BCBS MT Medicare	$7.20
Rate for Payer: BCBS MT POS	$7.60
Rate for Payer: BCBS MT Traditional	$8.00
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial	$7.60
Rate for Payer: Cigna Medicare	$7.20
Rate for Payer: Medicaid All Medicaid	$7.36
Rate for Payer: Medicare All Medicare	$5.60
Rate for Payer: Monida Allegiance	$7.60
Rate for Payer: Monida First Choice Health	$7.76
Rate for Payer: Monida Montana Health Co-op	$7.60
Rate for Payer: Monida PacificSource	$7.60

PAP SMEAR AUTO SCREEN(W/MAN REV) 88175

Facility

$99.00

Service Code	CPT 88175
Hospital Charge Code	4088175
Hospital Revenue Code	310
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

PAP SMEAR AUTO SCREEN(W/MAN REV) 88175

Facility

$99.00

Service Code	CPT 88175
Hospital Charge Code	4088175
Hospital Revenue Code	310
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

PAP SMEAR AUTO SCREEN(W/MANUAL REVIEW)

Facility

$99.00

Service Code	CPT 88175
Hospital Charge Code	8088175
Hospital Revenue Code	521
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

PAP SMEAR AUTO SCREEN(W/MANUAL REVIEW)

Facility

$99.00

Service Code	CPT 88175
Hospital Charge Code	8088175
Hospital Revenue Code	521
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

PARATHYROID HORMONE, INTACT (015610)

Facility

$110.00

Service Code	CPT 83970
Hospital Charge Code	4083970
Hospital Revenue Code	301
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare	$99.00
Rate for Payer: BCBS MT CHIP	$99.00
Rate for Payer: BCBS MT Closed Plan Network	$104.50
Rate for Payer: BCBS MT HealthLink	$99.00
Rate for Payer: BCBS MT Medicare	$99.00
Rate for Payer: BCBS MT POS	$104.50
Rate for Payer: BCBS MT Traditional	$110.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial	$104.50
Rate for Payer: Cigna Medicare	$99.00
Rate for Payer: Medicaid All Medicaid	$101.20
Rate for Payer: Medicare All Medicare	$77.00
Rate for Payer: Monida Allegiance	$104.50
Rate for Payer: Monida First Choice Health	$106.70
Rate for Payer: Monida Montana Health Co-op	$104.50
Rate for Payer: Monida PacificSource	$104.50

PARATHYROID HORMONE, INTACT (015610)

Facility

$110.00

Service Code	CPT 83970
Hospital Charge Code	4083970
Hospital Revenue Code	301
Min. Negotiated Rate	$77.00
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare	$99.00
Rate for Payer: BCBS MT CHIP	$99.00
Rate for Payer: BCBS MT Closed Plan Network	$104.50
Rate for Payer: BCBS MT HealthLink	$99.00
Rate for Payer: BCBS MT Medicare	$99.00
Rate for Payer: BCBS MT POS	$104.50
Rate for Payer: BCBS MT Traditional	$110.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial	$104.50
Rate for Payer: Cigna Medicare	$99.00
Rate for Payer: Medicaid All Medicaid	$101.20
Rate for Payer: Medicare All Medicare	$77.00
Rate for Payer: Monida Allegiance	$104.50
Rate for Payer: Monida First Choice Health	$106.70
Rate for Payer: Monida Montana Health Co-op	$104.50
Rate for Payer: Monida PacificSource	$104.50

PARATHYROID HORM RELAT PEPTIDE(2010677)

Facility

$155.00

Service Code	CPT 82542
Hospital Charge Code	4088146
Hospital Revenue Code	302
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$147.25
Rate for Payer: Aetna Medicare	$139.50
Rate for Payer: BCBS MT CHIP	$139.50
Rate for Payer: BCBS MT Closed Plan Network	$147.25
Rate for Payer: BCBS MT HealthLink	$139.50
Rate for Payer: BCBS MT Medicare	$139.50
Rate for Payer: BCBS MT POS	$147.25
Rate for Payer: BCBS MT Traditional	$155.00
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial	$147.25
Rate for Payer: Cigna Medicare	$139.50
Rate for Payer: Medicaid All Medicaid	$142.60
Rate for Payer: Medicare All Medicare	$108.50
Rate for Payer: Monida Allegiance	$147.25
Rate for Payer: Monida First Choice Health	$150.35
Rate for Payer: Monida Montana Health Co-op	$147.25
Rate for Payer: Monida PacificSource	$147.25

PARATHYROID HORM RELAT PEPTIDE(2010677)

Facility

$155.00

Service Code	CPT 82542
Hospital Charge Code	4088146
Hospital Revenue Code	302
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$147.25
Rate for Payer: Aetna Medicare	$139.50
Rate for Payer: BCBS MT CHIP	$139.50
Rate for Payer: BCBS MT Closed Plan Network	$147.25
Rate for Payer: BCBS MT HealthLink	$139.50
Rate for Payer: BCBS MT Medicare	$139.50
Rate for Payer: BCBS MT POS	$147.25
Rate for Payer: BCBS MT Traditional	$155.00
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial	$147.25
Rate for Payer: Cigna Medicare	$139.50
Rate for Payer: Medicaid All Medicaid	$142.60
Rate for Payer: Medicare All Medicare	$108.50
Rate for Payer: Monida Allegiance	$147.25
Rate for Payer: Monida First Choice Health	$150.35
Rate for Payer: Monida Montana Health Co-op	$147.25
Rate for Payer: Monida PacificSource	$147.25

PARIETAL CELL ANTIBODIES

Facility

$92.00

Service Code	CPT 83516
Hospital Charge Code	4087992
Hospital Revenue Code	302
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare	$82.80
Rate for Payer: BCBS MT CHIP	$82.80
Rate for Payer: BCBS MT Closed Plan Network	$87.40
Rate for Payer: BCBS MT HealthLink	$82.80
Rate for Payer: BCBS MT Medicare	$82.80
Rate for Payer: BCBS MT POS	$87.40
Rate for Payer: BCBS MT Traditional	$92.00
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial	$87.40
Rate for Payer: Cigna Medicare	$82.80
Rate for Payer: Medicaid All Medicaid	$84.64
Rate for Payer: Medicare All Medicare	$64.40
Rate for Payer: Monida Allegiance	$87.40
Rate for Payer: Monida First Choice Health	$89.24
Rate for Payer: Monida Montana Health Co-op	$87.40
Rate for Payer: Monida PacificSource	$87.40

PARIETAL CELL ANTIBODIES

Facility

$92.00

Service Code	CPT 83516
Hospital Charge Code	4087992
Hospital Revenue Code	302
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare	$82.80
Rate for Payer: BCBS MT CHIP	$82.80
Rate for Payer: BCBS MT Closed Plan Network	$87.40
Rate for Payer: BCBS MT HealthLink	$82.80
Rate for Payer: BCBS MT Medicare	$82.80
Rate for Payer: BCBS MT POS	$87.40
Rate for Payer: BCBS MT Traditional	$92.00
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial	$87.40
Rate for Payer: Cigna Medicare	$82.80
Rate for Payer: Medicaid All Medicaid	$84.64
Rate for Payer: Medicare All Medicare	$64.40
Rate for Payer: Monida Allegiance	$87.40
Rate for Payer: Monida First Choice Health	$89.24
Rate for Payer: Monida Montana Health Co-op	$87.40
Rate for Payer: Monida PacificSource	$87.40

Know your out-of-pocket cost for care.

All Charges