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Montana rates for HCPCS 86258

Gliadin (deamidated) (DGP) antibody, each immunoglobulin (Ig) class

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $62.74 / $123.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.67 / $19.94 / $29.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.14 / $16.14 / $91,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.14 / $16.14 / $16.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.47 / $17.47 / $17.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.63 / $17.04 / $17.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.47 / $17.47 / $17.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.38 / $11.53 / $17.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.84 / $4.84 / $11.53