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Wisconsin rates for HCPCS A9502

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $707.95 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $107.15 / $794.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $87.10 / $338.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $134.90 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $346.74 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $158.49 / $218.78
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $102.33 / $251.19
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $380.19 / $398.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $114.82 / $524.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $724.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $64.57 / $138.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $275.42 / $389.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $724.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $109.65 / $724.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $204.17 / $251.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $117.49