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Indiana 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 / $600.61 / $1,723.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.48 / $102.48 / $198.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.47 / $89.47 / $170.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $144.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.00 / $75.00 / $106.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.29 / $155.08 / $190.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.29 / $137.18 / $178.94
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.58 / $450.58 / $601.88