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Montana rates for HCPCS Q2017

Injection Teniposide 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.11 / $2,485.96 / $2,545.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.08 / $348.08 / $764.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.08 / $2,545.87 / $2,545.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.67 / $381.50 / $2,995.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.08 / $2,545.87 / $3,119.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.94 / $2,495.94 / $2,495.94