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California rates for HCPCS A9501

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.42 / $119.42 / $1,003.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.91 / $119.42 / $140.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.25 / $306.00 / $400.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.80 / $102.00 / $248.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $393.93 / $393.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $312.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.91 / $119.42 / $170.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00