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Montana rates for HCPCS 85290

Clotting; factor XIII (fibrin stabilizing)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $15.14 / $107.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $57.54 / $91,201.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $27.54 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $19.05 / $23.99
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $22.91 / $50.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $22.91 / $50.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $27.54 / $93.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $14.79 / $23.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $7.08 / $22.39