Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

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

LAB ANTIPEROXIDASE AB

Facility

$71.00

Service Code	HCPCS 84432
Hospital Charge Code	4084432
Hospital Revenue Code	301
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

LAB ANTIPEROXIDASE AB

Facility

$71.00

Service Code	HCPCS 84432
Hospital Charge Code	4084432
Hospital Revenue Code	301
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$67.45
Rate for Payer: Aetna Medicare	$63.90
Rate for Payer: BCBS MT CHIP	$63.90
Rate for Payer: BCBS MT Closed Plan Network	$67.45
Rate for Payer: BCBS MT HealthLink	$63.90
Rate for Payer: BCBS MT Medicare	$63.90
Rate for Payer: BCBS MT POS	$67.45
Rate for Payer: BCBS MT Traditional	$71.00
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial	$67.45
Rate for Payer: Cigna Medicare	$63.90
Rate for Payer: Medicaid All Medicaid	$65.32
Rate for Payer: Medicare All Medicare	$49.70
Rate for Payer: Monida Allegiance	$67.45
Rate for Payer: Monida First Choice Health	$68.87
Rate for Payer: Monida Montana Health Co-op	$67.45
Rate for Payer: Monida PacificSource	$67.45

LAB ARSENIC

Facility

$78.00

Service Code	HCPCS 82175
Hospital Charge Code	4082175
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

LAB ARSENIC

Facility

$78.00

Service Code	HCPCS 82175
Hospital Charge Code	4082175
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

LAB ARTERIAL PUNCTURE

Facility

$84.00

Service Code	HCPCS 36600
Hospital Charge Code	4036600
Hospital Revenue Code	300
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 ARTERIAL PUNCTURE

Facility

$84.00

Service Code	HCPCS 36600
Hospital Charge Code	4036600
Hospital Revenue Code	300
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 ASPIRATE - CRYSTAL IDENTIFICATION

Facility

$59.00

Service Code	HCPCS 89060
Hospital Charge Code	4089060
Hospital Revenue Code	300
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$56.05
Rate for Payer: Aetna Medicare	$53.10
Rate for Payer: BCBS MT CHIP	$53.10
Rate for Payer: BCBS MT Closed Plan Network	$56.05
Rate for Payer: BCBS MT HealthLink	$53.10
Rate for Payer: BCBS MT Medicare	$53.10
Rate for Payer: BCBS MT POS	$56.05
Rate for Payer: BCBS MT Traditional	$59.00
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cigna Commercial	$56.05
Rate for Payer: Cigna Medicare	$53.10
Rate for Payer: Medicaid All Medicaid	$54.28
Rate for Payer: Medicare All Medicare	$41.30
Rate for Payer: Monida Allegiance	$56.05
Rate for Payer: Monida First Choice Health	$57.23
Rate for Payer: Monida Montana Health Co-op	$56.05
Rate for Payer: Monida PacificSource	$56.05

LAB ASPIRATE - CRYSTAL IDENTIFICATION

Facility

$59.00

Service Code	HCPCS 89060
Hospital Charge Code	4089060
Hospital Revenue Code	300
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$56.05
Rate for Payer: Aetna Medicare	$53.10
Rate for Payer: BCBS MT CHIP	$53.10
Rate for Payer: BCBS MT Closed Plan Network	$56.05
Rate for Payer: BCBS MT HealthLink	$53.10
Rate for Payer: BCBS MT Medicare	$53.10
Rate for Payer: BCBS MT POS	$56.05
Rate for Payer: BCBS MT Traditional	$59.00
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cigna Commercial	$56.05
Rate for Payer: Cigna Medicare	$53.10
Rate for Payer: Medicaid All Medicaid	$54.28
Rate for Payer: Medicare All Medicare	$41.30
Rate for Payer: Monida Allegiance	$56.05
Rate for Payer: Monida First Choice Health	$57.23
Rate for Payer: Monida Montana Health Co-op	$56.05
Rate for Payer: Monida PacificSource	$56.05

LAB BACTERIAL ID

Facility

$83.00

Service Code	HCPCS 87077
Hospital Charge Code	4087077
Hospital Revenue Code	306
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$78.85
Rate for Payer: Aetna Medicare	$74.70
Rate for Payer: BCBS MT CHIP	$74.70
Rate for Payer: BCBS MT Closed Plan Network	$78.85
Rate for Payer: BCBS MT HealthLink	$74.70
Rate for Payer: BCBS MT Medicare	$74.70
Rate for Payer: BCBS MT POS	$78.85
Rate for Payer: BCBS MT Traditional	$83.00
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cigna Commercial	$78.85
Rate for Payer: Cigna Medicare	$74.70
Rate for Payer: Medicaid All Medicaid	$76.36
Rate for Payer: Medicare All Medicare	$58.10
Rate for Payer: Monida Allegiance	$78.85
Rate for Payer: Monida First Choice Health	$80.51
Rate for Payer: Monida Montana Health Co-op	$78.85
Rate for Payer: Monida PacificSource	$78.85

LAB BACTERIAL ID

Facility

$83.00

Service Code	HCPCS 87077
Hospital Charge Code	4087077
Hospital Revenue Code	306
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$78.85
Rate for Payer: Aetna Medicare	$74.70
Rate for Payer: BCBS MT CHIP	$74.70
Rate for Payer: BCBS MT Closed Plan Network	$78.85
Rate for Payer: BCBS MT HealthLink	$74.70
Rate for Payer: BCBS MT Medicare	$74.70
Rate for Payer: BCBS MT POS	$78.85
Rate for Payer: BCBS MT Traditional	$83.00
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cigna Commercial	$78.85
Rate for Payer: Cigna Medicare	$74.70
Rate for Payer: Medicaid All Medicaid	$76.36
Rate for Payer: Medicare All Medicare	$58.10
Rate for Payer: Monida Allegiance	$78.85
Rate for Payer: Monida First Choice Health	$80.51
Rate for Payer: Monida Montana Health Co-op	$78.85
Rate for Payer: Monida PacificSource	$78.85

LAB BARTONELLA SEROLOGY

Facility

$149.00

Service Code	HCPCS 86256
Hospital Charge Code	4086256
Hospital Revenue Code	300
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$149.00
Rate for Payer: Aetna Commercial	$141.55
Rate for Payer: Aetna Medicare	$134.10
Rate for Payer: BCBS MT CHIP	$134.10
Rate for Payer: BCBS MT Closed Plan Network	$141.55
Rate for Payer: BCBS MT HealthLink	$134.10
Rate for Payer: BCBS MT Medicare	$134.10
Rate for Payer: BCBS MT POS	$141.55
Rate for Payer: BCBS MT Traditional	$149.00
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial	$141.55
Rate for Payer: Cigna Medicare	$134.10
Rate for Payer: Medicaid All Medicaid	$137.08
Rate for Payer: Medicare All Medicare	$104.30
Rate for Payer: Monida Allegiance	$141.55
Rate for Payer: Monida First Choice Health	$144.53
Rate for Payer: Monida Montana Health Co-op	$141.55
Rate for Payer: Monida PacificSource	$141.55

LAB BARTONELLA SEROLOGY

Facility

$149.00

Service Code	HCPCS 86256
Hospital Charge Code	4086256
Hospital Revenue Code	300
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$149.00
Rate for Payer: Aetna Commercial	$141.55
Rate for Payer: Aetna Medicare	$134.10
Rate for Payer: BCBS MT CHIP	$134.10
Rate for Payer: BCBS MT Closed Plan Network	$141.55
Rate for Payer: BCBS MT HealthLink	$134.10
Rate for Payer: BCBS MT Medicare	$134.10
Rate for Payer: BCBS MT POS	$141.55
Rate for Payer: BCBS MT Traditional	$149.00
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial	$141.55
Rate for Payer: Cigna Medicare	$134.10
Rate for Payer: Medicaid All Medicaid	$137.08
Rate for Payer: Medicare All Medicare	$104.30
Rate for Payer: Monida Allegiance	$141.55
Rate for Payer: Monida First Choice Health	$144.53
Rate for Payer: Monida Montana Health Co-op	$141.55
Rate for Payer: Monida PacificSource	$141.55

LAB BETA LACTAMASE

Facility

$52.00

Service Code	HCPCS 87185
Hospital Charge Code	4087185
Hospital Revenue Code	306
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare	$46.80
Rate for Payer: BCBS MT CHIP	$46.80
Rate for Payer: BCBS MT Closed Plan Network	$49.40
Rate for Payer: BCBS MT HealthLink	$46.80
Rate for Payer: BCBS MT Medicare	$46.80
Rate for Payer: BCBS MT POS	$49.40
Rate for Payer: BCBS MT Traditional	$52.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial	$49.40
Rate for Payer: Cigna Medicare	$46.80
Rate for Payer: Medicaid All Medicaid	$47.84
Rate for Payer: Medicare All Medicare	$36.40
Rate for Payer: Monida Allegiance	$49.40
Rate for Payer: Monida First Choice Health	$50.44
Rate for Payer: Monida Montana Health Co-op	$49.40
Rate for Payer: Monida PacificSource	$49.40

LAB BETA LACTAMASE

Facility

$52.00

Service Code	HCPCS 87185
Hospital Charge Code	4087185
Hospital Revenue Code	306
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare	$46.80
Rate for Payer: BCBS MT CHIP	$46.80
Rate for Payer: BCBS MT Closed Plan Network	$49.40
Rate for Payer: BCBS MT HealthLink	$46.80
Rate for Payer: BCBS MT Medicare	$46.80
Rate for Payer: BCBS MT POS	$49.40
Rate for Payer: BCBS MT Traditional	$52.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial	$49.40
Rate for Payer: Cigna Medicare	$46.80
Rate for Payer: Medicaid All Medicaid	$47.84
Rate for Payer: Medicare All Medicare	$36.40
Rate for Payer: Monida Allegiance	$49.40
Rate for Payer: Monida First Choice Health	$50.44
Rate for Payer: Monida Montana Health Co-op	$49.40
Rate for Payer: Monida PacificSource	$49.40

LAB BIOTINIDOSE

Facility

$78.00

Service Code	HCPCS 82261
Hospital Charge Code	4082261
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

LAB BIOTINIDOSE

Facility

$78.00

Service Code	HCPCS 82261
Hospital Charge Code	4082261
Hospital Revenue Code	300
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare	$70.20
Rate for Payer: BCBS MT CHIP	$70.20
Rate for Payer: BCBS MT Closed Plan Network	$74.10
Rate for Payer: BCBS MT HealthLink	$70.20
Rate for Payer: BCBS MT Medicare	$70.20
Rate for Payer: BCBS MT POS	$74.10
Rate for Payer: BCBS MT Traditional	$78.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cigna Commercial	$74.10
Rate for Payer: Cigna Medicare	$70.20
Rate for Payer: Medicaid All Medicaid	$71.76
Rate for Payer: Medicare All Medicare	$54.60
Rate for Payer: Monida Allegiance	$74.10
Rate for Payer: Monida First Choice Health	$75.66
Rate for Payer: Monida Montana Health Co-op	$74.10
Rate for Payer: Monida PacificSource	$74.10

LAB BLOOD DRAW FROM IMPLANTED DEVICE

Facility

$120.00

Service Code	HCPCS 36591
Hospital Charge Code	4036591
Hospital Revenue Code	300
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS MT CHIP	$108.00
Rate for Payer: BCBS MT Closed Plan Network	$114.00
Rate for Payer: BCBS MT HealthLink	$108.00
Rate for Payer: BCBS MT Medicare	$108.00
Rate for Payer: BCBS MT POS	$114.00
Rate for Payer: BCBS MT Traditional	$120.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: Cigna Medicare	$108.00
Rate for Payer: Medicaid All Medicaid	$110.40
Rate for Payer: Medicare All Medicare	$84.00
Rate for Payer: Monida Allegiance	$114.00
Rate for Payer: Monida First Choice Health	$116.40
Rate for Payer: Monida Montana Health Co-op	$114.00
Rate for Payer: Monida PacificSource	$114.00

LAB BLOOD DRAW FROM IMPLANTED DEVICE

Facility

$120.00

Service Code	HCPCS 36591
Hospital Charge Code	4036591
Hospital Revenue Code	300
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS MT CHIP	$108.00
Rate for Payer: BCBS MT Closed Plan Network	$114.00
Rate for Payer: BCBS MT HealthLink	$108.00
Rate for Payer: BCBS MT Medicare	$108.00
Rate for Payer: BCBS MT POS	$114.00
Rate for Payer: BCBS MT Traditional	$120.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: Cigna Medicare	$108.00
Rate for Payer: Medicaid All Medicaid	$110.40
Rate for Payer: Medicare All Medicare	$84.00
Rate for Payer: Monida Allegiance	$114.00
Rate for Payer: Monida First Choice Health	$116.40
Rate for Payer: Monida Montana Health Co-op	$114.00
Rate for Payer: Monida PacificSource	$114.00

LAB BLOOD TYPE ANTIGEN TESTING USING RE

Facility

$86.00

Service Code	HCPCS 86902
Hospital Charge Code	4086902
Hospital Revenue Code	300
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$86.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare	$77.40
Rate for Payer: BCBS MT CHIP	$77.40
Rate for Payer: BCBS MT Closed Plan Network	$81.70
Rate for Payer: BCBS MT HealthLink	$77.40
Rate for Payer: BCBS MT Medicare	$77.40
Rate for Payer: BCBS MT POS	$81.70
Rate for Payer: BCBS MT Traditional	$86.00
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cigna Commercial	$81.70
Rate for Payer: Cigna Medicare	$77.40
Rate for Payer: Medicaid All Medicaid	$79.12
Rate for Payer: Medicare All Medicare	$60.20
Rate for Payer: Monida Allegiance	$81.70
Rate for Payer: Monida First Choice Health	$83.42
Rate for Payer: Monida Montana Health Co-op	$81.70
Rate for Payer: Monida PacificSource	$81.70

LAB BLOOD TYPE ANTIGEN TESTING USING RE

Facility

$86.00

Service Code	HCPCS 86902
Hospital Charge Code	4086902
Hospital Revenue Code	300
Min. Negotiated Rate	$60.20
Max. Negotiated Rate	$86.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare	$77.40
Rate for Payer: BCBS MT CHIP	$77.40
Rate for Payer: BCBS MT Closed Plan Network	$81.70
Rate for Payer: BCBS MT HealthLink	$77.40
Rate for Payer: BCBS MT Medicare	$77.40
Rate for Payer: BCBS MT POS	$81.70
Rate for Payer: BCBS MT Traditional	$86.00
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cigna Commercial	$81.70
Rate for Payer: Cigna Medicare	$77.40
Rate for Payer: Medicaid All Medicaid	$79.12
Rate for Payer: Medicare All Medicare	$60.20
Rate for Payer: Monida Allegiance	$81.70
Rate for Payer: Monida First Choice Health	$83.42
Rate for Payer: Monida Montana Health Co-op	$81.70
Rate for Payer: Monida PacificSource	$81.70

LAB BLOOD X-MATCH

Facility

$158.00

Service Code	HCPCS 86920
Hospital Charge Code	4086920
Hospital Revenue Code	300
Min. Negotiated Rate	$110.60
Max. Negotiated Rate	$158.00
Rate for Payer: Aetna Commercial	$150.10
Rate for Payer: Aetna Medicare	$142.20
Rate for Payer: BCBS MT CHIP	$142.20
Rate for Payer: BCBS MT Closed Plan Network	$150.10
Rate for Payer: BCBS MT HealthLink	$142.20
Rate for Payer: BCBS MT Medicare	$142.20
Rate for Payer: BCBS MT POS	$150.10
Rate for Payer: BCBS MT Traditional	$158.00
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cigna Commercial	$150.10
Rate for Payer: Cigna Medicare	$142.20
Rate for Payer: Medicaid All Medicaid	$145.36
Rate for Payer: Medicare All Medicare	$110.60
Rate for Payer: Monida Allegiance	$150.10
Rate for Payer: Monida First Choice Health	$153.26
Rate for Payer: Monida Montana Health Co-op	$150.10
Rate for Payer: Monida PacificSource	$150.10

LAB BLOOD X-MATCH

Facility

$178.00

Service Code	HCPCS 86922
Hospital Charge Code	4086922
Hospital Revenue Code	300
Min. Negotiated Rate	$124.60
Max. Negotiated Rate	$178.00
Rate for Payer: Aetna Commercial	$169.10
Rate for Payer: Aetna Medicare	$160.20
Rate for Payer: BCBS MT CHIP	$160.20
Rate for Payer: BCBS MT Closed Plan Network	$169.10
Rate for Payer: BCBS MT HealthLink	$160.20
Rate for Payer: BCBS MT Medicare	$160.20
Rate for Payer: BCBS MT POS	$169.10
Rate for Payer: BCBS MT Traditional	$178.00
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial	$169.10
Rate for Payer: Cigna Medicare	$160.20
Rate for Payer: Medicaid All Medicaid	$163.76
Rate for Payer: Medicare All Medicare	$124.60
Rate for Payer: Monida Allegiance	$169.10
Rate for Payer: Monida First Choice Health	$172.66
Rate for Payer: Monida Montana Health Co-op	$169.10
Rate for Payer: Monida PacificSource	$169.10

LAB BLOOD X-MATCH

Facility

$97.00

Service Code	HCPCS 86921
Hospital Charge Code	4086921
Hospital Revenue Code	300
Min. Negotiated Rate	$67.90
Max. Negotiated Rate	$97.00
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare	$87.30
Rate for Payer: BCBS MT CHIP	$87.30
Rate for Payer: BCBS MT Closed Plan Network	$92.15
Rate for Payer: BCBS MT HealthLink	$87.30
Rate for Payer: BCBS MT Medicare	$87.30
Rate for Payer: BCBS MT POS	$92.15
Rate for Payer: BCBS MT Traditional	$97.00
Rate for Payer: Cash Price	$87.30
Rate for Payer: Cigna Commercial	$92.15
Rate for Payer: Cigna Medicare	$87.30
Rate for Payer: Medicaid All Medicaid	$89.24
Rate for Payer: Medicare All Medicare	$67.90
Rate for Payer: Monida Allegiance	$92.15
Rate for Payer: Monida First Choice Health	$94.09
Rate for Payer: Monida Montana Health Co-op	$92.15
Rate for Payer: Monida PacificSource	$92.15

LAB BLOOD X-MATCH

Facility

$178.00

Service Code	HCPCS 86922
Hospital Charge Code	4086922
Hospital Revenue Code	300
Min. Negotiated Rate	$124.60
Max. Negotiated Rate	$178.00
Rate for Payer: Aetna Commercial	$169.10
Rate for Payer: Aetna Medicare	$160.20
Rate for Payer: BCBS MT CHIP	$160.20
Rate for Payer: BCBS MT Closed Plan Network	$169.10
Rate for Payer: BCBS MT HealthLink	$160.20
Rate for Payer: BCBS MT Medicare	$160.20
Rate for Payer: BCBS MT POS	$169.10
Rate for Payer: BCBS MT Traditional	$178.00
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial	$169.10
Rate for Payer: Cigna Medicare	$160.20
Rate for Payer: Medicaid All Medicaid	$163.76
Rate for Payer: Medicare All Medicare	$124.60
Rate for Payer: Monida Allegiance	$169.10
Rate for Payer: Monida First Choice Health	$172.66
Rate for Payer: Monida Montana Health Co-op	$169.10
Rate for Payer: Monida PacificSource	$169.10

Know your out-of-pocket cost for care.

All Charges