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Illinois rates for HCPCS A9500

Technetium Tc-99m sestamibi, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.48 / $505.50 / $1,263.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.48 / $108.89 / $389.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.23 / $75.23 / $154.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$423.93 / $841.61 / $1,542.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.79 / $116.79 / $116.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.99 / $109.99 / $109.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.99 / $109.99 / $109.99
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $182.75 / $496.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.07 / $175.07 / $175.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.58 / $450.58 / $478.07