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Montana rates for HCPCS Q9955

Injection, perflexane lipid microspheres, per ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $16.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $13.80 / $20.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $79.43 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18