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Montana rates for HCPCS 81313

PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio (eg, prostate cancer)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $239.88 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $436.52 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $380.19 / $776.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $380.19 / $776.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $436.52 / $1,445.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $107.15 / $213.80