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Montana rates for HCPCS 84081

Phosphatidylglycerol

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $106.22 / $106.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.95 / $32.21 / $48.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.40 / $23.75 / $23.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.95 / $28.08 / $48.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.87 / $14.87 / $23.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.94 / $6.94 / $16.52