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Montana rates for HCPCS A9507

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

Facilitymedian $1,995 · 10th–90th $41–$2,5120%50%10th90th$1,995Professionalmedian $4,365 · 10th–90th $1,995–$5,2480%50%10th90th$4,365$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

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