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Montana rates for HCPCS A9510

Technetium Tc-99m disofenin, diagnostic, per study dose, up to 15 mCi

Facilitymedian $120 · 10th–90th $2–$1620%50%10th90th$120Professionalmedian $69 · 10th–90th $68–$1230%50%10th90th$69$5.0$10.0$20.0$50.0$100.0$200.0

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
$67.61 / $69.18 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $104.71
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.29 / $120.23 / $123.03
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.29 / $120.23 / $123.03
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $117.49 / $416.87
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43