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Montana rates for HCPCS J2997

Alteplase Recombinant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.70 / $461.70 / $1,141.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.09 / $102.95 / $463.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.46 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.40 / $104.40 / $259.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.45 / $94.45 / $104.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.40 / $104.40 / $259.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.45 / $102.47 / $133.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.45 / $94.45 / $94.45