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Montana rates for HCPCS A9568

Technetium Tc-99m arcitumomab, diagnostic, per study dose, up to 45 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.00 / $1,079.00 / $1,079.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,889.73 / $2,991.37 / $7,622.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,889.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,889.73 / $2,991.37 / $7,622.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,568.30 / $2,259.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,235.00