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Montana rates for HCPCS 80158

Drug Assay Cyclosporine

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.76 / $116.06 / $116.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.19 / $24.19 / $91,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.19 / $24.19 / $24.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.17 / $35.20 / $53.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.42 / $25.81 / $26.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.17 / $30.69 / $53.34
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.25 / $18.05 / $26.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.58 / $7.58 / $24.81