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Illinois 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
$398.11 / $398.11 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $416.87 / $501.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,905.46 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $346.74 / $707.95
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $831.76 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $524.81