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Montana rates for HCPCS A9548

Indium In-111 pentetate, diagnostic, per 0.5 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.55 / $503.55 / $503.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.96 / $881.96 / $881.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,747.86 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.14 / $479.04 / $1,220.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.14 / $903.21 / $903.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.14 / $479.04 / $1,220.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.28 / $265.94 / $903.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$885.50 / $885.50 / $885.50