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Montana rates for HCPCS A9516

Iodine I-123 sodium iodide, diagnostic, per 100 mcCi, up to 999 mcCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.48 / $411.48 / $1,306.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.81 / $455.20 / $1,461.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.40 / $271.87 / $692.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $181.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.40 / $271.87 / $692.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.78 / $149.86 / $205.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $106.24