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Iowa 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
$16,887.80 / $16,887.80 / $17,839.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,800.00 / $4,800.00 / $4,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,500.13 / $5,500.13 / $6,875.16
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $6,515.83 / $7,640.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,062.94 / $6,000.00 / $7,695.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,000.00 / $5,000.00 / $10,000.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,094.41 / $3,403.85 / $4,847.91
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.30 / $178.30 / $178.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,000.00 / $5,000.00 / $6,505.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,266.00 / $5,400.00 / $5,400.00