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Massachusetts rates for HCPCS A9504

Technetium Tc-99m Apcitide Diagnostic Per Study Dose Up To 20 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.00 / $425.00 / $576.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $425.00 / $475.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.32 / $1,476.06 / $1,746.28
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $506.02 / $1,266.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.99 / $1,827.48 / $3,366.12
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$506.02 / $799.51 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.66 / $708.43 / $1,025.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $475.00 / $766.18
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,011.44 / $1,011.44 / $2,887.57
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $500.00 / $3,061.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $500.00 / $750.00