Ruby Valley Medical Center

All Charges

Charge

Type

Setting

Price

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

$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 BORDETELLA PERTUSSIS

Facility

$70.00

Service Code	HCPCS 87265
Hospital Charge Code	4087265
Hospital Revenue Code	301
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCBS MT CHIP	$63.00
Rate for Payer: BCBS MT Closed Plan Network	$66.50
Rate for Payer: BCBS MT HealthLink	$63.00
Rate for Payer: BCBS MT Medicare	$63.00
Rate for Payer: BCBS MT POS	$66.50
Rate for Payer: BCBS MT Traditional	$70.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial	$66.50
Rate for Payer: Cigna Medicare	$63.00
Rate for Payer: Medicaid All Medicaid	$64.40
Rate for Payer: Medicare All Medicare	$49.00
Rate for Payer: Monida Allegiance	$66.50
Rate for Payer: Monida First Choice Health	$67.90
Rate for Payer: Monida Montana Health Co-op	$66.50
Rate for Payer: Monida PacificSource	$66.50

LAB BORDETELLA PERTUSSIS

Facility

$70.00

Service Code	HCPCS 87265
Hospital Charge Code	4087265
Hospital Revenue Code	301
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCBS MT CHIP	$63.00
Rate for Payer: BCBS MT Closed Plan Network	$66.50
Rate for Payer: BCBS MT HealthLink	$63.00
Rate for Payer: BCBS MT Medicare	$63.00
Rate for Payer: BCBS MT POS	$66.50
Rate for Payer: BCBS MT Traditional	$70.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial	$66.50
Rate for Payer: Cigna Medicare	$63.00
Rate for Payer: Medicaid All Medicaid	$64.40
Rate for Payer: Medicare All Medicare	$49.00
Rate for Payer: Monida Allegiance	$66.50
Rate for Payer: Monida First Choice Health	$67.90
Rate for Payer: Monida Montana Health Co-op	$66.50
Rate for Payer: Monida PacificSource	$66.50

LAB BORRELIA HERMSII TITER

Facility

$113.00

Service Code	HCPCS 86619
Hospital Charge Code	4086619
Hospital Revenue Code	300
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$107.35
Rate for Payer: Aetna Medicare	$101.70
Rate for Payer: BCBS MT CHIP	$101.70
Rate for Payer: BCBS MT Closed Plan Network	$107.35
Rate for Payer: BCBS MT HealthLink	$101.70
Rate for Payer: BCBS MT Medicare	$101.70
Rate for Payer: BCBS MT POS	$107.35
Rate for Payer: BCBS MT Traditional	$113.00
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial	$107.35
Rate for Payer: Cigna Medicare	$101.70
Rate for Payer: Medicaid All Medicaid	$103.96
Rate for Payer: Medicare All Medicare	$79.10
Rate for Payer: Monida Allegiance	$107.35
Rate for Payer: Monida First Choice Health	$109.61
Rate for Payer: Monida Montana Health Co-op	$107.35
Rate for Payer: Monida PacificSource	$107.35

LAB BORRELIA HERMSII TITER

Facility

$113.00

Service Code	HCPCS 86619
Hospital Charge Code	4086619
Hospital Revenue Code	300
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$113.00
Rate for Payer: Aetna Commercial	$107.35
Rate for Payer: Aetna Medicare	$101.70
Rate for Payer: BCBS MT CHIP	$101.70
Rate for Payer: BCBS MT Closed Plan Network	$107.35
Rate for Payer: BCBS MT HealthLink	$101.70
Rate for Payer: BCBS MT Medicare	$101.70
Rate for Payer: BCBS MT POS	$107.35
Rate for Payer: BCBS MT Traditional	$113.00
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial	$107.35
Rate for Payer: Cigna Medicare	$101.70
Rate for Payer: Medicaid All Medicaid	$103.96
Rate for Payer: Medicare All Medicare	$79.10
Rate for Payer: Monida Allegiance	$107.35
Rate for Payer: Monida First Choice Health	$109.61
Rate for Payer: Monida Montana Health Co-op	$107.35
Rate for Payer: Monida PacificSource	$107.35

LAB BRUCELLA

Facility

$211.00

Service Code	HCPCS 86622
Hospital Charge Code	4086623
Hospital Revenue Code	300
Min. Negotiated Rate	$147.70
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$200.45
Rate for Payer: Aetna Medicare	$189.90
Rate for Payer: BCBS MT CHIP	$189.90
Rate for Payer: BCBS MT Closed Plan Network	$200.45
Rate for Payer: BCBS MT HealthLink	$189.90
Rate for Payer: BCBS MT Medicare	$189.90
Rate for Payer: BCBS MT POS	$200.45
Rate for Payer: BCBS MT Traditional	$211.00
Rate for Payer: Cash Price	$189.90
Rate for Payer: Cigna Commercial	$200.45
Rate for Payer: Cigna Medicare	$189.90
Rate for Payer: Medicaid All Medicaid	$194.12
Rate for Payer: Medicare All Medicare	$147.70
Rate for Payer: Monida Allegiance	$200.45
Rate for Payer: Monida First Choice Health	$204.67
Rate for Payer: Monida Montana Health Co-op	$200.45
Rate for Payer: Monida PacificSource	$200.45

LAB BRUCELLA

Facility

$211.00

Service Code	HCPCS 86622
Hospital Charge Code	4086623
Hospital Revenue Code	300
Min. Negotiated Rate	$147.70
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$200.45
Rate for Payer: Aetna Medicare	$189.90
Rate for Payer: BCBS MT CHIP	$189.90
Rate for Payer: BCBS MT Closed Plan Network	$200.45
Rate for Payer: BCBS MT HealthLink	$189.90
Rate for Payer: BCBS MT Medicare	$189.90
Rate for Payer: BCBS MT POS	$200.45
Rate for Payer: BCBS MT Traditional	$211.00
Rate for Payer: Cash Price	$189.90
Rate for Payer: Cigna Commercial	$200.45
Rate for Payer: Cigna Medicare	$189.90
Rate for Payer: Medicaid All Medicaid	$194.12
Rate for Payer: Medicare All Medicare	$147.70
Rate for Payer: Monida Allegiance	$200.45
Rate for Payer: Monida First Choice Health	$204.67
Rate for Payer: Monida Montana Health Co-op	$200.45
Rate for Payer: Monida PacificSource	$200.45

LAB CADMIUM

Facility

$68.00

Service Code	HCPCS 82300
Hospital Charge Code	4082300
Hospital Revenue Code	301
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare	$61.20
Rate for Payer: BCBS MT CHIP	$61.20
Rate for Payer: BCBS MT Closed Plan Network	$64.60
Rate for Payer: BCBS MT HealthLink	$61.20
Rate for Payer: BCBS MT Medicare	$61.20
Rate for Payer: BCBS MT POS	$64.60
Rate for Payer: BCBS MT Traditional	$68.00
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna Commercial	$64.60
Rate for Payer: Cigna Medicare	$61.20
Rate for Payer: Medicaid All Medicaid	$62.56
Rate for Payer: Medicare All Medicare	$47.60
Rate for Payer: Monida Allegiance	$64.60
Rate for Payer: Monida First Choice Health	$65.96
Rate for Payer: Monida Montana Health Co-op	$64.60
Rate for Payer: Monida PacificSource	$64.60

LAB CADMIUM

Facility

$68.00

Service Code	HCPCS 82300
Hospital Charge Code	4082300
Hospital Revenue Code	301
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare	$61.20
Rate for Payer: BCBS MT CHIP	$61.20
Rate for Payer: BCBS MT Closed Plan Network	$64.60
Rate for Payer: BCBS MT HealthLink	$61.20
Rate for Payer: BCBS MT Medicare	$61.20
Rate for Payer: BCBS MT POS	$64.60
Rate for Payer: BCBS MT Traditional	$68.00
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna Commercial	$64.60
Rate for Payer: Cigna Medicare	$61.20
Rate for Payer: Medicaid All Medicaid	$62.56
Rate for Payer: Medicare All Medicare	$47.60
Rate for Payer: Monida Allegiance	$64.60
Rate for Payer: Monida First Choice Health	$65.96
Rate for Payer: Monida Montana Health Co-op	$64.60
Rate for Payer: Monida PacificSource	$64.60

LAB CANDIDA ALBICANS IGE

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4000316
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 CANDIDA ALBICANS IGE

Facility

$36.00

Service Code	HCPCS 86003
Hospital Charge Code	4000316
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 CANDIDA SPECIES DIR 1

Facility

$125.00

Service Code	HCPCS 87480
Hospital Charge Code	4087480
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: BCBS MT CHIP	$112.50
Rate for Payer: BCBS MT Closed Plan Network	$118.75
Rate for Payer: BCBS MT HealthLink	$112.50
Rate for Payer: BCBS MT Medicare	$112.50
Rate for Payer: BCBS MT POS	$118.75
Rate for Payer: BCBS MT Traditional	$125.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: Cigna Medicare	$112.50
Rate for Payer: Medicaid All Medicaid	$115.00
Rate for Payer: Medicare All Medicare	$87.50
Rate for Payer: Monida Allegiance	$118.75
Rate for Payer: Monida First Choice Health	$121.25
Rate for Payer: Monida Montana Health Co-op	$118.75
Rate for Payer: Monida PacificSource	$118.75

LAB CANDIDA SPECIES DIR 1

Facility

$125.00

Service Code	HCPCS 87480
Hospital Charge Code	4087480
Hospital Revenue Code	300
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna Medicare	$112.50
Rate for Payer: BCBS MT CHIP	$112.50
Rate for Payer: BCBS MT Closed Plan Network	$118.75
Rate for Payer: BCBS MT HealthLink	$112.50
Rate for Payer: BCBS MT Medicare	$112.50
Rate for Payer: BCBS MT POS	$118.75
Rate for Payer: BCBS MT Traditional	$125.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: Cigna Medicare	$112.50
Rate for Payer: Medicaid All Medicaid	$115.00
Rate for Payer: Medicare All Medicare	$87.50
Rate for Payer: Monida Allegiance	$118.75
Rate for Payer: Monida First Choice Health	$121.25
Rate for Payer: Monida Montana Health Co-op	$118.75
Rate for Payer: Monida PacificSource	$118.75

LAB CARBON MONOXIDE

Facility

$81.00

Service Code	HCPCS 82375
Hospital Charge Code	4082375
Hospital Revenue Code	301
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: Aetna Medicare	$72.90
Rate for Payer: BCBS MT CHIP	$72.90
Rate for Payer: BCBS MT Closed Plan Network	$76.95
Rate for Payer: BCBS MT HealthLink	$72.90
Rate for Payer: BCBS MT Medicare	$72.90
Rate for Payer: BCBS MT POS	$76.95
Rate for Payer: BCBS MT Traditional	$81.00
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial	$76.95
Rate for Payer: Cigna Medicare	$72.90
Rate for Payer: Medicaid All Medicaid	$74.52
Rate for Payer: Medicare All Medicare	$56.70
Rate for Payer: Monida Allegiance	$76.95
Rate for Payer: Monida First Choice Health	$78.57
Rate for Payer: Monida Montana Health Co-op	$76.95
Rate for Payer: Monida PacificSource	$76.95

LAB CARBON MONOXIDE

Facility

$81.00

Service Code	HCPCS 82375
Hospital Charge Code	4082375
Hospital Revenue Code	301
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$76.95
Rate for Payer: Aetna Medicare	$72.90
Rate for Payer: BCBS MT CHIP	$72.90
Rate for Payer: BCBS MT Closed Plan Network	$76.95
Rate for Payer: BCBS MT HealthLink	$72.90
Rate for Payer: BCBS MT Medicare	$72.90
Rate for Payer: BCBS MT POS	$76.95
Rate for Payer: BCBS MT Traditional	$81.00
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial	$76.95
Rate for Payer: Cigna Medicare	$72.90
Rate for Payer: Medicaid All Medicaid	$74.52
Rate for Payer: Medicare All Medicare	$56.70
Rate for Payer: Monida Allegiance	$76.95
Rate for Payer: Monida First Choice Health	$78.57
Rate for Payer: Monida Montana Health Co-op	$76.95
Rate for Payer: Monida PacificSource	$76.95

LAB CATACHOLAMINES

Facility

$148.00

Service Code	HCPCS 82384
Hospital Charge Code	4082384
Hospital Revenue Code	300
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$148.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare	$133.20
Rate for Payer: BCBS MT CHIP	$133.20
Rate for Payer: BCBS MT Closed Plan Network	$140.60
Rate for Payer: BCBS MT HealthLink	$133.20
Rate for Payer: BCBS MT Medicare	$133.20
Rate for Payer: BCBS MT POS	$140.60
Rate for Payer: BCBS MT Traditional	$148.00
Rate for Payer: Cash Price	$133.20
Rate for Payer: Cigna Commercial	$140.60
Rate for Payer: Cigna Medicare	$133.20
Rate for Payer: Medicaid All Medicaid	$136.16
Rate for Payer: Medicare All Medicare	$103.60
Rate for Payer: Monida Allegiance	$140.60
Rate for Payer: Monida First Choice Health	$143.56
Rate for Payer: Monida Montana Health Co-op	$140.60
Rate for Payer: Monida PacificSource	$140.60

LAB CATACHOLAMINES

Facility

$148.00

Service Code	HCPCS 82384
Hospital Charge Code	4082384
Hospital Revenue Code	300
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$148.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare	$133.20
Rate for Payer: BCBS MT CHIP	$133.20
Rate for Payer: BCBS MT Closed Plan Network	$140.60
Rate for Payer: BCBS MT HealthLink	$133.20
Rate for Payer: BCBS MT Medicare	$133.20
Rate for Payer: BCBS MT POS	$140.60
Rate for Payer: BCBS MT Traditional	$148.00
Rate for Payer: Cash Price	$133.20
Rate for Payer: Cigna Commercial	$140.60
Rate for Payer: Cigna Medicare	$133.20
Rate for Payer: Medicaid All Medicaid	$136.16
Rate for Payer: Medicare All Medicare	$103.60
Rate for Payer: Monida Allegiance	$140.60
Rate for Payer: Monida First Choice Health	$143.56
Rate for Payer: Monida Montana Health Co-op	$140.60
Rate for Payer: Monida PacificSource	$140.60

LAB CEA

Facility

$135.00

Service Code	HCPCS 82378
Hospital Charge Code	4086151
Hospital Revenue Code	301
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

LAB CEA

Facility

$135.00

Service Code	HCPCS 82378
Hospital Charge Code	4086151
Hospital Revenue Code	301
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

LAB CFTR GENE COM VARIANTS

Facility

$649.00

Service Code	HCPCS 81220
Hospital Charge Code	4081220
Hospital Revenue Code	300
Min. Negotiated Rate	$454.30
Max. Negotiated Rate	$649.00
Rate for Payer: Aetna Commercial	$616.55
Rate for Payer: Aetna Medicare	$584.10
Rate for Payer: BCBS MT CHIP	$584.10
Rate for Payer: BCBS MT Closed Plan Network	$616.55
Rate for Payer: BCBS MT HealthLink	$584.10
Rate for Payer: BCBS MT Medicare	$584.10
Rate for Payer: BCBS MT POS	$616.55
Rate for Payer: BCBS MT Traditional	$649.00
Rate for Payer: Cash Price	$584.10
Rate for Payer: Cigna Commercial	$616.55
Rate for Payer: Cigna Medicare	$584.10
Rate for Payer: Medicaid All Medicaid	$597.08
Rate for Payer: Medicare All Medicare	$454.30
Rate for Payer: Monida Allegiance	$616.55
Rate for Payer: Monida First Choice Health	$629.53
Rate for Payer: Monida Montana Health Co-op	$616.55
Rate for Payer: Monida PacificSource	$616.55

LAB CFTR GENE COM VARIANTS

Facility

$649.00

Service Code	HCPCS 81220
Hospital Charge Code	4081220
Hospital Revenue Code	300
Min. Negotiated Rate	$454.30
Max. Negotiated Rate	$649.00
Rate for Payer: Aetna Commercial	$616.55
Rate for Payer: Aetna Medicare	$584.10
Rate for Payer: BCBS MT CHIP	$584.10
Rate for Payer: BCBS MT Closed Plan Network	$616.55
Rate for Payer: BCBS MT HealthLink	$584.10
Rate for Payer: BCBS MT Medicare	$584.10
Rate for Payer: BCBS MT POS	$616.55
Rate for Payer: BCBS MT Traditional	$649.00
Rate for Payer: Cash Price	$584.10
Rate for Payer: Cigna Commercial	$616.55
Rate for Payer: Cigna Medicare	$584.10
Rate for Payer: Medicaid All Medicaid	$597.08
Rate for Payer: Medicare All Medicare	$454.30
Rate for Payer: Monida Allegiance	$616.55
Rate for Payer: Monida First Choice Health	$629.53
Rate for Payer: Monida Montana Health Co-op	$616.55
Rate for Payer: Monida PacificSource	$616.55

LAB CHLAMYDIA PNEUMONIA

Facility

$87.00

Service Code	HCPCS 87486
Hospital Charge Code	4087486
Hospital Revenue Code	306
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$82.65
Rate for Payer: Aetna Medicare	$78.30
Rate for Payer: BCBS MT CHIP	$78.30
Rate for Payer: BCBS MT Closed Plan Network	$82.65
Rate for Payer: BCBS MT HealthLink	$78.30
Rate for Payer: BCBS MT Medicare	$78.30
Rate for Payer: BCBS MT POS	$82.65
Rate for Payer: BCBS MT Traditional	$87.00
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial	$82.65
Rate for Payer: Cigna Medicare	$78.30
Rate for Payer: Medicaid All Medicaid	$80.04
Rate for Payer: Medicare All Medicare	$60.90
Rate for Payer: Monida Allegiance	$82.65
Rate for Payer: Monida First Choice Health	$84.39
Rate for Payer: Monida Montana Health Co-op	$82.65
Rate for Payer: Monida PacificSource	$82.65

LAB CHLAMYDIA PNEUMONIA

Facility

$87.00

Service Code	HCPCS 87486
Hospital Charge Code	4087486
Hospital Revenue Code	306
Min. Negotiated Rate	$60.90
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$82.65
Rate for Payer: Aetna Medicare	$78.30
Rate for Payer: BCBS MT CHIP	$78.30
Rate for Payer: BCBS MT Closed Plan Network	$82.65
Rate for Payer: BCBS MT HealthLink	$78.30
Rate for Payer: BCBS MT Medicare	$78.30
Rate for Payer: BCBS MT POS	$82.65
Rate for Payer: BCBS MT Traditional	$87.00
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial	$82.65
Rate for Payer: Cigna Medicare	$78.30
Rate for Payer: Medicaid All Medicaid	$80.04
Rate for Payer: Medicare All Medicare	$60.90
Rate for Payer: Monida Allegiance	$82.65
Rate for Payer: Monida First Choice Health	$84.39
Rate for Payer: Monida Montana Health Co-op	$82.65
Rate for Payer: Monida PacificSource	$82.65

LAB CHROMOGRANIN A

Facility

$94.00

Service Code	HCPCS 86316
Hospital Charge Code	4086316
Hospital Revenue Code	300
Min. Negotiated Rate	$65.80
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare	$84.60
Rate for Payer: BCBS MT CHIP	$84.60
Rate for Payer: BCBS MT Closed Plan Network	$89.30
Rate for Payer: BCBS MT HealthLink	$84.60
Rate for Payer: BCBS MT Medicare	$84.60
Rate for Payer: BCBS MT POS	$89.30
Rate for Payer: BCBS MT Traditional	$94.00
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cigna Commercial	$89.30
Rate for Payer: Cigna Medicare	$84.60
Rate for Payer: Medicaid All Medicaid	$86.48
Rate for Payer: Medicare All Medicare	$65.80
Rate for Payer: Monida Allegiance	$89.30
Rate for Payer: Monida First Choice Health	$91.18
Rate for Payer: Monida Montana Health Co-op	$89.30
Rate for Payer: Monida PacificSource	$89.30

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