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Montana rates for HCPCS A9517

Iodine I-131 sodium iodide capsule(s), therapeutic, per mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,782.90 / $2,073.60 / $2,073.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.56 / $35.56 / $65.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.21 / $139.00 / $354.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.54 / $88.54 / $134.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.84 / $50.88 / $139.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.25 / $54.35 / $124.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.84 / $42.84 / $42.84