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Montana rates for HCPCS 95875

Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.66 / $140.60 / $188.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.88 / $173.20 / $520.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.69 / $198.46 / $323.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.11 / $211.68 / $241.92