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Montana rates for HCPCS 84403

Testosterone; total

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.50 / $136.75 / $443.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.07 / $24.26 / $38.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.59 / $34.59 / $77,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.59 / $34.59 / $34.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.42 / $50.33 / $76.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.69 / $37.17 / $37.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.42 / $43.88 / $76.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.23 / $23.23 / $37.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.84 / $10.84 / $35.49