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Montana rates for HCPCS A9582

Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,087.97 / $5,087.97 / $5,087.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,852.30 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,522.33 / $5,855.98 / $14,922.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,522.33 / $5,210.58 / $5,210.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,522.33 / $5,855.98 / $14,922.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,348.00 / $3,612.10 / $6,655.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,108.41 / $5,108.41 / $5,108.41