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Wisconsin rates for HCPCS A9501

Technetium Tc-99m Sestamibi Diagnostic Per Study Dose Up To 40 Millucries

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 / $77.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.91 / $77.91 / $119.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.91 / $77.91 / $119.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.91 / $77.91 / $119.42