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Texas 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
$83.91 / $414.40 / $835.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.86 / $84.93 / $304.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.00 / $67.50 / $177.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.07 / $245.68 / $490.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.12 / $106.93 / $173.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.36 / $190.36 / $190.36
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.07 / $717.30 / $717.30
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.30 / $717.30 / $717.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.93 / $102.33 / $345.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.41 / $106.99 / $233.33
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.84 / $681.91 / $2,184.63
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.22 / $169.25 / $177.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.98 / $102.33 / $177.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.98 / $86.98 / $86.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $85.27 / $86.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $200.00 / $270.00