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Montana rates for HCPCS A9507

Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,365.16 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,511.89 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $4,466.84 / $4,466.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $1,995.26 / $2,041.74
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $1,995.26 / $2,041.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,019.95 / $6,456.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,047.13 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07