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Washington 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 / $735.25 / $1,007.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.00 / $425.00 / $498.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.76 / $956.25 / $2,785.98
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.00 / $3,061.82 / $4,354.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.81 / $432.81 / $822.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.59 / $179.57 / $1,402.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.22 / $211.01 / $1,402.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $641.25 / $1,187.50
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.24 / $957.56 / $1,002.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.00 / $500.00 / $500.00