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Nebraska rates for HCPCS A9510

Technetium Tc-99m disofenin, diagnostic, per study dose, up to 15 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $117.60 / $145.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $67.20 / $67.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.45 / $500.30 / $975.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.04 / $60.04 / $60.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.25 / $74.06 / $160.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $127.68 / $327.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $119.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.94 / $89.76 / $160.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.16 / $105.04 / $162.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.81 / $79.80 / $84.00