Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

BETA-HYDROXYBUTYRATE (503610)

Facility

$215.00

Service Code	CPT 82010
Hospital Charge Code	4082010
Hospital Revenue Code	300
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$204.25
Rate for Payer: Aetna Medicare	$193.50
Rate for Payer: BCBS MT CHIP	$193.50
Rate for Payer: BCBS MT Closed Plan Network	$204.25
Rate for Payer: BCBS MT HealthLink	$193.50
Rate for Payer: BCBS MT Medicare	$193.50
Rate for Payer: BCBS MT POS	$204.25
Rate for Payer: BCBS MT Traditional	$215.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cigna Commercial	$204.25
Rate for Payer: Cigna Medicare	$193.50
Rate for Payer: Medicaid All Medicaid	$197.80
Rate for Payer: Medicare All Medicare	$150.50
Rate for Payer: Monida Allegiance	$204.25
Rate for Payer: Monida First Choice Health	$208.55
Rate for Payer: Monida Montana Health Co-op	$204.25
Rate for Payer: Monida PacificSource	$204.25

BETAMETHASONE INJ [6 MG/ML] NF

Facility

$135.00

Service Code	HCPCS J0702
Hospital Charge Code	3000051
Hospital Revenue Code	259
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

BETAMETHASONE INJ [6 MG/ML] NF

Facility

$135.00

Service Code	HCPCS J0702
Hospital Charge Code	3000051
Hospital Revenue Code	259
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

BILE ACIDS TOTAL

Facility

$150.00

Service Code	CPT 82239
Hospital Charge Code	4087922
Hospital Revenue Code	300
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare	$135.00
Rate for Payer: BCBS MT CHIP	$135.00
Rate for Payer: BCBS MT Closed Plan Network	$142.50
Rate for Payer: BCBS MT HealthLink	$135.00
Rate for Payer: BCBS MT Medicare	$135.00
Rate for Payer: BCBS MT POS	$142.50
Rate for Payer: BCBS MT Traditional	$150.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: Cigna Medicare	$135.00
Rate for Payer: Medicaid All Medicaid	$138.00
Rate for Payer: Medicare All Medicare	$105.00
Rate for Payer: Monida Allegiance	$142.50
Rate for Payer: Monida First Choice Health	$145.50
Rate for Payer: Monida Montana Health Co-op	$142.50
Rate for Payer: Monida PacificSource	$142.50

BILE ACIDS TOTAL

Facility

$150.00

Service Code	CPT 82239
Hospital Charge Code	4087922
Hospital Revenue Code	300
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare	$135.00
Rate for Payer: BCBS MT CHIP	$135.00
Rate for Payer: BCBS MT Closed Plan Network	$142.50
Rate for Payer: BCBS MT HealthLink	$135.00
Rate for Payer: BCBS MT Medicare	$135.00
Rate for Payer: BCBS MT POS	$142.50
Rate for Payer: BCBS MT Traditional	$150.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial	$142.50
Rate for Payer: Cigna Medicare	$135.00
Rate for Payer: Medicaid All Medicaid	$138.00
Rate for Payer: Medicare All Medicare	$105.00
Rate for Payer: Monida Allegiance	$142.50
Rate for Payer: Monida First Choice Health	$145.50
Rate for Payer: Monida Montana Health Co-op	$142.50
Rate for Payer: Monida PacificSource	$142.50

BILIRUBIN, TOTAL

Facility

$61.00

Service Code	CPT 82247
Hospital Charge Code	4082247
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare	$54.90
Rate for Payer: BCBS MT CHIP	$54.90
Rate for Payer: BCBS MT Closed Plan Network	$57.95
Rate for Payer: BCBS MT HealthLink	$54.90
Rate for Payer: BCBS MT Medicare	$54.90
Rate for Payer: BCBS MT POS	$57.95
Rate for Payer: BCBS MT Traditional	$61.00
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: Cigna Medicare	$54.90
Rate for Payer: Medicaid All Medicaid	$56.12
Rate for Payer: Medicare All Medicare	$42.70
Rate for Payer: Monida Allegiance	$57.95
Rate for Payer: Monida First Choice Health	$59.17
Rate for Payer: Monida Montana Health Co-op	$57.95
Rate for Payer: Monida PacificSource	$57.95

BILIRUBIN, TOTAL

Facility

$61.00

Service Code	CPT 82247
Hospital Charge Code	4082247
Hospital Revenue Code	301
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$61.00
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare	$54.90
Rate for Payer: BCBS MT CHIP	$54.90
Rate for Payer: BCBS MT Closed Plan Network	$57.95
Rate for Payer: BCBS MT HealthLink	$54.90
Rate for Payer: BCBS MT Medicare	$54.90
Rate for Payer: BCBS MT POS	$57.95
Rate for Payer: BCBS MT Traditional	$61.00
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: Cigna Medicare	$54.90
Rate for Payer: Medicaid All Medicaid	$56.12
Rate for Payer: Medicare All Medicare	$42.70
Rate for Payer: Monida Allegiance	$57.95
Rate for Payer: Monida First Choice Health	$59.17
Rate for Payer: Monida Montana Health Co-op	$57.95
Rate for Payer: Monida PacificSource	$57.95

BIOFIRE GI PANEL RVMC

Facility

$1,029.00

Service Code	CPT 87507
Hospital Charge Code	4087895
Hospital Revenue Code	300
Min. Negotiated Rate	$720.30
Max. Negotiated Rate	$1,029.00
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare	$926.10
Rate for Payer: BCBS MT CHIP	$926.10
Rate for Payer: BCBS MT Closed Plan Network	$977.55
Rate for Payer: BCBS MT HealthLink	$926.10
Rate for Payer: BCBS MT Medicare	$926.10
Rate for Payer: BCBS MT POS	$977.55
Rate for Payer: BCBS MT Traditional	$1,029.00
Rate for Payer: Cash Price	$926.10
Rate for Payer: Cigna Commercial	$977.55
Rate for Payer: Cigna Medicare	$926.10
Rate for Payer: Medicaid All Medicaid	$946.68
Rate for Payer: Medicare All Medicare	$720.30
Rate for Payer: Monida Allegiance	$977.55
Rate for Payer: Monida First Choice Health	$998.13
Rate for Payer: Monida Montana Health Co-op	$977.55
Rate for Payer: Monida PacificSource	$977.55

BIOFIRE GI PANEL RVMC

Facility

$1,029.00

Service Code	CPT 87507
Hospital Charge Code	4087895
Hospital Revenue Code	300
Min. Negotiated Rate	$720.30
Max. Negotiated Rate	$1,029.00
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare	$926.10
Rate for Payer: BCBS MT CHIP	$926.10
Rate for Payer: BCBS MT Closed Plan Network	$977.55
Rate for Payer: BCBS MT HealthLink	$926.10
Rate for Payer: BCBS MT Medicare	$926.10
Rate for Payer: BCBS MT POS	$977.55
Rate for Payer: BCBS MT Traditional	$1,029.00
Rate for Payer: Cash Price	$926.10
Rate for Payer: Cigna Commercial	$977.55
Rate for Payer: Cigna Medicare	$926.10
Rate for Payer: Medicaid All Medicaid	$946.68
Rate for Payer: Medicare All Medicare	$720.30
Rate for Payer: Monida Allegiance	$977.55
Rate for Payer: Monida First Choice Health	$998.13
Rate for Payer: Monida Montana Health Co-op	$977.55
Rate for Payer: Monida PacificSource	$977.55

BIOPSY-INCISION SNGL LESION-11106

Facility

$187.00

Service Code	CPT 11106
Hospital Charge Code	8011100
Hospital Revenue Code	521
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

BIOPSY-INCISION SNGL LESION-11106

Facility

$187.00

Service Code	CPT 11106
Hospital Charge Code	8011100
Hospital Revenue Code	521
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

BIOPSY LIP

Facility

$356.00

Service Code	CPT 40490
Hospital Charge Code	8040490
Hospital Revenue Code	521
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$356.00
Rate for Payer: Aetna Commercial	$338.20
Rate for Payer: Aetna Medicare	$320.40
Rate for Payer: BCBS MT CHIP	$320.40
Rate for Payer: BCBS MT Closed Plan Network	$338.20
Rate for Payer: BCBS MT HealthLink	$320.40
Rate for Payer: BCBS MT Medicare	$320.40
Rate for Payer: BCBS MT POS	$338.20
Rate for Payer: BCBS MT Traditional	$356.00
Rate for Payer: Cash Price	$320.40
Rate for Payer: Cigna Commercial	$338.20
Rate for Payer: Cigna Medicare	$320.40
Rate for Payer: Medicaid All Medicaid	$327.52
Rate for Payer: Medicare All Medicare	$249.20
Rate for Payer: Monida Allegiance	$338.20
Rate for Payer: Monida First Choice Health	$345.32
Rate for Payer: Monida Montana Health Co-op	$338.20
Rate for Payer: Monida PacificSource	$338.20

BIOPSY LIP

Facility

$356.00

Service Code	CPT 40490
Hospital Charge Code	8040490
Hospital Revenue Code	521
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$356.00
Rate for Payer: Aetna Commercial	$338.20
Rate for Payer: Aetna Medicare	$320.40
Rate for Payer: BCBS MT CHIP	$320.40
Rate for Payer: BCBS MT Closed Plan Network	$338.20
Rate for Payer: BCBS MT HealthLink	$320.40
Rate for Payer: BCBS MT Medicare	$320.40
Rate for Payer: BCBS MT POS	$338.20
Rate for Payer: BCBS MT Traditional	$356.00
Rate for Payer: Cash Price	$320.40
Rate for Payer: Cigna Commercial	$338.20
Rate for Payer: Cigna Medicare	$320.40
Rate for Payer: Medicaid All Medicaid	$327.52
Rate for Payer: Medicare All Medicare	$249.20
Rate for Payer: Monida Allegiance	$338.20
Rate for Payer: Monida First Choice Health	$345.32
Rate for Payer: Monida Montana Health Co-op	$338.20
Rate for Payer: Monida PacificSource	$338.20

BIOPSY LYMPH NODE

Facility

$630.00

Service Code	CPT 38500
Hospital Charge Code	8038500
Hospital Revenue Code	521
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare	$567.00
Rate for Payer: BCBS MT CHIP	$567.00
Rate for Payer: BCBS MT Closed Plan Network	$598.50
Rate for Payer: BCBS MT HealthLink	$567.00
Rate for Payer: BCBS MT Medicare	$567.00
Rate for Payer: BCBS MT POS	$598.50
Rate for Payer: BCBS MT Traditional	$630.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cigna Commercial	$598.50
Rate for Payer: Cigna Medicare	$567.00
Rate for Payer: Medicaid All Medicaid	$579.60
Rate for Payer: Medicare All Medicare	$441.00
Rate for Payer: Monida Allegiance	$598.50
Rate for Payer: Monida First Choice Health	$611.10
Rate for Payer: Monida Montana Health Co-op	$598.50
Rate for Payer: Monida PacificSource	$598.50

BIOPSY LYMPH NODE

Facility

$630.00

Service Code	CPT 38500
Hospital Charge Code	8038500
Hospital Revenue Code	521
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare	$567.00
Rate for Payer: BCBS MT CHIP	$567.00
Rate for Payer: BCBS MT Closed Plan Network	$598.50
Rate for Payer: BCBS MT HealthLink	$567.00
Rate for Payer: BCBS MT Medicare	$567.00
Rate for Payer: BCBS MT POS	$598.50
Rate for Payer: BCBS MT Traditional	$630.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cigna Commercial	$598.50
Rate for Payer: Cigna Medicare	$567.00
Rate for Payer: Medicaid All Medicaid	$579.60
Rate for Payer: Medicare All Medicare	$441.00
Rate for Payer: Monida Allegiance	$598.50
Rate for Payer: Monida First Choice Health	$611.10
Rate for Payer: Monida Montana Health Co-op	$598.50
Rate for Payer: Monida PacificSource	$598.50

BIOPSY-PUNCH SINGLE LESION-11104

Facility

$208.00

Service Code	CPT 11104
Hospital Charge Code	8011104
Hospital Revenue Code	521
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare	$187.20
Rate for Payer: BCBS MT CHIP	$187.20
Rate for Payer: BCBS MT Closed Plan Network	$197.60
Rate for Payer: BCBS MT HealthLink	$187.20
Rate for Payer: BCBS MT Medicare	$187.20
Rate for Payer: BCBS MT POS	$197.60
Rate for Payer: BCBS MT Traditional	$208.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial	$197.60
Rate for Payer: Cigna Medicare	$187.20
Rate for Payer: Medicaid All Medicaid	$191.36
Rate for Payer: Medicare All Medicare	$145.60
Rate for Payer: Monida Allegiance	$197.60
Rate for Payer: Monida First Choice Health	$201.76
Rate for Payer: Monida Montana Health Co-op	$197.60
Rate for Payer: Monida PacificSource	$197.60

BIOPSY-PUNCH SINGLE LESION-11104

Facility

$208.00

Service Code	CPT 11104
Hospital Charge Code	8011104
Hospital Revenue Code	521
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$208.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare	$187.20
Rate for Payer: BCBS MT CHIP	$187.20
Rate for Payer: BCBS MT Closed Plan Network	$197.60
Rate for Payer: BCBS MT HealthLink	$187.20
Rate for Payer: BCBS MT Medicare	$187.20
Rate for Payer: BCBS MT POS	$197.60
Rate for Payer: BCBS MT Traditional	$208.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial	$197.60
Rate for Payer: Cigna Medicare	$187.20
Rate for Payer: Medicaid All Medicaid	$191.36
Rate for Payer: Medicare All Medicare	$145.60
Rate for Payer: Monida Allegiance	$197.60
Rate for Payer: Monida First Choice Health	$201.76
Rate for Payer: Monida Montana Health Co-op	$197.60
Rate for Payer: Monida PacificSource	$197.60

BIOPSY-SHAVE/SCOOP SNGL LESION-11102

Facility

$186.00

Service Code	CPT 11102
Hospital Charge Code	8011102
Hospital Revenue Code	521
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare	$167.40
Rate for Payer: BCBS MT CHIP	$167.40
Rate for Payer: BCBS MT Closed Plan Network	$176.70
Rate for Payer: BCBS MT HealthLink	$167.40
Rate for Payer: BCBS MT Medicare	$167.40
Rate for Payer: BCBS MT POS	$176.70
Rate for Payer: BCBS MT Traditional	$186.00
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cigna Commercial	$176.70
Rate for Payer: Cigna Medicare	$167.40
Rate for Payer: Medicaid All Medicaid	$171.12
Rate for Payer: Medicare All Medicare	$130.20
Rate for Payer: Monida Allegiance	$176.70
Rate for Payer: Monida First Choice Health	$180.42
Rate for Payer: Monida Montana Health Co-op	$176.70
Rate for Payer: Monida PacificSource	$176.70

BIOPSY-SHAVE/SCOOP SNGL LESION-11102

Facility

$186.00

Service Code	CPT 11102
Hospital Charge Code	8011102
Hospital Revenue Code	521
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare	$167.40
Rate for Payer: BCBS MT CHIP	$167.40
Rate for Payer: BCBS MT Closed Plan Network	$176.70
Rate for Payer: BCBS MT HealthLink	$167.40
Rate for Payer: BCBS MT Medicare	$167.40
Rate for Payer: BCBS MT POS	$176.70
Rate for Payer: BCBS MT Traditional	$186.00
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cigna Commercial	$176.70
Rate for Payer: Cigna Medicare	$167.40
Rate for Payer: Medicaid All Medicaid	$171.12
Rate for Payer: Medicare All Medicare	$130.20
Rate for Payer: Monida Allegiance	$176.70
Rate for Payer: Monida First Choice Health	$180.42
Rate for Payer: Monida Montana Health Co-op	$176.70
Rate for Payer: Monida PacificSource	$176.70

BIOPSY-SKIN SINGLE LESION- ER

Facility

$186.00

Service Code	CPT 11102
Hospital Charge Code	1011100
Hospital Revenue Code	450
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare	$167.40
Rate for Payer: BCBS MT CHIP	$167.40
Rate for Payer: BCBS MT Closed Plan Network	$176.70
Rate for Payer: BCBS MT HealthLink	$167.40
Rate for Payer: BCBS MT Medicare	$167.40
Rate for Payer: BCBS MT POS	$176.70
Rate for Payer: BCBS MT Traditional	$186.00
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cigna Commercial	$176.70
Rate for Payer: Cigna Medicare	$167.40
Rate for Payer: Medicaid All Medicaid	$171.12
Rate for Payer: Medicare All Medicare	$130.20
Rate for Payer: Monida Allegiance	$176.70
Rate for Payer: Monida First Choice Health	$180.42
Rate for Payer: Monida Montana Health Co-op	$176.70
Rate for Payer: Monida PacificSource	$176.70

BIOPSY-SKIN SINGLE LESION- ER

Facility

$186.00

Service Code	CPT 11102
Hospital Charge Code	1011100
Hospital Revenue Code	450
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare	$167.40
Rate for Payer: BCBS MT CHIP	$167.40
Rate for Payer: BCBS MT Closed Plan Network	$176.70
Rate for Payer: BCBS MT HealthLink	$167.40
Rate for Payer: BCBS MT Medicare	$167.40
Rate for Payer: BCBS MT POS	$176.70
Rate for Payer: BCBS MT Traditional	$186.00
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cigna Commercial	$176.70
Rate for Payer: Cigna Medicare	$167.40
Rate for Payer: Medicaid All Medicaid	$171.12
Rate for Payer: Medicare All Medicare	$130.20
Rate for Payer: Monida Allegiance	$176.70
Rate for Payer: Monida First Choice Health	$180.42
Rate for Payer: Monida Montana Health Co-op	$176.70
Rate for Payer: Monida PacificSource	$176.70

BIOPSY SUPERFICIAL FOREARM/WRIST

Facility

$648.00

Service Code	CPT 25065
Hospital Charge Code	8025065
Hospital Revenue Code	521
Min. Negotiated Rate	$453.60
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare	$583.20
Rate for Payer: BCBS MT CHIP	$583.20
Rate for Payer: BCBS MT Closed Plan Network	$615.60
Rate for Payer: BCBS MT HealthLink	$583.20
Rate for Payer: BCBS MT Medicare	$583.20
Rate for Payer: BCBS MT POS	$615.60
Rate for Payer: BCBS MT Traditional	$648.00
Rate for Payer: Cash Price	$583.20
Rate for Payer: Cigna Commercial	$615.60
Rate for Payer: Cigna Medicare	$583.20
Rate for Payer: Medicaid All Medicaid	$596.16
Rate for Payer: Medicare All Medicare	$453.60
Rate for Payer: Monida Allegiance	$615.60
Rate for Payer: Monida First Choice Health	$628.56
Rate for Payer: Monida Montana Health Co-op	$615.60
Rate for Payer: Monida PacificSource	$615.60

BIOPSY SUPERFICIAL FOREARM/WRIST

Facility

$648.00

Service Code	CPT 25065
Hospital Charge Code	8025065
Hospital Revenue Code	521
Min. Negotiated Rate	$453.60
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare	$583.20
Rate for Payer: BCBS MT CHIP	$583.20
Rate for Payer: BCBS MT Closed Plan Network	$615.60
Rate for Payer: BCBS MT HealthLink	$583.20
Rate for Payer: BCBS MT Medicare	$583.20
Rate for Payer: BCBS MT POS	$615.60
Rate for Payer: BCBS MT Traditional	$648.00
Rate for Payer: Cash Price	$583.20
Rate for Payer: Cigna Commercial	$615.60
Rate for Payer: Cigna Medicare	$583.20
Rate for Payer: Medicaid All Medicaid	$596.16
Rate for Payer: Medicare All Medicare	$453.60
Rate for Payer: Monida Allegiance	$615.60
Rate for Payer: Monida First Choice Health	$628.56
Rate for Payer: Monida Montana Health Co-op	$615.60
Rate for Payer: Monida PacificSource	$615.60

BIOPSY VULVA OR PERI-EA ADD LESION 56606

Facility

$254.00

Service Code	CPT 56606
Hospital Charge Code	8056606
Hospital Revenue Code	521
Min. Negotiated Rate	$177.80
Max. Negotiated Rate	$254.00
Rate for Payer: Aetna Commercial	$241.30
Rate for Payer: Aetna Medicare	$228.60
Rate for Payer: BCBS MT CHIP	$228.60
Rate for Payer: BCBS MT Closed Plan Network	$241.30
Rate for Payer: BCBS MT HealthLink	$228.60
Rate for Payer: BCBS MT Medicare	$228.60
Rate for Payer: BCBS MT POS	$241.30
Rate for Payer: BCBS MT Traditional	$254.00
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cigna Commercial	$241.30
Rate for Payer: Cigna Medicare	$228.60
Rate for Payer: Medicaid All Medicaid	$233.68
Rate for Payer: Medicare All Medicare	$177.80
Rate for Payer: Monida Allegiance	$241.30
Rate for Payer: Monida First Choice Health	$246.38
Rate for Payer: Monida Montana Health Co-op	$241.30
Rate for Payer: Monida PacificSource	$241.30

BIOPSY VULVA OR PERI-EA ADD LESION 56606

Facility

$254.00

Service Code	CPT 56606
Hospital Charge Code	8056606
Hospital Revenue Code	521
Min. Negotiated Rate	$177.80
Max. Negotiated Rate	$254.00
Rate for Payer: Aetna Commercial	$241.30
Rate for Payer: Aetna Medicare	$228.60
Rate for Payer: BCBS MT CHIP	$228.60
Rate for Payer: BCBS MT Closed Plan Network	$241.30
Rate for Payer: BCBS MT HealthLink	$228.60
Rate for Payer: BCBS MT Medicare	$228.60
Rate for Payer: BCBS MT POS	$241.30
Rate for Payer: BCBS MT Traditional	$254.00
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cigna Commercial	$241.30
Rate for Payer: Cigna Medicare	$228.60
Rate for Payer: Medicaid All Medicaid	$233.68
Rate for Payer: Medicare All Medicare	$177.80
Rate for Payer: Monida Allegiance	$241.30
Rate for Payer: Monida First Choice Health	$246.38
Rate for Payer: Monida Montana Health Co-op	$241.30
Rate for Payer: Monida PacificSource	$241.30

Know your out-of-pocket cost for care.

All Charges