Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

LAB ALLERGY TEST: SESAME SEED

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060035
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST: SESAME SEED

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060035
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST: SHRIMP

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4000312
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST: SHRIMP

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4000312
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST:SOYBEAN

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060033
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST:SOYBEAN

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060033
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST: TUNA

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4000314
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST: TUNA

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4000314
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST: WALNUT

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060037
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST: WALNUT

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060037
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST:WHEAT

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060034
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALLERGY TEST:WHEAT

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4060034
Hospital Revenue Code	300
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare	$32.40
Rate for Payer: BCBS MT CHIP	$32.40
Rate for Payer: BCBS MT Closed Plan Network	$34.20
Rate for Payer: BCBS MT HealthLink	$32.40
Rate for Payer: BCBS MT Medicare	$32.40
Rate for Payer: BCBS MT POS	$34.20
Rate for Payer: BCBS MT Traditional	$36.00
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial	$34.20
Rate for Payer: Cigna Medicare	$32.40
Rate for Payer: Medicaid All Medicaid	$33.12
Rate for Payer: Medicare All Medicare	$25.20
Rate for Payer: Monida Allegiance	$34.20
Rate for Payer: Monida First Choice Health	$34.92
Rate for Payer: Monida Montana Health Co-op	$34.20
Rate for Payer: Monida PacificSource	$34.20

LAB ALPHA FETORPTEIN L3

Facility

$156.00

Service Code	HCPCS 82107
Hospital Charge Code	4082107
Hospital Revenue Code	301
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare	$140.40
Rate for Payer: BCBS MT CHIP	$140.40
Rate for Payer: BCBS MT Closed Plan Network	$148.20
Rate for Payer: BCBS MT HealthLink	$140.40
Rate for Payer: BCBS MT Medicare	$140.40
Rate for Payer: BCBS MT POS	$148.20
Rate for Payer: BCBS MT Traditional	$156.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial	$148.20
Rate for Payer: Cigna Medicare	$140.40
Rate for Payer: Medicaid All Medicaid	$143.52
Rate for Payer: Medicare All Medicare	$109.20
Rate for Payer: Monida Allegiance	$148.20
Rate for Payer: Monida First Choice Health	$151.32
Rate for Payer: Monida Montana Health Co-op	$148.20
Rate for Payer: Monida PacificSource	$148.20

LAB ALPHA FETORPTEIN L3

Facility

$156.00

Service Code	HCPCS 82107
Hospital Charge Code	4082107
Hospital Revenue Code	301
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare	$140.40
Rate for Payer: BCBS MT CHIP	$140.40
Rate for Payer: BCBS MT Closed Plan Network	$148.20
Rate for Payer: BCBS MT HealthLink	$140.40
Rate for Payer: BCBS MT Medicare	$140.40
Rate for Payer: BCBS MT POS	$148.20
Rate for Payer: BCBS MT Traditional	$156.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial	$148.20
Rate for Payer: Cigna Medicare	$140.40
Rate for Payer: Medicaid All Medicaid	$143.52
Rate for Payer: Medicare All Medicare	$109.20
Rate for Payer: Monida Allegiance	$148.20
Rate for Payer: Monida First Choice Health	$151.32
Rate for Payer: Monida Montana Health Co-op	$148.20
Rate for Payer: Monida PacificSource	$148.20

LAB AMINO ACID DISORDER

Facility

$130.00

Service Code	HCPCS 82136
Hospital Charge Code	4082136
Hospital Revenue Code	300
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

LAB AMINO ACID DISORDER

Facility

$130.00

Service Code	HCPCS 82136
Hospital Charge Code	4082136
Hospital Revenue Code	300
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS MT CHIP	$117.00
Rate for Payer: BCBS MT Closed Plan Network	$123.50
Rate for Payer: BCBS MT HealthLink	$117.00
Rate for Payer: BCBS MT Medicare	$117.00
Rate for Payer: BCBS MT POS	$123.50
Rate for Payer: BCBS MT Traditional	$130.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: Cigna Medicare	$117.00
Rate for Payer: Medicaid All Medicaid	$119.60
Rate for Payer: Medicare All Medicare	$91.00
Rate for Payer: Monida Allegiance	$123.50
Rate for Payer: Monida First Choice Health	$126.10
Rate for Payer: Monida Montana Health Co-op	$123.50
Rate for Payer: Monida PacificSource	$123.50

LAB ANAEROBIC IDENTIFICATION

Facility

$67.00

Service Code	HCPCS 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 ANAEROBIC IDENTIFICATION

Facility

$67.00

Service Code	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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	HCPCS 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

Know your out-of-pocket cost for care.

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