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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
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $199.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90