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All Charges

Charge Type Price  
Service Code CPT J2543
Hospital Charge Code 20221105
Hospital Revenue Code 259
Min. Negotiated Rate $43.40
Max. Negotiated Rate $62.00
Rate for Payer: AETNA Commercial $58.90
Rate for Payer: AETNA Medicare $55.80
Rate for Payer: BCBS CLOSED PLAN NETWORK $58.90
Rate for Payer: BCBS Healthlink $55.80
Rate for Payer: BCBS HMK CHIP $55.80
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A $55.80
Rate for Payer: BCBS POS $58.90
Rate for Payer: BCBS Traditional $62.00
Rate for Payer: CASH_PRICE $49.60
Rate for Payer: CIGNA Commercial $58.90
Rate for Payer: CIGNA Medicare $55.80
Rate for Payer: HUMANA Commercial $55.80
Rate for Payer: MEDICAID Medicaid $57.04
Rate for Payer: MEDICARE Medicare $43.40
Rate for Payer: MONIDA - ALLEGIANCE Commercial $58.90
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial $60.14
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial $58.90
Rate for Payer: MONIDA - PACIFICSOURCE Commercial $58.90
Rate for Payer: UNITED HEALTHCARE Commercial $52.70
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid $49.60
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare $49.60
Service Code CPT J2543
Hospital Charge Code 20221105
Hospital Revenue Code 259
Min. Negotiated Rate $43.40
Max. Negotiated Rate $62.00
Rate for Payer: AETNA Commercial $58.90
Rate for Payer: AETNA Medicare $55.80
Rate for Payer: BCBS CLOSED PLAN NETWORK $58.90
Rate for Payer: BCBS Healthlink $55.80
Rate for Payer: BCBS HMK CHIP $55.80
Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A $55.80
Rate for Payer: BCBS POS $58.90
Rate for Payer: BCBS Traditional $62.00
Rate for Payer: CASH_PRICE $49.60
Rate for Payer: CIGNA Commercial $58.90
Rate for Payer: CIGNA Medicare $55.80
Rate for Payer: HUMANA Commercial $55.80
Rate for Payer: MEDICAID Medicaid $57.04
Rate for Payer: MEDICARE Medicare $43.40
Rate for Payer: MONIDA - ALLEGIANCE Commercial $58.90
Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial $60.14
Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial $58.90
Rate for Payer: MONIDA - PACIFICSOURCE Commercial $58.90
Rate for Payer: UNITED HEALTHCARE Commercial $52.70
Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid $49.60
Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare $49.60