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Utah 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
$84.93 / $84.93 / $84.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $84.93 / $84.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.98 / $86.98 / $86.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $13.12 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.21 / $119.78 / $126.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $85.27 / $85.27