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Montana rates for HCPCS A9557

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,651.66 / $3,651.66 / $3,651.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.76 / $1,224.89 / $2,588.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,531.73 / $3,739.65 / $3,739.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.76 / $1,224.89 / $2,588.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.91 / $563.91 / $3,739.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,666.33 / $3,666.33 / $3,666.33