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Montana rates for HCPCS A9554

Iodine I-125 sodium iothalamate, diagnostic, per study dose, up to 10 mcCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.35 / $37.35 / $37.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.89 / $321.69 / $819.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.25 / $38.25 / $58.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.89 / $321.69 / $819.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.22 / $51.33 / $82.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $37.50 / $37.50