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Montana rates for HCPCS 0247U

Obstetrics (preterm birth), insulin-like growth factor-binding protein 4 (IBP4), sex hormone-binding globulin (SHBG), quantitative measurement by LC-MS/MS, utilizing maternal serum, combined with clinical data, reported as predictive-risk stratification for spontaneous preterm birth

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.50 / $862.50 / $862.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,087.50 / $1,087.50 / $1,087.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.93 / $1,077.41 / $1,087.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,087.50 / $1,087.50 / $1,087.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.00 / $675.00 / $1,087.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $750.00