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Montana rates for HCPCS A9572

Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,854.52 / $3,854.52 / $3,854.52
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
$9,963.91 / $15,678.89 / $39,953.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $9,963.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,963.91 / $15,678.89 / $39,953.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $8,220.07 / $11,278.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $3,870.00