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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
$4,677.35 / $18,620.87 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,023.29 / $1,230.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $2,041.74
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $2,041.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,230.27 / $1,862.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $1,096.48 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48