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California rates for HCPCS A9504

Technetium Tc-99m apcitide, diagnostic, per study dose, up to 20 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.00 / $415.00 / $3,486.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.00 / $415.00 / $425.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.72 / $478.73 / $542.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.60 / $451.25 / $879.93
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.50 / $475.00 / $1,157.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.00 / $380.00 / $456.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $393.93 / $393.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,011.44 / $2,785.98 / $2,887.57
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,061.82 / $3,061.82 / $4,452.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.00 / $432.81 / $844.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.00 / $418.00 / $646.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.00 / $500.00 / $949.50