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Montana rates for HCPCS 0025U

Tenofovir, by liquid chromatography with tandem mass spectrometry (LC-MS/MS), urine, quantitative

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $79.43 / $85.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $165.96 / $165.96
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $128.82 / $165.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $128.82 / $165.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $79.43 / $144.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $39.81 / $95.50