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Montana rates for HCPCS A4680

Activated carbon filter for hemodialysis, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.69 / $32.68 / $45.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.41 / $69.41 / $69.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $36.29 / $69.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.48 / $58.47 / $80.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $69.41 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.11 / $28.58 / $28.58