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Montana rates for HCPCS A9521

Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $2,041.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,715.35 / $9,549.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,511.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $2,754.23 / $2,754.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $2,754.23 / $2,754.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,570.40 / $9,549.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,584.89 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24