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Illinois rates for HCPCS A9502

Technetium Tc 99m Tetrofosmin Diagnostic Per Study Dose Up To 40 Millicuries (Special Coverage Instructions Apply. See Mcm: 15

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.08 / $459.46 / $953.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.86 / $93.42 / $311.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.00 / $420.00 / $420.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.44 / $732.68 / $1,406.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.95 / $116.95 / $116.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.98 / $86.98 / $86.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.98 / $86.98 / $86.98
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.40 / $662.74 / $1,169.54
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.60 / $1,013.60 / $1,013.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.27 / $85.27 / $85.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $85.27 / $93.48