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Montana rates for HCPCS 78456

Acute Venous Thrombosis Imaging Peptide

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.54 / $1,826.23 / $1,826.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.13 / $545.58 / $1,535.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.58 / $454.82 / $885.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.13 / $545.58 / $1,535.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.02 / $407.43 / $547.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.56 / $282.70 / $611.83