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Montana rates for HCPCS A9562

Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.04 / $1,179.29 / $2,708.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.67 / $771.67 / $1,368.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,248.78 / $1,958.12 / $4,989.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,248.78 / $1,248.78 / $1,248.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,248.78 / $1,958.12 / $4,989.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.64 / $1,026.58 / $1,493.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.24 / $883.24 / $883.24