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Montana rates for HCPCS Q9967

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.86 / $153.94 / $836.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $26.03 / $72.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $0.17 / $0.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.16 / $0.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15