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Montana rates for HCPCS 94453

High altitude simulation test (HAST), with interpretation and report by a physician or other qualified health care professional; with supplemental oxygen titration

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.81 / $80.15 / $88.47
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.39 / $28.39 / $33.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.27 / $105.35 / $207.12
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.39 / $28.39 / $33.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.52 / $117.22 / $181.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.47 / $119.77 / $140.07