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New Mexico 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
$79.80 / $79.80 / $79.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.72 / $69.72 / $79.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.40 / $71.40 / $71.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.40 / $71.40 / $71.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $60.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.92 / $71.40 / $71.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.40 / $71.40 / $71.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $79.80