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Montana rates for HCPCS A9520

Technetium Tc-99m, tilmanocept, diagnostic, up to 0.5 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,220.00 / $1,220.00 / $1,220.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.20 / $535.57 / $966.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.63 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.81 / $674.81 / $674.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.81 / $905.04 / $905.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.57 / $661.57 / $661.57