Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

CORTISOL, FREE, 24 HOUR URINE (004432)

Facility

$85.00

Service Code	CPT 82530
Hospital Charge Code	4082530
Hospital Revenue Code	300
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$80.75
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS MT CHIP	$76.50
Rate for Payer: BCBS MT Closed Plan Network	$80.75
Rate for Payer: BCBS MT HealthLink	$76.50
Rate for Payer: BCBS MT Medicare	$76.50
Rate for Payer: BCBS MT POS	$80.75
Rate for Payer: BCBS MT Traditional	$85.00
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cigna Commercial	$80.75
Rate for Payer: Cigna Medicare	$76.50
Rate for Payer: Medicaid All Medicaid	$78.20
Rate for Payer: Medicare All Medicare	$59.50
Rate for Payer: Monida Allegiance	$80.75
Rate for Payer: Monida First Choice Health	$82.45
Rate for Payer: Monida Montana Health Co-op	$80.75
Rate for Payer: Monida PacificSource	$80.75

CORTISOL, FREE, 24 HOUR URINE (004432)

Facility

$85.00

Service Code	CPT 82530
Hospital Charge Code	4082530
Hospital Revenue Code	300
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$80.75
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS MT CHIP	$76.50
Rate for Payer: BCBS MT Closed Plan Network	$80.75
Rate for Payer: BCBS MT HealthLink	$76.50
Rate for Payer: BCBS MT Medicare	$76.50
Rate for Payer: BCBS MT POS	$80.75
Rate for Payer: BCBS MT Traditional	$85.00
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cigna Commercial	$80.75
Rate for Payer: Cigna Medicare	$76.50
Rate for Payer: Medicaid All Medicaid	$78.20
Rate for Payer: Medicare All Medicare	$59.50
Rate for Payer: Monida Allegiance	$80.75
Rate for Payer: Monida First Choice Health	$82.45
Rate for Payer: Monida Montana Health Co-op	$80.75
Rate for Payer: Monida PacificSource	$80.75

CORTISOL, SALIVA (500179)

Facility

$121.00

Service Code	CPT 82533
Hospital Charge Code	4000053
Hospital Revenue Code	301
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$114.95
Rate for Payer: Aetna Medicare	$108.90
Rate for Payer: BCBS MT CHIP	$108.90
Rate for Payer: BCBS MT Closed Plan Network	$114.95
Rate for Payer: BCBS MT HealthLink	$108.90
Rate for Payer: BCBS MT Medicare	$108.90
Rate for Payer: BCBS MT POS	$114.95
Rate for Payer: BCBS MT Traditional	$121.00
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial	$114.95
Rate for Payer: Cigna Medicare	$108.90
Rate for Payer: Medicaid All Medicaid	$111.32
Rate for Payer: Medicare All Medicare	$84.70
Rate for Payer: Monida Allegiance	$114.95
Rate for Payer: Monida First Choice Health	$117.37
Rate for Payer: Monida Montana Health Co-op	$114.95
Rate for Payer: Monida PacificSource	$114.95

CORTISOL, SALIVA (500179)

Facility

$121.00

Service Code	CPT 82533
Hospital Charge Code	4000053
Hospital Revenue Code	301
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$114.95
Rate for Payer: Aetna Medicare	$108.90
Rate for Payer: BCBS MT CHIP	$108.90
Rate for Payer: BCBS MT Closed Plan Network	$114.95
Rate for Payer: BCBS MT HealthLink	$108.90
Rate for Payer: BCBS MT Medicare	$108.90
Rate for Payer: BCBS MT POS	$114.95
Rate for Payer: BCBS MT Traditional	$121.00
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial	$114.95
Rate for Payer: Cigna Medicare	$108.90
Rate for Payer: Medicaid All Medicaid	$111.32
Rate for Payer: Medicare All Medicare	$84.70
Rate for Payer: Monida Allegiance	$114.95
Rate for Payer: Monida First Choice Health	$117.37
Rate for Payer: Monida Montana Health Co-op	$114.95
Rate for Payer: Monida PacificSource	$114.95

COVID-19 ADMIN 1ST DOSE MODERNA

Facility

$51.00

Service Code	CPT 0011A
Hospital Charge Code	8040011
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN 1ST DOSE MODERNA

Facility

$51.00

Service Code	CPT 0011A
Hospital Charge Code	8040011
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN 2ND DOSE MODERNA

Facility

$51.00

Service Code	CPT 0012A
Hospital Charge Code	8050012
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN 2ND DOSE MODERNA

Facility

$51.00

Service Code	CPT 0012A
Hospital Charge Code	8050012
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN 3RD DOSE MODERNA

Facility

$51.00

Service Code	CPT 0013A
Hospital Charge Code	8060011
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN 3RD DOSE MODERNA

Facility

$51.00

Service Code	CPT 0013A
Hospital Charge Code	8060011
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN JANSSEN SINGLE DOSE

Facility

$51.00

Service Code	CPT 0031A
Hospital Charge Code	8040031
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN JANSSEN SINGLE DOSE

Facility

$51.00

Service Code	CPT 0031A
Hospital Charge Code	8040031
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN MODERNA BOOSTER

Facility

$51.00

Service Code	CPT 0134A
Hospital Charge Code	8070012
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 ADMIN MODERNA BOOSTER

Facility

$51.00

Service Code	CPT 0134A
Hospital Charge Code	8070012
Hospital Revenue Code	521
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$48.45
Rate for Payer: Aetna Medicare	$45.90
Rate for Payer: BCBS MT CHIP	$45.90
Rate for Payer: BCBS MT Closed Plan Network	$48.45
Rate for Payer: BCBS MT HealthLink	$45.90
Rate for Payer: BCBS MT Medicare	$45.90
Rate for Payer: BCBS MT POS	$48.45
Rate for Payer: BCBS MT Traditional	$51.00
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cigna Commercial	$48.45
Rate for Payer: Cigna Medicare	$45.90
Rate for Payer: Medicaid All Medicaid	$46.92
Rate for Payer: Medicare All Medicare	$35.70
Rate for Payer: Monida Allegiance	$48.45
Rate for Payer: Monida First Choice Health	$49.47
Rate for Payer: Monida Montana Health Co-op	$48.45
Rate for Payer: Monida PacificSource	$48.45

COVID-19 INJ ADMIN PFIZER COVID

Facility

$73.00

Service Code	CPT 90480
Hospital Charge Code	8070124
Hospital Revenue Code	521
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$69.35
Rate for Payer: Aetna Medicare	$65.70
Rate for Payer: BCBS MT CHIP	$65.70
Rate for Payer: BCBS MT Closed Plan Network	$69.35
Rate for Payer: BCBS MT HealthLink	$65.70
Rate for Payer: BCBS MT Medicare	$65.70
Rate for Payer: BCBS MT POS	$69.35
Rate for Payer: BCBS MT Traditional	$73.00
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: Cigna Medicare	$65.70
Rate for Payer: Medicaid All Medicaid	$67.16
Rate for Payer: Medicare All Medicare	$51.10
Rate for Payer: Monida Allegiance	$69.35
Rate for Payer: Monida First Choice Health	$70.81
Rate for Payer: Monida Montana Health Co-op	$69.35
Rate for Payer: Monida PacificSource	$69.35

COVID-19 INJ ADMIN PFIZER COVID

Facility

$73.00

Service Code	CPT 90480
Hospital Charge Code	8070124
Hospital Revenue Code	521
Min. Negotiated Rate	$51.10
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$69.35
Rate for Payer: Aetna Medicare	$65.70
Rate for Payer: BCBS MT CHIP	$65.70
Rate for Payer: BCBS MT Closed Plan Network	$69.35
Rate for Payer: BCBS MT HealthLink	$65.70
Rate for Payer: BCBS MT Medicare	$65.70
Rate for Payer: BCBS MT POS	$69.35
Rate for Payer: BCBS MT Traditional	$73.00
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cigna Commercial	$69.35
Rate for Payer: Cigna Medicare	$65.70
Rate for Payer: Medicaid All Medicaid	$67.16
Rate for Payer: Medicare All Medicare	$51.10
Rate for Payer: Monida Allegiance	$69.35
Rate for Payer: Monida First Choice Health	$70.81
Rate for Payer: Monida Montana Health Co-op	$69.35
Rate for Payer: Monida PacificSource	$69.35

COVID-19 PFIZER

Facility

$449.00

Service Code	HCPCS M0201
Hospital Charge Code	3000510
Hospital Revenue Code	636
Min. Negotiated Rate	$314.30
Max. Negotiated Rate	$449.00
Rate for Payer: Aetna Commercial	$426.55
Rate for Payer: Aetna Medicare	$404.10
Rate for Payer: BCBS MT CHIP	$404.10
Rate for Payer: BCBS MT Closed Plan Network	$426.55
Rate for Payer: BCBS MT HealthLink	$404.10
Rate for Payer: BCBS MT Medicare	$404.10
Rate for Payer: BCBS MT POS	$426.55
Rate for Payer: BCBS MT Traditional	$449.00
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cigna Commercial	$426.55
Rate for Payer: Cigna Medicare	$404.10
Rate for Payer: Medicaid All Medicaid	$413.08
Rate for Payer: Medicare All Medicare	$314.30
Rate for Payer: Monida Allegiance	$426.55
Rate for Payer: Monida First Choice Health	$435.53
Rate for Payer: Monida Montana Health Co-op	$426.55
Rate for Payer: Monida PacificSource	$426.55

COVID-19 PFIZER

Facility

$449.00

Service Code	HCPCS M0201
Hospital Charge Code	3000510
Hospital Revenue Code	636
Min. Negotiated Rate	$314.30
Max. Negotiated Rate	$449.00
Rate for Payer: Aetna Commercial	$426.55
Rate for Payer: Aetna Medicare	$404.10
Rate for Payer: BCBS MT CHIP	$404.10
Rate for Payer: BCBS MT Closed Plan Network	$426.55
Rate for Payer: BCBS MT HealthLink	$404.10
Rate for Payer: BCBS MT Medicare	$404.10
Rate for Payer: BCBS MT POS	$426.55
Rate for Payer: BCBS MT Traditional	$449.00
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cigna Commercial	$426.55
Rate for Payer: Cigna Medicare	$404.10
Rate for Payer: Medicaid All Medicaid	$413.08
Rate for Payer: Medicare All Medicare	$314.30
Rate for Payer: Monida Allegiance	$426.55
Rate for Payer: Monida First Choice Health	$435.53
Rate for Payer: Monida Montana Health Co-op	$426.55
Rate for Payer: Monida PacificSource	$426.55

C-PEPTIDE (010108)

Facility

$37.00

Service Code	CPT 84681
Hospital Charge Code	4084681
Hospital Revenue Code	301
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: BCBS MT CHIP	$33.30
Rate for Payer: BCBS MT Closed Plan Network	$35.15
Rate for Payer: BCBS MT HealthLink	$33.30
Rate for Payer: BCBS MT Medicare	$33.30
Rate for Payer: BCBS MT POS	$35.15
Rate for Payer: BCBS MT Traditional	$37.00
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial	$35.15
Rate for Payer: Cigna Medicare	$33.30
Rate for Payer: Medicaid All Medicaid	$34.04
Rate for Payer: Medicare All Medicare	$25.90
Rate for Payer: Monida Allegiance	$35.15
Rate for Payer: Monida First Choice Health	$35.89
Rate for Payer: Monida Montana Health Co-op	$35.15
Rate for Payer: Monida PacificSource	$35.15

C-PEPTIDE (010108)

Facility

$37.00

Service Code	CPT 84681
Hospital Charge Code	4084681
Hospital Revenue Code	301
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$35.15
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: BCBS MT CHIP	$33.30
Rate for Payer: BCBS MT Closed Plan Network	$35.15
Rate for Payer: BCBS MT HealthLink	$33.30
Rate for Payer: BCBS MT Medicare	$33.30
Rate for Payer: BCBS MT POS	$35.15
Rate for Payer: BCBS MT Traditional	$37.00
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial	$35.15
Rate for Payer: Cigna Medicare	$33.30
Rate for Payer: Medicaid All Medicaid	$34.04
Rate for Payer: Medicare All Medicare	$25.90
Rate for Payer: Monida Allegiance	$35.15
Rate for Payer: Monida First Choice Health	$35.89
Rate for Payer: Monida Montana Health Co-op	$35.15
Rate for Payer: Monida PacificSource	$35.15

C-REACTIVE PROTEIN

Facility

$91.00

Service Code	CPT 86140
Hospital Charge Code	4086140
Hospital Revenue Code	300
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: BCBS MT CHIP	$81.90
Rate for Payer: BCBS MT Closed Plan Network	$86.45
Rate for Payer: BCBS MT HealthLink	$81.90
Rate for Payer: BCBS MT Medicare	$81.90
Rate for Payer: BCBS MT POS	$86.45
Rate for Payer: BCBS MT Traditional	$91.00
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cigna Commercial	$86.45
Rate for Payer: Cigna Medicare	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

C-REACTIVE PROTEIN

Facility

$91.00

Service Code	CPT 86140
Hospital Charge Code	4086140
Hospital Revenue Code	300
Min. Negotiated Rate	$63.70
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$86.45
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: BCBS MT CHIP	$81.90
Rate for Payer: BCBS MT Closed Plan Network	$86.45
Rate for Payer: BCBS MT HealthLink	$81.90
Rate for Payer: BCBS MT Medicare	$81.90
Rate for Payer: BCBS MT POS	$86.45
Rate for Payer: BCBS MT Traditional	$91.00
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cigna Commercial	$86.45
Rate for Payer: Cigna Medicare	$81.90
Rate for Payer: Medicaid All Medicaid	$83.72
Rate for Payer: Medicare All Medicare	$63.70
Rate for Payer: Monida Allegiance	$86.45
Rate for Payer: Monida First Choice Health	$88.27
Rate for Payer: Monida Montana Health Co-op	$86.45
Rate for Payer: Monida PacificSource	$86.45

CREATINE KINASE, TOTAL

Facility

$96.00

Service Code	CPT 82550
Hospital Charge Code	4082550
Hospital Revenue Code	301
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare	$86.40
Rate for Payer: BCBS MT CHIP	$86.40
Rate for Payer: BCBS MT Closed Plan Network	$91.20
Rate for Payer: BCBS MT HealthLink	$86.40
Rate for Payer: BCBS MT Medicare	$86.40
Rate for Payer: BCBS MT POS	$91.20
Rate for Payer: BCBS MT Traditional	$96.00
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial	$91.20
Rate for Payer: Cigna Medicare	$86.40
Rate for Payer: Medicaid All Medicaid	$88.32
Rate for Payer: Medicare All Medicare	$67.20
Rate for Payer: Monida Allegiance	$91.20
Rate for Payer: Monida First Choice Health	$93.12
Rate for Payer: Monida Montana Health Co-op	$91.20
Rate for Payer: Monida PacificSource	$91.20

CREATINE KINASE, TOTAL

Facility

$96.00

Service Code	CPT 82550
Hospital Charge Code	4082550
Hospital Revenue Code	301
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare	$86.40
Rate for Payer: BCBS MT CHIP	$86.40
Rate for Payer: BCBS MT Closed Plan Network	$91.20
Rate for Payer: BCBS MT HealthLink	$86.40
Rate for Payer: BCBS MT Medicare	$86.40
Rate for Payer: BCBS MT POS	$91.20
Rate for Payer: BCBS MT Traditional	$96.00
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial	$91.20
Rate for Payer: Cigna Medicare	$86.40
Rate for Payer: Medicaid All Medicaid	$88.32
Rate for Payer: Medicare All Medicare	$67.20
Rate for Payer: Monida Allegiance	$91.20
Rate for Payer: Monida First Choice Health	$93.12
Rate for Payer: Monida Montana Health Co-op	$91.20
Rate for Payer: Monida PacificSource	$91.20

CREATININE

Facility

$65.00

Service Code	CPT 82565
Hospital Charge Code	4082565
Hospital Revenue Code	301
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

Know your out-of-pocket cost for care.

All Charges