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Montana rates for HCPCS G0400

Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.72 / $150.00 / $212.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.31 / $169.31 / $169.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.53 / $169.31 / $314.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.95 / $150.00 / $169.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.53 / $169.31 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.04 / $269.33 / $327.04