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Utah rates for HCPCS A9502

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $83.18 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $13.18 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $128.82
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $102.33 / $141.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11