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Washington rates for HCPCS A9500

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.89 / $326.62 / $731.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.31 / $110.17 / $710.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.00 / $141.00 / $262.39
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.27 / $245.00 / $638.99
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.09 / $739.96 / $992.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.99 / $109.99 / $198.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.99 / $109.99 / $109.99
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.46 / $267.27 / $328.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.46 / $267.27 / $353.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $133.73
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.08 / $228.47 / $228.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.58 / $450.58 / $540.70