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Tennessee 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
$416.87 / $416.87 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $416.87 / $426.58
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,090.30
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $501.19 / $501.19