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Florida rates for HCPCS A9515

Choline C-11 Diagnostic Per Study Dose Up To 20 Millicuries (Reinstated 01/01/2017) Supply Of Radiopharmaceutical Diagnostic Imaging Agent Technitium Tc-99m Pentetate Per Mci (Del 12/31/2005)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,800.00 / $4,980.00 / $4,980.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,800.00 / $4,980.00 / $5,100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,166.09 / $5,100.00 / $5,100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,520.00 / $5,520.00 / $5,520.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,864.00 / $5,520.00 / $5,520.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $8,224.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,000.00 / $5,000.00 / $5,250.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,851.20 / $5,851.20 / $5,851.20