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Lab
PROCEDURE NAME UNIT PRICE
TCIPF B CELLS TOTAL 86355 $351.00
TCIPF NK CELLS 86357 $351.00
TCIPF T CELLS TOTAL 86359 $351.00
TCIPF CD4 CD8 ABSOLUTE COUNT 86360 $372.00
DEAMID. GLIADIN AB IGA 83516.018 $36.00
DEAMID. GLIADIN AB IGG 83516.019 $36.00
TISSUE TRANSGLUTAMINASE IGG AB 83516.034 $47.00
ANTI PARIETAL CELL ANTI 83516.003 $46.00
CHIKUNGUNYA IGG IGM AB 86790.010 $255.00
MI-2 AUTOANTIBODY 83516.030 $36.00
ANTI SMOOTH MUS AB IGG 83516.002 $159.00
HISTONE ANTIBODIES 83516.001 $48.00
ACTIVATED CLOTTING TIME 85347 $116.00
MITOCHONDRIAL AB M2 83516.029 $37.00
MYELOPEROXIDASE AB $138.00
PROTEINASE 3 AB 83516.016 $183.00
TISSUE TRANSGLUTAM. IGA 83516.023 $184.00
INFUENZA AB 87502.006 $197.00
INFLUENZA AB AND RSV 87631.004 $435.00
STREP GROUP A 87651.003 $120.00
FISH INTERP & REPORT SO 88291 $75.00
HAIR DRUG TEST $72.00
MRO REVIEW-HAIR DRUG TESTING $166.00
BREATH HYDROGEN TEST $226.00
RBC LR PROC UNIT P9016 $717.00
FRESH FRZ PLASM PROC UNITP9017 $236.00
PLATELET PHERES LEUKOREDUCED $2,317.00
PLASMA FROZEN WIN 24 HOURS P9059 $236.00
CRYOPRECIPITAT PROC UNIT P9012 $415.00
BLOOD L R CMV-NEG $76.00
PROTIME - PROTIME CLINIC 85610 $23.00
RBC ANTIGEN TYPING PT 86905 $130.00
CHLAMYDIA AB 86631 $72.00
CROSSMATCH ELECTRONIC 86923 $147.00
ARTERIAL PUNCTURE $65.00
GLUCOSE POCT 82962 $26.00
SKIN TEST CANDIDA 86485 $29.00
SKIN TEST TB INTRADERM 86580 $30.00
ED 36415 VENIPUNCTURE $17.00
MORPMET ALYS TMR IMHCEM 88361 $384.00
PSA TOTAL 84153 $140.00
PAMG-1 CERVICOVAGINAL 84112 $252.00
CARDIOLIPIN ANTIBODY IGA 86147 $69.00
BETA-2 GLYCOPROTEN IGA 86146 $69.00
RBC $28.00
CARDIOLIPIN IGG AB $66.00
Page 1 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
CARDIOLIPIN IGM AB $66.00
BETA 2 GP1 AB IGG $66.00
BETA 2 GP1 AB IGM $66.00
EGG WHITE ALLERGEN COMPONENT PANEL 86008.003 $16.00
MILK ALLERGEN COMPONENT PANEL 86008.005 $16.00
PEANUT ALLERGEN COMPONENT PANEL 86008.006 $16.00
CBC AUTOMATED WDIFF 85025 $98.00
ESR AUTOMATED 85652 $41.00
AMYLASE 82150 $90.00
GLUCOSE 82947 $54.00
IRON 83540 $57.00
TROPONIN QUANT 84484 $114.00
TSH 84443 $160.00
COMPREHENS METABOLC PANL 80053 $59.00
LIPID PROFILE 80061 $107.00
URINALYSIS W MICROSCOPIC 81001 $25.00
FREE T4 84439 $100.00
LIPASE 83690 $60.00
CBC AUTOMATED NO DIFF 85027 $82.00
GLYCOSYLATED (A1C) HGB 83036 $79.00
C REACTIVE PROTEIN QUANT 86140 $54.00
HEP B SURF ANTIGEN HBSAG87340 $109.00
AMIKACIN 80150 $43.00
ALPHA-1-ANTITRPSIN FECA $63.00
PANCREATIC POLYPEPTIDE 83519 $140.00
SULFATIDE AUTOANTIBODY 83520 $345.00
MAGNESIUM STOOL 83735 $48.00
PHENYLALANINE 84030 $59.00
ACID PHOSPHATASE PROST 84066 $41.00
TYROSINE $98.00
ANTIDIURETIC HORMONE 84588 $82.00
FACTOR II ASSAY 85210 $101.00
ACTIVATED PROTEIN C RES 85307 $97.00
D-DIMER QUANT 85379 $126.00
NATURAL KILLER CELLS 86357 $146.00
SACCHA CEREV IGG IGA 86671 $109.00
HIV AB CONFIRM 86689 $191.00
HEP B CORE AB-IGM ONLY 86705 $49.00
HEP A ACUTE AB-HAV-IGM 86709 $126.00
RUBELLA ANTIBODY IGM 86762 $71.00
HERPES VIRU 6 AB HHV-6 86790 $110.00
MIX STUDY PROTIME $56.00
CHLAMYDIA IGM 86632 $48.00
LEAD 83655 $67.00
BETA HYDROXYBUTYRATE 82010 $29.00
CYSTATIN C $67.00
Page 2 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
HEMOSIDERIN QUAL 83070 $62.00
SALIVA TEST $48.00
NEUROMYELITIS OPTICA IGG 86255 $223.00
PAE RFLX BILL ACH REC 83519 $51.00
SEROTONIN RELEASING ASSAY $425.00
BERYLLIUM 83018 $122.00
MYCOBACTERIA PCR 87556 $177.00
VITAMIN B2 84252 $67.00
SCHISTOSOMA AB 86682 $170.00
BETHESDA UNITS 85335 $190.00
FACTOR VIII INHIB SCR 85335 $348.00
VON WILEBRND WRKUP INTRP 85390 $65.00
F8IS FACTOR VIII INTERP 85390 $68.00
SPECIAL COAG INTERP 85390 $68.00
RENIN WITH ALDOSTERONE 84244 $218.00
CDMR CYP2D6 COMMON VAR 81226.002 $579.00
FLT3 GENE ITD VARI 81245 $500.00
PLASMINOGEN ACTIVITY 85420 $95.00
YEAST CULTURE $90.00
BRUCELLA AB SCREEN IGM $224.00
CREATININE URINE $23.00
NEUTROPHIL SPECIFIC AB 86255 $27.00
SACCH. CEREVISIAE AB IGA 83520 $27.00
SACCH. CEREVISIAE AB IGG 83520 $27.00
CLOZAPINE 80159 $45.00
PARANEOPLAST AUTO AB 86255 $70.00
PS/PT AB G,M 86148 $226.00
CONNECT TISSUE ANTINUCLEAR AB 86038.007 $37.00
CONNECT TISS CYCLIC CITRULLINATED PEPTIDE AB 86200.003 $38.00
MYASTHENIA GRAVIS ACH RECPT AB 83519 $123.00
MYASTHENIA GRAVIS STRIAT MUSCLE RECPT AB 83520 $69.00
SODIUM FECES PANEL 84302 $41.00
OSMOLALITY FECES PANEL 84999 $5.00
POTASSIUM FECES PANEL 84999 $5.00
CHLORIDE FECES PANEL 82438 $41.00
BARBITUATE 80345 G0480 $87.00
HIV 1,2 ANTIBODY HIV ANTIGEN $91.00
AZETHIOPRINE 80375 G0480 $179.00
TREPONEMA PALLIDUM ANTIBODY 86780 $82.00
LO OPIATE CONFIRM MECONIUM 80361 G0480 $103.00
LO OPIATE CONFIRM MECONIUM 80365 G0480 $103.00
AMPHETAMINE CONF MECONIUM 80324 G0480 $108.00
AMPHETAMINE CONF MECONIUM 80359 G0480 $108.00
REDUCING SUBSTANCE, FECAL 84376 $80.00
TOTAL LT CHAIN KAPPA OR LAMBDA UR 83883.005 $49.00
DRUG SCREEN PRESUMP CHEM ANALYZER 80307 $140.00
Page 3 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
BUPRENORPHINE 80307 $214.00
PAIN CLINIC SURVEY WITH REFLEX 80307 $92.00
DRUG SCR PRESC OTC 80307 $69.00
AMPHETAMINE 80325 G0480 $44.00
HCG QUANT 84702 $126.00
AFP TUMOR MRKR 82105 $91.00
CULTUR TB ACID FST BACILL87116 $88.00
CONCENTRATION (AFB) 87015 $91.00
SMEAR FLUORES ACD FST STN87206 $49.00
OB UA DIPSTK NONAU 81002 $17.00
BLD GAS CAL O2SAT 82803 $260.00
HEMATOCRIT 85014 $28.00
HEMOGLOBIN 85018 $28.00
DIFFERENTAIL MANUAL 85007 $8.00
PROTIME 85610 $60.00
PTT 85730 $84.00
WBC 85048 $28.00
ABO 86900 $36.00
ANTIBODY SCREEN 86850 $116.00
RH 86901 $36.00
DIRECT COOMBS 86880 $54.00
ALBUMIN 82040 $54.00
ALKALINE PHOSPHATE 84075 $65.00
ALT 84460 $30.00
AST 84450 $57.00
TOTAL BILI 82247 $54.00
DIRECT BILI 82248 $28.00
BUN 84520 $54.00
CALCIUM 82310 $46.00
CARBON DIOXIDE 82374 $24.00
CHLORIDE 82435 $24.00
CHOLESTEROL 82465 $62.00
CPK 82550 $57.00
CREATININE 82565 $54.00
LDH 83615 $57.00
PHOSPHORUS 84100 $65.00
POTASSIUM 84132 $47.00
SODIUM 84295 $46.00
TRIGLYCERIDES 84478 $79.00
URIC ACID 84550 $51.00
DIGOXIN 80162 $162.00
MAGNESIUM 83735 $79.00
CKMB 82553 $105.00
SERUM KETONE 82009 $26.00
PSA 84153 $139.00
T4 84436 $88.00
Page 4 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
MONOSCREEN 86308 $61.00
PREGNANCY TEST (URINE) 81025 $79.00
HCG QUAL 84703 $79.00
RPD GROUP A STREP SCREEN 87880 $50.00
BASIC METABOLIC PANEL 80048 $47.00
PANEL HEPATIC FUNCTION 80076 $57.00
RENAL FUNCTION PANEL 80069 $49.00
ELECTROLYTE PANEL 80051 $54.00
CAPILLARY COLLECTION 36416 $23.00
GRAM STAIN 87205 $36.00
URINALYSIS-DIPSTICK ONLY 81003 $29.00
MICROALBUMIN 82043 $54.00
VENIPUNCTURE 36415 $14.00
WET MOUNT INFECT AGENT 87210 $36.00
CULTURE ANAEROBIC 87075 $89.00
CULT STOOL SAL SHIG SCR 87045 $47.00
CULTURE URINE 87086 $66.00
OVA AND PARASITES 87177 $107.00
SENSITIVITY STUDY MIC 87186 $105.00
VITAMIN B12 82607 $156.00
CA 125 86304 $146.00
CREATININE CLEARANCE 82575 $97.00
CA 27-29 86300 $126.00
CEA 82378 $116.00
CYCLOSPORINE 80158 $48.00
PHENYTOIN 80185 $184.00
FERRITIN 82728 $151.00
RBC FETAL ROSETTE 85461 $89.00
FOLATE 82746 $151.00
H PYLORI IGG 86677 $134.00
TACROLIMUS 80197 $53.00
CARBAMAZEPINE (TEGRETOL) 80156 $184.00
CROSSMATCH ANTIGLOBULIN 86922 $146.00
GLUC TOL 3 SPEC & DOSE 82951 $146.00
HDL 83718 $41.00
GLUCOSE BODY FLD 82945 $54.00
PROTEIN TOT SER 84155 $54.00
B-TYPE NATRI PEPT 83880 $205.00
INFLUENZA A 87400 $72.00
CLINITEST DIPSTICK TABLET81002 $17.00
SPERM PRESENCE MOTILITY 89321 $39.00
CULTURE BLOOD 87040 $148.00
CULTURE VIRAL 87252 $74.00
AEROBIC DEFINITIVE ID 87077 $45.00
IRON BINDING 83550 $66.00
PHENOBARBITOL 80184 $184.00
Page 5 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
THEOPHYLLINE 80198 $189.00
AMMONIA 82140 $144.00
CALCIUM IONIZED 82330 $105.00
CREATININE RAND UR 82570 $62.00
CREATININE 24 HR UR 82570 $79.00
GGTP (GAMMA GT) 82977 $57.00
PSA FREE 84154 $139.00
SODIUM URINE 84300 $48.00
C PEPTIDE 84681 $88.00
ANTITHROMBIN III ACTIVITY85300 $174.00
PROTEIN C ACTIVITY 85303 $229.00
PROTEIN S ACTIVITY 85306 $225.00
FIBRINOGEN QUANT ASSAY 85384 $114.00
ANTINUCLEAR ANTIBODY SCRE86038 $114.00
ANTI MITOCHONDRIAL ANTIBO86255 $142.00
RPR 86592 $51.00
MYCOPLASMA ANTIBODY TITER86738 $72.00
ANTIBODY ID 86870 $359.00
RBC ANTIGEN TYPING UNIT 86902 $57.00
LEGIONELLA ANTIGEN URINE 87450 $128.00
CELL COUNT BDY FLD WDIFF89051 $107.00
SEROQUEL (QUETIAPINE) 80342 G0480 $134.00
HOMOCYSTEINE PLASMA 83090 $109.00
PSA SCREENING G0103 $139.00
COLD AGGLUTININ 86157 $48.00
STONE ANAL 82365 $38.00
CORTISOL TOTAL SER 82533 $139.00
FSH 83001 $171.00
LUTENIZING HORMONE 83002 $206.00
INSULIN LEVEL 83525 $133.00
ESTROGEN SER TOT 82672 $144.00
LITHIUM 80178 $107.00
ACTH HIGH SENS 82024 $222.00
MUMPS IGG SCREEN 86735 $43.00
HEPATITIS B SURFACE ANTIB86706 $168.00
EPSTEIN B VIRUS AB COMPLE86665 $45.00
ELECTROPHORESIS SER 84165 $108.00
FETAL FIBRINECTIN ASSAY 82731 $510.00
RUBELLA ANTIBODY SCRN IGG86762 $50.00
CALCIUM 24 HR UR 82340 $34.00
PLATELET COUNT 85049 $61.00
IMMUNOFIX ELECT24HR URINE86335 $120.00
CA 19-9PANCREATIC CANCER86301 $113.00
VIT D 1 25-DIHYDROXY SER 82652 $207.00
VITAMIN B6 84207 $152.00
VIT D 25-HYDR 82306 $109.00
Page 6 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
RBC FETL KLEIHAUER-BETKE 85460 $129.00
RA FACTOR QUALITATIVE 86430 $74.00
COMPLEMENT ANTIGEN EA 86160 $95.00
HEPARIN ANTI-XA ASSAY 85520 $100.00
HEPATITIS C ANTIBODY 86803 $206.00
HANDLING CHARGE DRAW AND PROCESS $59.00
VALPROIC ACID (DEPAKANE) 80164 $164.00
METHOTREXATE 80299 $152.00
SULFONYL UREA SCREEN 82542 $114.00
CYCLOSPORIN S.O. 80158 $48.00
ZARONTIN-ETHOSUXIMIDE 80168 $67.00
PRIMIDONE (MYSOLINE) 80188 $156.00
TOPIRAMATE (TOPAMAX) 80201 $177.00
AMIODARONE 80299.018 $57.00
LACOSAMIDE 80299 $189.00
FELBAMATE 80299 $140.00
LAMOTRIGINE (LAMICTAL) 80299 $132.00
SIROLIMUS (RAPAMUNE) 80195 $47.00
URINE AUTO NO MICRO SGL ANALYT $29.00
URINALYSIS DIPSTICK POCT $29.00
URINALYSIS MICRO 81015 $22.00
ACYLCARNITINE BLOOD 82017 $65.00
IGG SYN ALB CSF $34.00
ALBUMIN URIN OTHER SOURCE82042 $34.00
ALDOLASE 82085 $112.00
ALDOSTERONE 82088 $218.00
ALPHA-1-ANTITRYP 82103 $96.00
ALPHA FETOPROTEIN MAT $144.00
ALUMINUM 82108 $132.00
AMINOLEVULENIC ACID 82135 $183.00
AMINO ACID QUANT LEVEL I 82139 $203.00
AMYLASE ISO & TOTAL $87.00
ANDROSTENEDIONE 82157 $373.00
ANGIOTENSION ENZ ACE 82164 $154.00
APOLIPOPROTEIN A1 B 82172 $59.00
ARSENIC URINE 82175 $29.00
HEAVY METAL SCR ARSENIC 82175 $29.00
ASCORBIC ACID VITAMIN C 82180 $59.00
BETA 2 MICROGLOBULIN 82232 $131.00
BILE ACIDS TOTAL 82239 $98.00
BILIRUBIN AMNIOTIC FL 82247 $54.00
BIOTINIDASE SERUM 82261 $65.00
NEWBORN METAB SCR BIOTIN 82261 $65.00
OCCULT GASTRIC 82271 $19.00
OCCULT BLOOD 82272 $20.00
CADMIUM 82300 $29.00
Page 7 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
HEAVY METAL SCR CADMIUM 82300 $29.00
CALCITONIN 82308 $257.00
CARBON MONOXIDE 82375 $105.00
CARNITINE SERUM 82379 $216.00
CATECHOLAMINE FRACT BLOOD82384 $130.00
CERULOPLASMIN 82390 $82.00
CHLORIDE URI 82436 $37.00
CHOLINSTERASE SERUM 82480 $116.00
CHROMIUM 82495 $111.00
CITRATE URINE 82507 $62.00
COPPER 82525 $110.00
CORTISOL SALIVA $139.00
CREATININE FLUID 82570 $28.00
CRYOGLOBULIN QUAL 82595 $47.00
B 12 BINDING CAPACITY 82608 $163.00
DHEA 82626 $228.00
DHEA SULFATE 82627 $120.00
TPMT ENZYME 82657 $291.00
ERYTHROPOIETIN 82668 $101.00
ESTRADIOL 82670 $145.00
ESTRONE 82679 $315.00
FECAL FAT QUANT 82710 $210.00
FOLIC ACID RBC 82747 $122.00
GALACTOSE-1-PHOS URIDYL 82775 $85.00
IGG SYN IGG CSF SERUM $68.00
IMMUNOGLOBULIN G $68.00
IGD 82784 $140.00
IGE 82785 $19.00
IGG SUBCLASS IGG 1 2 3 4 82787 $100.00
PH BLOOD 82800 $79.00
BLOOD GASES 82805 $260.00
GASTRIN 82941 $128.00
GLUCAGON $75.00
G6PD 82955 $72.00
FRUCTOSAMINE 82985 $67.00
FSH S.O. $194.00
LUTEINIZING HORMONE S.O. $183.00
GROWTH HORMONE 83003 $91.00
HAPTOGLOBIN 83010 $92.00
H PYLORI BREATH ANALYSIS 83013 $118.00
H PYLORI BREATH COL 83014 $44.00
HEAVY METAL 24 HR UA 83018 $71.00
HEMOGLOBIN ELP 83020 $48.00
NEWBORN METAB SCR HGB 83020 $48.00
HEMOGLOBIN ELP HPLC 83021 $201.00
METHEMOGLOBIN QUANT 83050 $62.00
Page 8 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
HISTAMINE 83088 $228.00
HOMOVANILLIC ACID U 83150 $192.00
HIAA-5 24 HR URINE 83497 $140.00
HIAA-5 RANDOM URINE $140.00
HYDROXYPROGESTERONE-17 $160.00
HYDROXYPROGESTERONE 17A 83498 $160.00
NEWBORN METAB SCR 170HP 83498 $22.00
NEWBORN METAB SCR CF 83516 $45.00
TISSUE TRANSGLUT $62.00
PARNEOPLST-CA CHANL BIND 83519 $74.00
IGF BINDING PROTEIN-3 83519 $245.00
21 HYDROXYLASE AB 83519 $245.00
ACETYLCHOLINE REC BL AB 83519 $128.00
THYROTROPIN RECEPTOR AB 83519 $267.00
IBD IMMUNO QUANT 83520 $39.00
PARANEOPLAST STRIAT AB 83520 $71.00
ANTI GLOMERULAR BASEMT 83520 $67.00
ANTIGLIADIN AB IGA IGG 83516 $64.00
INTERFERON BETA AB 83520 $273.00
TRYPTASE 83520 $158.00
D-LACTATE $118.00
LACTATE (LACTIC ACID) 83605 $118.00
LDH ISOENZYME 83625 $91.00
HEAVY METAL SCR LEAD 83655 $84.00
LEAD BLOOD WITH DEMOGRAPHICS 83655 $66.00
LIPOPROTEIN A 83695 $120.00
LDL DIRECT 83721 $53.00
THIOPURINE METH TRAN 83789 $138.00
HEAVY METAL SCR MERCURY 83825 $29.00
MERCURY 83825 $86.00
METANEPHRINE 83835 $92.00
METANEPHRINES PLASMA 83835 $163.00
MUCOPOLYSACCHARIDES QNT 83864 $93.00
MYOGLOBIN URINE 83874 $264.00
MYOGLOBIN 83874 $264.00
OLIGOCLONAL BANDS 83916 $109.00
OLIGOCLONAL BAND MS 83916 $109.00
ORGANIC ACID SCR URINE 83919 $82.00
GHB-GAMMA HYDRXYBT ACID 83921 $286.00
METHYLMALONIC ACID SER 83921 $286.00
OSMOLALITY FLUID 83930 $109.00
OSMOLALITY URINE 83935 $72.00
OSTEOCALCIN $103.00
PTH INTACT 83970 $156.00
PH NONBLOOD 83986 $38.00
PKU MONITOR SPOT TEST 84030 $23.00
Page 9 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
ALK PHOS ISO TOTAL 84075 $30.00
ALKALINE PHOS ISOENZYME 84080 $49.00
PHOSPHORUS UR 84105 $29.00
PORPHOBILINOGEN 24HR UR 84110 $110.00
K: URINE 84133 $36.00
PREALBUMIN 84134 $79.00
HYDROXYPREG-17 84143 $188.00
PROGESTERONE 84144 $129.00
PROLACTIN 84146 $206.00
PROTEIN TOT UR 84156 $54.00
PROTEIN TOT OTH 84157 $54.00
PROTEIN ELECTRO URI 84166 $140.00
PROINSULIN 84206 $189.00
PYRUVIC ACID 84210 $212.00
RENIN 84244 $119.00
SELENIUM BLOOD 84255 $116.00
SEROTONIN BLOOD 84260 $278.00
SEX HORMONE BIND GLOB 84270 $134.00
SOMATOMEDIN-C (IGF-1) 84305 $318.00
TESTOSTERONE FREE 84402 $124.00
TESTOST TOTAL COMBO 84403 $140.00
TESTOSTERONE TOTAL 84403 $158.00
VITAMIN B1 84425 $72.00
THYROGLOBULIN 84432 $62.00
NEWBORN METAB SCR T4 84437 $25.00
T4 FREE BY EQU DIR DIAL $100.00
TBG-THYROXIN BDG GLOB 84442 $79.00
THYROID STIM IMMUNOGLOB 84445 $290.00
TOCOPHERAL ALPHA (VIT E) 84446 $147.00
TRANSFERRIN 84466 $85.00
T3 UPTAKE 84479 $134.00
T3 TOTAL (TRIIODOTHYRON) 84480 $41.00
T3 FREE 84481 $92.00
T3 REVERSE 84482 $155.00
UREA NITROGEN URINE 84540 $62.00
URIC ACID OTHER 84560 $27.00
VMA 24HR UR 84585 $122.00
VASOACTIVE INT PEPTIDE 84586 $122.00
VITAMIN A 84590 $156.00
VITAMIN K 84597 $218.00
ZINC 84630 $80.00
OSMOLALITY STOOL 84999 $3,087.00
K: STOOL 84999 $3,087.00
DIFFERENTIAL AUTOMATED 85004 $9.00
FACTOR V 85220 $214.00
FACTOR VII 85230 $188.00
Page 10 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
FACTOR VIII 85240 $205.00
FACTOR VIII IH 85240 $205.00
VON WILLIBRAND ANTIGEN 85246 $194.00
VONWILLEBRAND FAC MULTI 85247 $107.00
FACTOR IX 85250 $225.00
FACTOR X 85260 $201.00
FACTOR XI $249.00
FACTOR XII $161.00
ANTITHROMBIN III ANTIGN 85301 $228.00
PROTEIN C ANTIGEN 85302 $174.00
PROTEIN S AG TOTAL 85305 $296.00
PROTEIN S AG FREE 85306 $225.00
OSMOTIC FRAGILITY $189.00
PLATELET AGGREGATE AGG $117.00
PLATELET FUNCTION-EPI $117.00
PLATELET FUNCTION EPI ADP 85576 $117.00
DILUTE RUSS VIP CONFIRM $54.00
DILUTE RUSSELLS VIPER 85613 $54.00
SICKLE CELL TEST 85660 $38.00
THROMBIN TIME 85670 $54.00
VISCOSITY SERUM 85810 $176.00
FRANCISELLA AB SERUM 86668 $107.00
ALERGEN SPEC IGE QNT SO 86003 $32.00
1 ANCA TITER 86256 $67.00
ANCA-MPO MYELOPEROXIDAS 86021 $138.00
ANCA 86255 $138.00
ANCA-PR3 PROTEINASE 3 86021 $183.00
PLATELET ANTIBODY 86022 $386.00
CELL BOUND PLATELET AB 86022 $386.00
HEPARIN PF4 AB -HIT $386.00
ANA TITER 86039 $59.00
ANTISTREPTOLYSIN O TITR 86060 $148.00
C-REACTIVE PROTEIN HISEN 86141 $71.00
ANTIPHOSPHATIDYL G M A 86148 $207.00
C1 ESTERASE INHIBITOR 86160 $95.00
C1 ESTERASE INH FUNCT 86161 $108.00
COMPLEMENT TOTAL 50 86162 $140.00
CYCLIC CITR PEP AB(CCP) 86200 $138.00
ANTI DNASE B 86215 $179.00
ANTI DNA DBL STRAND AB 86225 $41.00
ANTI DNA SINGLE STRAND 86226 $109.00
ANTI SCL70 86235 $46.00
JO-1 AB 86235 $46.00
ENA ANY AB 86235 $46.00
PARANEOPLAST-ANNA PCA 86256 $66.00
CA 15-3 ANTIGEN 86300 $112.00
Page 11 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
CHROMOGRANIN A 86316 $80.00
HIV 1 & 2 RAPID 86703 $71.00
HYPERSENS PN IMMUNODI AB 86331 $194.00
IMMUNOFIXATION 86334 $201.00
INHIBIN 86336 $280.00
CD19 TOTAL 86355 $146.00
CD3 (T CELL TOTAL) 86359 $146.00
CD4 CD8 86360 $43.00
T-HELPER LYMPH MARKER 86361 $71.00
ANTITHYROID AB ANTI TPO 86376 $82.00
LIVER KDNEY MIC TYP1 AB 86376 $32.00
BACTERIAL ANTIGEN 86403 $54.00
CRYPTOCOCCUS ANTIGEN 86403 $140.00
RHEUMATOID FACTOR QUANT 86431 $119.00
VDRL CSF 86592 $67.00
PNEUMOCOCCAL AB EA 86317 $79.00
B PERTUSS AB IGG BY MAID 86615 $148.00
LYMES WESTERN BLOT 86617 $116.00
LYMES TOTAL 86618 $170.00
BRUCELLA ANTIBY IGG IGM 86622 $146.00
CHLAMYDIA TITER IGG IGA 86631 $103.00
CHLAMYDIA TITER IGM 86632 $103.00
Q FEVER AB G M 86638 $91.00
CMV IGG AB 86644 $80.00
CMV IGM AB 86645 $70.00
DIPHTHERIA ANTIBODY 86648 $101.00
COXSACKI A 86658 $425.00
COXSACKIE B (1-6) 86658 $256.00
EPSTEIN BARR EARLY AG 86663 $138.00
EB VIRUS-EBNA 86664 $39.00
EPSTEIN B VIRUS-VCA 86665 $98.00
HEMOPHILUS INFLUENZA AB 86684 $86.00
HTLV 1 ANTIBODY 86790 $41.00
HERPES SMPLX VIR AB IGM 86694 $63.00
HERPES SIMPLX VIR1 IGG 86695 $72.00
HERPES SMPLX VIR 2 IGG 86696 $106.00
HISTOPLASMA AB 86698 $66.00
HEP B CORE AB TOTAL 86704 $57.00
HEP BE AB-HBEAB 86707 $64.00
HEP A TOTAL 86708 $88.00
LEPTOSPIRA ANTIBODY 86720 $146.00
MUMPS TITER G&M 86735 $45.00
PARVOVIRUS IGM IGG 86747 $84.00
E HISTOLYTICA AB $106.00
RICKETTSIA AB-RICK TYPHI 86757 $48.00
RUBEOLA TITER IGG IGM 86765 $40.00
Page 12 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
RUBEOLA IGG ANTIBODY 86765 $40.00
TETANUS ANTIBODY EIA 86774 $101.00
TOXOPLASMA IGG 86777 $46.00
TOXOPLASMA IGM 86778 $47.00
FLUORES TREPONEMAL AB 86780 $57.00
VARICELLA ZOSTER IGG&IGM 86787 $47.00
VARICELLA ZOSTER SCREEN 86787 $47.00
HANTAVIRUS ANTIBODY 86790 $82.00
W NILE VIR G SER OR CF 86789 $62.00
ANTI THYROGLOBULIN AB 86800 $37.00
THYROGLOBULIN AB 86800 $62.00
HLA-B27 ANTIGEN 86812 $75.00
ELUTION 86860 $224.00
ANTIBODY TITER 86886 $107.00
CROSSMATCH IMMEDIATESPIN 86920 $146.00
CULTURE STOOL ADD PATHGN87046 $66.00
CULTURE: STOOL SAL SHIG 87045 $60.00
CULT STOOL ADD'L PLT SCR 87046 $66.00
CULTURE: BACT OTHER 87070 $95.00
CULTURE: BACT RESPITOR 87070 $107.00
ANAEROBIC IDENTIFICATION 87076 $37.00
PATHOGENIC ORGANISM SCR 87081 $54.00
H PYLORI BIOPSY 87081 $84.00
ISOLAT&PRESUMPT ID URINE 87088 $32.00
CULTURE:FC SKN-HAIR-NAIL 87101 $96.00
CULTURE: FUNGUS $95.00
CULTURE: FUNGUS BLOOD 87103 $159.00
CULTURE: FUNGUS YEAST ID $37.00
CULTURE TB BLOOD 87116 $88.00
CULTURE: AFB ID 87118 $114.00
CULT CHLAMYDIA TRACHOMA 87110 $64.00
CULTURE: TYPING ANTISERU 87147 $57.00
PARASITE ID-ARTHROPOD 87168 $19.00
PARASITE ID-WORM 87169 $19.00
PIN WORM EXAM 87172 $28.00
SENSITIVITY STUDY KB 87184 $98.00
BETA LACTAMASE 87185 $45.00
SENSITIVITY AEROB MIC SO $105.00
MALARIA SMEAR 87207 $97.00
TRICHROME STAIN 87209 $98.00
KOH SKIN HAIR NAILS 87220 $25.00
CMV RAPID CULTURE 87254 $91.00
GIARDIA LAMBLIA 87329 $66.00
H PYLORI AG STOOL 87338 $59.00
HEP B SURF AG CONF 87341 $130.00
HEP BE AG-HBEAG 87350 $68.00
Page 13 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
HISTOPLASMA AG URINE 87385 $142.00
ROTAVIRUS FECAL 87425 $66.00
SHIGA-LIKE TOXIN 87427 $66.00
ASPERGILLUS ANTIGEN 87305 $126.00
CHLAMYDIA BY AMPLIFICAT 87491 $134.00
CMV PCR 87496 $396.00
HEP B VIRAL DNA 87517 $227.00
HEP C GENOTYPE PCR 87902 $680.00
HEP C VIRUS BY BDNA 87522 $533.00
HEP C RNA PCR QNT 87522 $533.00
HIV 1 RNA PCR QNT 87536 $141.00
GC BY DNA AMPLIFICATION 87591 $134.00
ENTEROVIRUS RT-PCR 87498 $377.00
VARICELLA ZOSTR PCR CSF $131.00
EPSTEIN BARR PCR NON-BLOOD 87798 $131.00
PERTUSSIS PCR 87798 $156.00
BK VIRUS DNA QUANT 87799 $159.00
INFLUENZA A B DIRECT 87804 $51.00
RSV DIRECT ELISA 87807 $215.00
HIV-1 GENOTYPE $725.00
SYN FLUID CRYSTAL 89060 $54.00
EOSINOPHIL SMEAR 89190 $45.00
HANDLING CHARGE $28.00
ESR NON AUTOMATED 85651 $28.00
PTT SUBSTITUTION 85732 $84.00
MIX STUDY PTT 85732 $84.00
IRRADIATION CHARGE CONTRACT $433.00
AB BACTERIUM NES 86609 $418.00
INSULIN ANTIBODIES 86337 $117.00
VALPROIC ACD TOT S.O.80164.003 $164.00
HERPES SIMPLEX VIR PCR 87529 $97.00
NOROVIRUS FECAL 87799 $230.00
HISTAMINE 24HR URINE 83088 $228.00
ITRACONAZOLE 80299 $74.00
GLUCOSE & DOSE 82950 $68.00
ALPHA SUBUNIT GONADOTRO 83520 $65.00
COMPLEMENT C2 86160 $95.00
CATECHOLAMINES FRAC URINE 24HR 82384 $135.00
PANCREATIC ELASTASE 1FE $118.00
CULTURE:DERMATOPHYTE SCR $96.00
STREP PNEUMO URINARY AG 87450 $128.00
LYMES IGG IGM 86618 $92.00
CPK ISO ELECTROPHORESIS 82552 $45.00
ENDOMYSIAL IGA AB QUAL 86255 $128.00
CARBAMAZEPINE FREE $181.00
H PYLORI IGM $134.00
Page 14 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
CMV DNA QUANTITATIVE 87497 $162.00
HGB ELP IEL CONFIRM 82664 $174.00
HGB ELP CASCADE 2 UNSTABLE $85.00
IDENDIFICATION AER SO $44.00
INFECT AGT NUC ACD AMP EA ORG $166.00
UNIT SPLITTING FEE 86985 $5.00
INHIBIN B 83520 $122.00
CALPROTECTIN 83993 $318.00
VEN BLD COLLECTION IVAD 36591 $92.00
VMA RANDOM UR 84585 $122.00
URINE DRUG SCR COLLECTCORP CHG $38.00
LACTOFERRIN FECAL QUAL 83630 $107.00
ADAMTS13 VWFCP 85397 $245.00
W NILE VIR M SER OR CF 86788 $62.00
HEAVY METAL URINE ARSENIC $29.00
CELL CNT BDY FLD NO DIFF89050 $45.00
SEMEN ANALYSIS COMPLETE 89322 $171.00
ZINC PROTOPORPHYRIN $91.00
NT-PRO B-TYPE NATRIU PEPTIDE 83880 $205.00
IGG SYN ALB SERUM $54.00
GALACTOSE 1 PHOSPHATE RBC84378 $128.00
GLUC TOL ADD SPECS 82952 $28.00
CORTISOL FREE 82530 $164.00
MANGANESE 83785 $103.00
RETICULOCYTE WITH CELLULAR PARAMETER 85046 $41.00
INTRINSIC FACTOR ANTIBODY86340 $110.00
ALLERGEN IGG 86001 $23.00
ALLERG SPEC IGE QUANT 86003 $20.00
CREATININE UA FOR DISORD 82570 $27.00
FREE LIGHT CHAIN 83883 $19.00
SPERM ANTIBODY 89325 $155.00
FACTOR X ACTIVITY BY CHROM $260.00
ESTRIOL 82677 $131.00
IMUNOASSAY NONINF MULT 83516 $318.00
COCCIDIODES AB 86635 $79.00
DISSACHARIDASE ANALYSIS 82657 $372.00
YEAST SUSCEPTIBILITY $195.00
BLD OCC FECAL HGB DETERM 82274 $87.00
OXALATE 83945 $42.00
PROLACTIN PITUITARY MACROADENO $206.00
COLLAGEN XLINK LEVEL 2 82523 $38.00
COPPER 24 HR URINE 82525 $144.00
OBSTETRIC PANEL 80055 $128.00
GENTAMICIN PEK TRGH RANDM80170 $203.00
TOBRAMYCIN PEK TRGH RNDM 80200 $72.00
VANCOMYCIN PEK TRGH RNDM 80202 $201.00
Page 15 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
CARBOHYDRATE DEFIC TRANS 82373 $74.00
CREATINE 82540 $148.00
IMMUNOGLOB A G OR M EACH82784 $68.00
GLUCOSE BLD REAGENT STRIP82948 $20.00
PORPHY URINE QUANT&FRACT 84120 $122.00
SULFATE URINE 84392 $27.00
VITAMIN NOT OTH SPEC 84591 $268.00
COLD AGGLUTININ SCREEN 86156 $48.00
ASPERGILLUS ANTIBODY 86606 $155.00
HIV 1 AB 86701 $90.00
LAB COLLECT PRORATED TRIP CHRG $27.00
FRESH FROZEN PLASMA THAW 86927 $51.00
RSV RAPID 87420 $224.00
STREPTOCOCCUS GROUP A 87430 $66.00
GLIADIN ANTI 82397 $38.00
STRIATIONAL AB 83520 $124.00
ALLERG SPEC IGE QUAL 86005 $74.00
H PYLORI IDENTIFICATION 87077 $44.00
CONSULT &REPRT REFER MATL88325 $288.00
EBV DNA QUANT 87799 $260.00
GENERAL HEALTH PANEL $26.00
VEN BLD COLLECTION PICC 36592 $103.00
ALCOHOL BREATH 82075 $72.00
SPECIMEN COLLECTION CORPORATE $19.00
CRYPTOSPORIDIUM AG STOOL 87328 $66.00
BASIC MET PNL (ION CAL) 80047 $65.00
HEMOCCULT SCR IFOB WPAT $23.00
ZONISAMIDE 80299 $276.00
ISLET CELL AB (DAG PNL)86341 $108.00
MACROPROLACTIN 84146 $206.00
CANDIDA SPECIES DIRECT PROBE $67.00
GARDNERELLA VAG DIRECT PROBE 87510 $67.00
TRICHOMONAS VAG DIRECT PROBE 87660 $67.00
TB TEST CELL MEDIATED IMMUNITY $160.00
SHBG BIIOAVAILABLE 84270 $134.00
TESTOSTERONE TOTAL BIOV 84403 $140.00
PREGNENOLONE 84140 $170.00
PAE RFLX BILL WBLOT 84182 $84.00
PAE RFLX BILL GAD65 86341 $108.00
PREGABALIN TIAGABINE 80366 G0480 $114.00
TRIGLYCERIDE (VAP) 84478 $79.00
SPECTROPHOTOMETRY 84311 $62.00
CENTROMERE AB 83520 $88.00
PROCALCITONIN 84145 $254.00
ANTI MULLERIN HORMONE 83520 $216.00
PT INR FINGERSTICK-QW 85610 $26.00
Page 16 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
PATERNITY COLLECT CORP CHG $59.00
VIT D2 & D3 25 HYDR 82306 $160.00
CAMPYLOBACTER AG 87449 $114.00
CORTISOL BINDING GLOBULIN $123.00
IODINE 83789 $92.00
PARVOVIRUS B19 QUAL PCR 87798 $175.00
RECEPTOR SOLUBL TRNSFRN 84238 $138.00
BETA-2 GLYCOPROTEIN G M 86146 $69.00
CONCENTRATE INFECT AGENT 87015 $37.00
MURAMIDASE (LYSOZYME) 85549 $134.00
VONWILEBRND FAC ACTIVITY 85397 $270.00
BETA-2 TRANSFERRIN 86335 $120.00
NEURON SPECIFIC ENOLASE 83520 $116.00
IGG SUBCLASS 4 82787 $186.00
C DIFFICILE TOXIN GENE AMP PROBE 87493 $189.00
FUNG AB SURV COCIDIOIDES 86635 $79.00
RUFINAMIDE (BANZEL) 82542 $114.00
INTERLEUKIN 6 HI SENS 83520 $38.00
CARDIOLIPIN ANTIBODY G M 86147 $138.00
NEUROMYELITIS OPTIC EVAL 86255 $258.00
ORGANC ACD TOT QNT URINE 83918 $188.00
BETA-D GLUCAN (FUNGITELL)87449 $198.00
PANCREASTATIN 83519 $123.00
STRONGYLOIDES ANTIBODY 86682 $105.00
MRSA PCR NASAL COLONIZATN87641 $189.00
VIT D 25-HYDR(TOT D2 D3)82306 $109.00
FUNGUS MOLD ID 87107 $109.00
BABESIA AB G M 86753 $116.00
EHRLICHIA ANAPLASMA PCR 87798 $146.00
BORRELIA BODY FLUID PCR 87476 $130.00
PNEUMOCYSTIS PCR 87798 $222.00
ASO TITER STREP AB PNL 86060 $148.00
DEOXYRIB AB STREP AB PNL 86215 $79.00
CRYOGLOBULIN S.O. 82595 $49.00
CRYOFIBRINOGEN 82585 $38.00
A1AT(ALPHA 1 ANTITRYPSIN)82103 $43.00
CYSTINURIA 82136 $65.00
ECHINOCOCCUS AB 86682 $216.00
LYME BORRELLIA PCR 87476 $124.00
FIBRINOGEN ANTIGEN 85385 $217.00
IBD CHEMILUM 82397 $39.00
IBD CRP 86140 $47.00
FLAT RATE 2 $16.00
FLAT RATE 3 $9.00
FLAT RATE 4 $7.00
CEA PANCREATIC CYST 82378 $116.00
Page 17 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
COBALT 83018 $71.00
TOXOPLASMA PCR QUAL 87798 $134.00
VORICONAZOLE 80299 $317.00
NMR LIPID PANEL 80061 $107.00
MAGNESIUM RBC 83735 $87.00
LACTOFERRIN QUANT 83631 $107.00
ENDOMYSTIAL IGG 86255 $38.00
KETONE QUANT SERUM 82010 $26.00
IA2-AB 86341 $103.00
HEPATITIS E AB (G M) 86790 $170.00
PTH RELATED PROTEIN 83519 $36.00
STREPTOCOCCUS GRPB AMP PROBE 87653 $189.00
HGB ELP HB VARIANT 83789 $175.00
CRMP-5-IGG WESTERN BLOT 84182 $84.00
AMPHIPHYSIN WESTERN BLOD 84182 $84.00
CRYOGLOB IMMUNOFIX 86334 $207.00
CRYPTOCOCCUS AG REFLX 86403 $57.00
CYTOPLASMIC NEUT AB 86255 $66.00
MYELOPEROXIDASE AB 83876 $124.00
PROTEINASE 3 AB 83516 $96.00
GLUCOSE POCT 82947 $50.00
CANDIDA ALBICANS AB 86628 $103.00
COMPLEMENT C1Q 86160 $95.00
ACEYLCHOLIN RECEP BIND AB83519 $214.00
BRUCELA AB AGLUTIN TITER 86622 $57.00
OVA-1 81503 $980.00
ALLERGEN CARMINE OR TILAPIA 86003 $85.00
ALLERGEN OTHER 86003 $67.00
GANGLIOSIDE AB 83520 $39.00
MANNOSE-BINDING LECTIN 83520 $183.00
BETA-GALACTOSIDASE LEUK 82657 $198.00
PURINE PYRIMIDINE 83789 $140.00
HSV 1 IGM SCR OR TITER 86695 $69.00
HSV 2 IGM SCR OR TITER 86696 $69.00
RISTOCETIN COFACTOR REFLX85245 $195.00
F2GENE ANALY 20210G VARI 81240 $317.00
HFE COMMON VARI 81256 $327.00
F5GENE ANALY LEIDEN VARI 81241 $315.00
MTHFR GENE 81291 $486.00
TPMT GENE 81401 $722.00
HBA1 HBA2 GENE 81257 $466.00
JAK2 GENE 81270 $204.00
BCR ABL1 MAJ BRKPNT 81206 $720.00
MYOTIC DYSTR S BLOT 81404 $1,110.00
HUNTINGTONS HTT 81401 $347.00
CONNEXIN PANL GJB2 81252 $445.00
Page 18 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
FETAL CONGEN ABN QUAD 81511 $420.00
CELIAC GENETICS 81382 $839.00
KRAS GENE ANALYSIS 81275 $560.00
CYSTIC FIBROSIS TR 81220 $668.00
A1AT PHENOTYPE $96.00
ACTINOMYCES CULTURE $89.00
ACHR GANG NEURO AB $70.00
HEPATITIS ACUTE PANEL $278.00
ALDOSTERONE 82088 $218.00
ALLERGEN ON PANEL 86003 $36.00
BONE ALK PHOSPHATASE S 84080 $49.00
BRUCELLA CULTURE $71.00
C1 ESTERASE INHIBITOR AG FUNC 83520 $138.00
C. DIFFICILE DNA BY PCR $189.00
CYSTIC FIBROSIS SPUTUM CULTURE $261.00
VENIPUNCTURE $29.00
CULT PROCESS CHG TISSUE $42.00
ESTRADIOL WITH ESTRONE 82670 $145.00
ETEST BUNDLING 87181 $27.00
FACTOR IX INHIBITOR $43.00
FAT STOOL $51.00
IRON $57.00
GAD65 AB ASSAY $237.00
HEPATITIS BS AB $26.00
HIV-2 AB EVAL S $176.00
HEMOCCULT ICT X3 82274 $87.00
HEPARIN XA UNFRACTIONATED $100.00
IGE IMMUNOGLOBULIN 82785 $95.00
I-STAT PROFILE 8 80047 $65.00
I-STAT CREATININE $54.00
LEGIONELLA ANTIBODY 86713 $183.00
LEGIONELLA AG URINE $62.00
MICROSPORIDIUM SMEAR 87207 $62.00
MIC CHARGE CODE $105.00
MTB COMPLEX RAPID PCR $234.00
NOCARDIA CULTURE $95.00
PHENCYCLIDINE (CONF) URINE 83992 G0480 $129.00
BORDETELLA PERTUSSIS DNA 87798 $156.00
PTH-RELATED PEPTIDE 82397 $214.00
SIMPLE SPERM PREP $119.00
COMPLEX SPERM PREP $203.00
RPR TITER 86593 $38.00
THYROGLOB FNA LYMPH NODE 84432 $37.00
THC CONFIRMATION URINE 80299 $122.00
TROPONIN-I $114.00
ANTI-GLIAL NEUR NUC AB2 $142.00
Page 19 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
JO 1 AB IGG 86235 $46.00
AMPHIPHYSIN AB $142.00
RNP AB IGG 86235 $46.00
ARSENIC B 82175 $24.00
SCL 70 AB IGG 86235 $46.00
SM AB IGG 86235 $46.00
ANTI-SMOOTH MUSCLE AB $128.00
SS-A RO AB IGG $46.00
SS-B LA AB IGG $46.00
BARTONELLA BUNDLE BHG & MB BQG & M 86611 $57.00
BASELINE P2Y12 85576 $117.00
CADMIUM B 82300 $24.00
CONCENTRATION S.O. 87015 $39.00
CRMP5 IGG $142.00
CRYPTOSPORIDIUM AG, FECES 87328 $64.00
C TRACHOMATIS NUC. ACID 87491 $134.00
DRVVT CONFIRM 85612 $54.00
PSA FREE 84154 $139.00
GIARDIA LAMBLIA AG FECES 87329 $66.00
HISTOPLASMA AG SERUM $169.00
HISTOPLASMA AG URINE $197.00
HSV1 DNA BY PCR $116.00
HSV2 DNA BY PCR $116.00
I-STAT BUN $54.00
I-STAT GLUCOSE $20.00
MERCURY B 83825 $24.00
ANTI-NEURONAL NUC AB 1 $142.00
ANTI-NEURONAL NUC AB 2 $142.00
ANTI-NEURONAL NUC AB 3 $142.00
N GONORRHOEAE NUC. ACID 87591 $134.00
LEAD B 83655 $24.00
PURKINJE CELL CYTO AB 1 $142.00
PURKINJE CELL CYTO AB 2 $142.00
PRU P2Y12 85576 $117.00
SPOTTED FEVER GRP IGG $45.00
STRIATIONAL(MUSCLE) AB 83520 $71.00
THYROTROPIN RECEPTOR AB 83520 $36.00
ACH RECEP (MUSCLE) MOD AB $214.00
ACH RECEP MUSCLE BIND AB $110.00
CARBAMAZEPINE TOTAL 80156 $184.00
HTLV -I -II AB SCREEN S 86687 $79.00
THC MECONIUM $128.00
NEURONAL (V-G) K+ CH AB $70.00
TESTOSTERONE FREE BIOAVAIL 84402 $102.00
HGB MOPATH 2 REFLEXD 81401 $1,274.00
MICRODISSECTION MANUAL MY 88381 $119.00
Page 20 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
LISTERIA AB 86609 $198.00
DENGUE FEVER IGG IGM 86790 $122.00
VONWILEBRND ACTIV WORKUP 85397 $234.00
TCIPF LYMPH PROLIF AG MITOGEN 86353 $453.00
LYMPH PROLIFERATION AG OR MITOGEN 86353 $418.00
MUMPS AMPLIFIED PROB 87798 $159.00
PHENOBARB WITH PRIMIDONE 80184 $184.00
GANGLIOSIDE GQ1B AB IGG 83520 $273.00
EVEROLIMUS 80169 $339.00
GABAPENTIN 80171 $65.00
LAMOTRIGINE 80175 $132.00
LEVETIRACETAM 80177 $159.00
MYCOPHENOLATE 80180 $175.00
OXCARBAZEPINE 80183 $182.00
ZONISAMIDE 80203 $264.00
NUCLEIC ACID TRICHOMON AMP 87661 $204.00
IODINE BLOOD 83789 $93.00
POLIO AB NEUTRALIZATION 86382 $310.00
PNEUMOCOCCAL AB EA PNL 23 86317 $5.00
B PERTUSSIS A G M EA ELISA 86615 $148.00
B PERTUSSIS A G M EA IMUNOBLT REFL 86615 $103.00
RA FACTOR QUANT 86431 $74.00
CULTURE QUANTITATIVE AEROBIC 87071 $96.00
CYP2C19 COMMON VARIANT 81225 $1,028.00
CYP2C9 COMMON VARIANT 81227 $1,028.00
TETANUS TOXOID IGG AB 86317 $79.00
CULTURE TYPING IMMFLUOUR EA 87140 $109.00
H IMPLEX I AGIF 87274 $51.00
VGKC COMPLEX AB CSF 83519 $169.00
ANTIMULLERIAN HORMONE (AMH) $225.00
HLA B27 TYPING 86812 $75.00
JAK2 V617F MUTATION DETECTION B 81270 $595.00
MTHFR MUTATION DETECTION 81291 $159.00
PROTHROMBIN G20210A MUTATION $317.00
FACTOR V LEIDEN GENE 81241 $315.00
UREAPLASMA SPECIES MOLECUL DETENTI PCR $170.00
MYCOPLASMA GENITALI MOLECU DETECTI PCR $163.00
RABIES RFFIT ENDPOINT S $201.00
HV 1 ANTIBODY 86701 $91.00
HIV 2 ANTIBODY 86702 $170.00
HIV1 AG HIV 1 2 AB $91.00
LACTIC ACID SPINAL FLUID 83605 $116.00
BODY FLUID CELL COUNT 89050 $45.00
JAK2V617F MY 81270.004 $394.00
PARAENOPLAST AUTOAB 86255 $63.00
MENINGITIS/ENCEPHALITIS PANEL 87483 $695.00
Page 21 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
AMYLASE PANCREATIC 82150 $79.00
PHOSPHORUS FECES PANEL 84100 $63.00
PORPHYIN TOTAL BLOOD 84311 $103.00
TESTOSTERONE FREE MEASURED 84402 $138.00
SACCHRMYCS CERVS IGG 86671 $218.00
ESTRONE WITH ESTRADIOL 82679 $315.00
INFLIXAMAB CONC 80299 $305.00
INFLIXAMAB AB 82397 $39.00
ADALIMUMAB 80299 $295.00
ADALIMUMAB AB 82397 $295.00
SUPERSATUR SODIUM U 84300 $59.00
SUPERSATUR POTASSIUM U 84133 $54.00
SUPERSATUR CALCIUM U 82340 $84.00
SUPERSATUR MAGNESIUM U 83735 $39.00
SUPERSATUR CHLORIDE U 82436 $46.00
SUPERSATUR PHOSPHORUS U 84105 $29.00
SUPERSATUR SULFATE U 84392 $27.00
SUPERSATUR CITRATE U 82507 $151.00
SUPERSATUR OXALATE U 83945 $70.00
SUPERSATUR PH U 83986 $21.00
SUPERSATUR URIC ACID U 84560 $76.00
SUPERSATUR CREATININE U 82570 $29.00
SUPERSATUR OSMOLALITY U 83935 $39.00
INFECTIOUS AGENT NUCLEIC ACID GI 12-25 TARGETS 87507 $722.00
HPV HIGH-RISK TYPES 87624 $91.00
HPV TYPES 16 & 18 ONLY 87625 $68.00
BENZODIAXPINE 1-12 80346 G0480 $116.00
NORTRIPTYLINE 80335 G0480 $41.00
OPIATES 80361 G0480 $41.00
ANABOLIC STEROIDS 80327 G0480 $74.00
IMPRAMINE 80335 G0480 $66.00
NICOTINE 80323 G0480 $48.00
MYCOPLASMA PNEUMONIAE AMPL PROBE 87581 $71.00
SULFONYLUREA 80377 $9.00
OXYCODONE 80365 G0480 $41.00
AMPHETAMINE 80324 G0480 $67.00
METHYLENEDIOXYAMPHETAMINE 80359 G0480 $67.00
COCAINE 80353 G0480 $69.00
ALBUMIN CSF IGG INDEX 82042 $34.00
ALBUMIN SERUM IGG INDEX 82040 $54.00
IGG CSF IGG INDEX 82784 $68.00
IGG SERUM IGG INDEX 82784 $68.00
CDMR DPYD GENOTYPING 81400.005 $423.00
FIRST TRIMESTER MATERIAL SCR 81508 $232.00
RESPIRATORY VIRUS AMP PROBE 12-25 87633 $1,001.00
BORDETELLA PERTUSSIS AMP PROBE 87798 $71.00
Page 22 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
CHLAMYDIA PNEUMONIAE AMP PROBE 87486 $71.00
MYCOPLASMA PNEUMONIAE AMP PROBE 87581 $71.00
ZINC PROTOPORPH OCC EXP 84202 $96.00
NEPHELOM KAPPA LAMBDA PROTEIN 83883 $74.00
KAPPA LAMBDA PROTEIN URINE 84156 $79.00
IMMUNOFIX KAPPA LAMBDA URINE 86335 $120.00
DRUG SCREEN EXTENSIVE URINE 80321 G0483 $67.00
HUMAN EPIDIYMIS PROTEIN 4 (HE4) 86305 $213.00
VOLATILE SCR S 80320 G0480 $97.00
ETHYLENE GLYCOL 80320 G0480 $91.00
LIPOPROT PANL CHOL 82465 $24.00
LIPOPROT PANL TRIG 84478 $24.00
LIPOPROT PANL ELECTO 83700 $43.00
LIPOPROT PANL APOLIPROT 82172 $54.00
CRYPTOCOCCAL ANTIGEN 87899 $140.00
DIPHTHERIA TOXOID IGG AB 86317 $79.00
CRC SCR OCCULT BLD FIT (1-3 CARDS) 82274 $87.00
VW FACTOR ACTIVITY (VWPR) MY 85397 $234.00
VW FACTOR AG (VWPR) MY 85246 $186.00
COAG VIII (VWPR) MY 85240 $195.00
NOROVIRUS BY NAD 87798 $189.00
CYTOMEGALOVIRUS (CMV) DETECT BY PRC QUAL NON-BLD 87496 $465.00
SEMEN LEUCOSCREEN 89398 $38.00
BLOOD CULTURE IDENTIFICATION PANEL 87150 $1,083.00
PROTEIN 14-3-3-, SPINAL FLUID 83520 $91.00
GREY ALDER ALLERGEN 86003 $9.00
MOUSE URINE ALLERGEN 86003 $20.00
ROCKY MOUNTAIN REGION RESP PNL & IGE 86003 $32.00
EARLY CHILDHOOD ALLERGY PNL & IGE 86003 $32.00
LO PEANUT COMPONENT PNL 86003 $128.00
PB2A STAPH AURES TESTING M59 87147 $57.00
HSV CULTURE (ELVIS) 87255 $176.00
WET MOUNT BY PCR 87800 $208.00
D-DIMER TEST 85380 $122.00
FUNGAL SEQUENCING ID 87153 $170.00
G6PD ENZYME SCREEN 82960 $172.00
HLA TYPING DR/DQ 86816 $145.00
HEALTH SCREEN BONE DENSITY $38.00
ANGIOTENSIS CONVERTING ENZYME 82164 $154.00
SMITH-LEMLI-OP SCREEN 82542 $122.00
THIOPURINE METABOLITES 82542 $114.00
SUPERSATURATION, CALCIUM, 82340 $27.00
SUPERSATURATION, CHLORIDE 82436 $27.00
SUPERSATURATION,CITRATE EXCRETN, 82507 $144.00
SUPERSATURATION,CREATININE, 82570 $28.00
SUPERSATURATION, MAGNESIUM, 83735 $37.00
Page 23 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
SUPERSATURATION, OSMOLALITY, 83935 $40.00
SUPERSATURATION, OXALATE, 83945 $67.00
SUPERSATURATION, PH, 83986 $27.00
SUPERSATURATION, PHOSPHORUS, 84105 $28.00
SUPERSATURATION, POTASSIUM, 84133 $27.00
SUPERSATURATION, SODIUM,84300 $27.00
SUPERSATURATION, SULFATE,84392 $27.00
SUPERSATURATION, URIC ACID, 84560 $27.00
SUPERSATURATION, AMMONIUM, 82140 $27.00
SUPERSATURATION, UREA NITROGEN, 84540 $27.00
CHROMOTOGRAPHY QUANT 82542 $152.00
ESCHERICHIA COLI 87798 $59.00
HAEMOPHILUS INFLUENZAE 87798.060 $59.00
NEISSERIA MENINGITIDIS 87798 $59.00
STREPTOCOCCUS AGALACTIAE 87653 $59.00
STREPTOCOCCUS PNEUMONIAE 87798 $59.00
CVM 87496 $59.00
ENTEROVIRUS 87498 $59.00
HHV-6 87532 $59.00
HSV-1 87529 $59.00
HSV-2 87529 $59.00
HUMAN PARECHOVIRUS 87798 $59.00
VZV 87798 $59.00
CRYPTOCOCCUS NEOFORMANS/GATTII 87798 $59.00
LISTERIA MONOCYVOGENES 87798 $59.00
THC CONFIRMATION URINE 80349 G0480 $116.00
LO HCV GEYNOTYPE RESOLUTION 87902 $1,096.00
CLOSTRIDIUM DIFFICILE A/B TOXIN DETECTION 87324 $134.00
FIBROTEST APOLIPOPROTEIN 82172 $125.00
FIBROTEST BILIRUBIN TOTAL 82247 $34.00
FIBROTEST GGT 82977 $32.00
FIBROTEST HAPTOGLOBIN 83010 $117.00
FIBROTEST ALPHA 2 MACROGLOBUIN 83883 $123.00
FIBROTEST ALT 84460 $34.00
PAINO OXYCODONE CONFIRM 80365 G0480 $237.00
THC CONFIRM MECON 80349 G0480 $103.00
MTB RIFAMPIN RESISTANCE 87798.067 $149.00
LO PAINO METHADONE CONFIRMATION 80358 G0480 $124.00
CREATINE DISORDERS PANEL URINE 82542 $78.00
MUCOPOLYSACCHARIDES SCREEN, URINE 82542.026 $82.00
HIV-1 DNA, QUALITATIVE PCR 87535 $110.00
SJORGRENS SYNDROME ANTIBODY 86235 $44.00
ALPHA 1 ANTI PROTEOTYPE LC MS/MS/SERUM 82542.027 $48.00
ALPHA SUBUNIT PIT GLYCO 82397.010 $65.00
LUPUS INHIBITOR SCREEN INTRINSIC PATHWAY 85598 $23.00
TRAMADOL AND METABOLITE, URINE 80373 G0480 $106.00
Page 24 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
PAIN CLINIC SURVEY WITH REFLEX 80364/G0480 $112.00
DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305 $133.00
DRUG SCR PRESUM INST ASSIST DIRECT OPT 80306 $132.00
NICOTINE SCREEN 80305 $92.00
DRUG OF ABUSE SCREEN 80307 $76.00
SALICYLATE 80307 $72.00
MECONIUM SCR MY 80307 $98.00
ACETAMINOPHEN 80307 $72.00
ALCOHOL NOT BREATH 80307 $72.00
KIT DRAW $27.00
IRRADIATION CHARGE 86945 $456.00
GLUCOSE 82947 $23.00
MULTIPLE INFECTIOUS ORGANISM / DNA SEQUENCING $301.00
GROSS ONLY 88300 $83.00
SURGICAL PATH LEVEL II 88302 $176.00
SURGICAL PATH LEVEL III 88304 $211.00
SURGICAL PATH LEVEL V 88307 $546.00
SURGICAL PATH LEVEL VI 88309 $751.00
DECALCIFIED TISSUE 88311 $28.00
STAIN SPECIAL I 88312 $303.00
FROZEN SECTION INITIAL 88331 $120.00
CYTOPATH CERV BETH 88164 $59.00
FNA INTERP REPORT 88173 $265.00
CYTO CERV THN MAN 88142 $88.00
CYTO CERV THN AUTO 88175 $98.00
CYTOPATH WINTERP 88112 $182.00
GROSS & MICRO PROSTATE NEEDLE BIOPSY G0416 $678.00
PROSTATE BIOPSY 88305 $286.00
CHROMOSOME BLD CULTURE 88230 $550.00
INTERPHASE 100-300 88275 $62.00
FLT3 ADDITIONAL CODING 81479 $264.00
FISH 88271.008 $114.00
ANALYSIS TRANS BCR ABL1 OTHER BREAKPOINT QL QN $258.00
BCR ABL MINOR BRKPNT 81207 $236.00
FLOW TC 1ST MARKER 88184 $327.00
PI LINKED AG 1ST MARKER 88184 $327.00
FLOW TR ADDNL MARKER 88185 $218.00
PI LINKED AG ADDNL MARKR 88185 $218.00
CHROMOSOME CULT TISS 88233 $285.00
CHROMOSOME CULTURE TISS 88237 $675.00
CHROMOSOME ANALYSIS 88262 $564.00
CHROMOSOME ANAL 20-25CEL 88264 $783.00
FISH INTERPHASE IN SITU 88275 $153.00
SURGICAL PATH LEVEL IV 88305 $286.00
STAIN SPECIAL II 88313 $162.00
FROZEN SECT ADDNL SLIDE 88332 $72.00
Page 25 of 26 Bozeman Health Deaconess Hospital 2020 pricing
Lab
PROCEDURE NAME UNIT PRICE
TOUCH PREP INITIAL CYTE $126.00
IMMUNOPEROXIDASE STAIN 88342 $232.00
CUTANE IMMUNOFLUO STAIN 88346 $56.00
IN SITU HYBRID MANUAL EA PROBE 88368 $479.00
INSITUHY COMP ASSIS SO 88367 $242.00
MORPHOMET ANALYS MANUAL 88360 $414.00
CHROMOSOME NEOP 88264 $783.00
RENAL ELECTON MICRO S.O. 88348 $734.00
IBD 81479 $89.00
HGB MOPATH 4 REFLEXD 81403 $731.00
MOLECULAR CYTOGENETICS INTERPHASE $1,036.00
CHROMOSOME ADD KARYOTYPE $135.00
FISH CLL LOCUS ANOM SPC $23.00
FISH 88271.006 $268.00
FISH INTERPHASE 882750.036 $194.00
RAS/RAF MOPATH 5 81404 $18.00
RAS/RAF MOPATH 4 81403 $13.00
RAS/RAF KRAS 81275 $758.00
RAF/RAS BRAF 81210 $689.00
RAS/RAF SLIDE REVIEW 88381 $116.00
CALR GENE MUTATION EXIB 9 81479 $359.00
IMMUNOHISTO ANTIBODY SLIDE EA ADDL SINGLE STAIN 88341 $239.00
IMMUNOHISTO ANTIBODY SLIDE EA MULTIPLEX STAIN 88344 $130.00
IN SITU HYBRID COMP ASSIST EA MULTIPLEX STAIN 88374 $506.00
ATG16L1 SNP (RS2241880) 81479 $89.00
ECM1 SNP (RS737240) 81479 $89.00
NFX2-3 SNP (RS10883365) 81479 $89.00
STAT SNP (RS744166) 81479 $89.00
KRAS GENE ANALYSIS MY 81275 $541.00
LO CHROM ANLYS CONGEN DISORDERS PANEL 88230 $576.00
LO CHROM ANLYS CONGEN DISORDERS PANEL 88291 $75.00
Y CHROMOSOME MICRODELETION 81403 $350.00
IBD INDIR IMMUNOFLOUR 88346 $158.00
IBD INDIR IMMUNOFLOUR ADD'L STAIN 88350 $39.00
MPL EXON 10 MUTATION DETECTION81403 $712.00
CALR MUTATION ANALYSIS, MYELOPROLIFERATIVE NEOPLASM 81219 $833.00
Page 26 of 26 Bozeman Health Deaconess Hospital 2020 pricing