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Indiana rates for HCPCS A9502

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $776.25 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $85.11 / $275.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $87.10 / $112.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $128.82 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $104.71 / $173.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $141.25 / $162.18
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $120.23 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $102.33