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Montana rates for HCPCS Q0112

All potassium hydroxide (KOH) preparations

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.27 / $307.27 / $307.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.99 / $5.11 / $8.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.81 / $68,099.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.81 / $7.81 / $7.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.44 / $11.37 / $17.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.75 / $8.44 / $8.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.45 / $9.91 / $17.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.83 / $8.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.49 / $3.50 / $5.87