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Washington 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
$71.40 / $123.52 / $169.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.04 / $71.40 / $83.66
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.80 / $94.12 / $327.45
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $617.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.40 / $71.40 / $142.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.40 / $71.40 / $71.40
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $158.05 / $194.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $158.05 / $198.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $87.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.80 / $79.80 / $134.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.80 / $79.80 / $79.80
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $79.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.80 / $79.80 / $79.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.81 / $79.80 / $79.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $79.80 / $95.76