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Montana rates for HCPCS 87428

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.67 / $60.67 / $192.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.48 / $73.48 / $207.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.85 / $27.85 / $84.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.14 / $34.40 / $81.92