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Montana rates for HCPCS A9547

Indium In-111 oxyquinoline, diagnostic, per 0.5 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,096.56 / $2,096.56 / $2,096.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,292.42 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.58 / $798.99 / $2,036.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.58 / $2,147.08 / $2,147.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.58 / $798.99 / $2,036.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.68 / $443.56 / $2,147.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,104.98 / $2,104.98 / $2,104.98