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Montana rates for HCPCS A9539

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.90 / $37.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $64,565.42 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $128.82 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $47.86
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $51.29 / $52.48
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $51.29 / $52.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $87.10 / $331.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $50.12 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02