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Michigan rates for HCPCS A9502

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $204.17 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $102.33 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $112.20 / $112.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $194.98 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $125.89 / $125.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $223.87 / $457.09
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $123.03 / $223.87
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $112.20 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $91.20