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Montana rates for HCPCS 85004

Blood count; automated differential WBC count

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.00 / $17.00 / $17.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.64 / $41.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.67 / $8.67 / $91,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.67 / $8.67 / $8.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.38 / $12.62 / $19.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.42 / $9.28 / $9.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.38 / $11.00 / $19.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.82 / $6.46 / $9.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $2.79 / $8.89