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Montana rates for HCPCS A9581

Eovist IV SOLN 0.25 MOL/L

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.82 / $568.88 / $3,202.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.88 / $51.22 / $280.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.91 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.79 / $16.79 / $43.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $14.73 / $16.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.79 / $16.79 / $43.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.96 / $15.99 / $17.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $14.73 / $14.73