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Michigan 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 / $305.27 / $617.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.48 / $106.31 / $389.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.68 / $117.87 / $165.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.55 / $190.82 / $339.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.70 / $128.10 / $153.72
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.87 / $129.66 / $167.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.30 / $194.12 / $258.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.89 / $109.99 / $109.99
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.48 / $303.14 / $909.77
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.48 / $125.59 / $300.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.70 / $121.70 / $152.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.58 / $450.58 / $485.64