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Montana rates for HCPCS A9596

Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,664.80 / $18,789.81 / $20,666.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.27 / $1,029.06 / $1,029.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,233.16 / $1,233.16 / $1,233.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$991.87 / $1,239.83 / $1,472.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.85 / $1,346.11 / $1,402.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.20 / $1,033.20 / $1,033.20