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Indiana rates for HCPCS A9501

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.91 / $77.91 / $77.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.91 / $77.91 / $150.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.48 / $102.48 / $197.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.48 / $102.48 / $141.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.27 / $135.27 / $135.27