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Montana rates for HCPCS Q4233

SurFactor or NuDyn, per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $6,606.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,623.41 / $8,709.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $85.11