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Montana rates for HCPCS A9521

Technetium Tc-99m Exametazime Diagnostic Per Study Dose Up To 25 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.11 / $1,707.11 / $1,707.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,584.70 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,504.83 / $3,735.27 / $9,518.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,522.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,504.83 / $3,735.27 / $9,518.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,466.75 / $2,077.92 / $2,850.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,713.97