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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
$85.50 / $85.86 / $3,777.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.97 / $2.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $1.06 / $2.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.06 / $2.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.34 / $1.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96