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Texas 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 / $136.40 / $252.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $68.88 / $71.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.72 / $161.05 / $338.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.72 / $69.72 / $69.72
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.87 / $339.39 / $339.39
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.65 / $429.65 / $523.28
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.72 / $84.00 / $168.85
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.55 / $56.55 / $56.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.72 / $75.59 / $113.40
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 / $80.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.90 / $53.87 / $63.69