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Montana rates for HCPCS A9502

Technetium Tc-99m tetrofosmin, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $478.63 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $102.33 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $46,773.51 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $269.15 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $251.19
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $269.15 / $275.42
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $269.15 / $275.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $251.19 / $691.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $87.10 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11