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Oregon 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
$5,100.00 / $5,100.00 / $5,100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,980.00 / $4,980.00 / $4,980.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,200.00 / $10,200.00 / $10,200.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,980.00 / $6,000.00 / $10,707.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,681.82 / $2,681.82 / $5,157.35
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,700.00 / $5,700.00 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,980.00 / $7,125.00 / $10,707.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $7,125.00 / $7,244.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,700.00 / $5,700.00 / $27,759.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,700.00 / $5,700.00 / $5,700.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,000.00 / $5,000.00 / $5,750.00