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Montana rates for HCPCS A9567

Technetium Tc-99mpentette Diagnostic Aerosol P Er Study Dose Up To 75 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.75 / $322.75 / $322.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $3.74 / $21.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.13 / $33.13 / $33.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $17.32 / $33.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.13 / $33.13 / $33.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $28.87 / $39.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $20.38 / $20.38