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Montana rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.05 / $23.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $1.07 / $2.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.07
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $1.07 / $2.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.07 / $2.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $1.29 / $2.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.48 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05