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Montana rates for HCPCS A9510

Technetium Tc-99m Disofennin Diagnostic Per Study Dose Up To 15 Millicuries L Coverage Instructions Apply. See Mcm: 15030)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.72 / $69.72 / $69.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.16 / $162.59 / $414.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.40 / $71.40 / $105.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.16 / $162.59 / $414.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.17 / $85.24 / $133.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $79.80