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Montana rates for HCPCS Q2004

Bladder Calculi Irrig Sol

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.79 / $100.79 / $100.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.61 / $31.71 / $95.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.61 / $31.71 / $95.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.91 / $20.87 / $118.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.19 / $101.19 / $101.19