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Montana rates for HCPCS 86759

Antibody; rotavirus

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.96 / $117.22 / $117.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.43 / $35.54 / $53.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.02 / $25.81 / $26.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.17 / $30.99 / $53.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.41 / $16.41 / $26.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.55 / $7.66 / $18.23