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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
$4,378.42 / $4,378.42 / $4,378.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,682.98 / $2,509.71 / $6,395.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,849.76 / $4,483.93 / $4,483.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,682.98 / $2,509.71 / $6,395.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.29 / $1,466.09 / $4,483.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,275.21