go back

Montana rates for HCPCS A9502

Technetium Tc 99m Tetrofosmin Diagnostic Per Study Dose Up To 40 Millicuries (Special Coverage Instructions Apply. See Mcm: 15

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.20 / $476.77 / $6,783.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $97.21 / $561.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.86 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.87 / $106.87 / $106.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.55 / $269.24 / $686.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.98 / $86.98 / $252.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.55 / $269.24 / $686.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.98 / $141.16 / $253.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $85.27 / $85.27