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Montana rates for HCPCS A9584

Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,581.63 / $2,839.79 / $4,694.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,041.59 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $3,376.22 / $3,376.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $2,592.00