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Wisconsin rates for HCPCS A9520

Technetium Tc-99m Tilmanocept Diagnostic Up To 0.5 Millicuries (Code Was Deleted 12/31/05 But Reinstated On 1/1/14) Supply Of Radiopharmaceutical Diagnostic Imaging Aagent Technitium Tc-99m Sulfur Colloid Per Mci

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.11 / $877.44 / $1,321.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.60 / $635.11 / $966.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.57 / $661.57 / $661.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.09 / $648.66 / $995.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $674.81 / $674.81
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.51 / $635.11 / $793.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.51 / $641.25 / $793.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.57 / $661.57 / $1,058.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $2,046.45
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.51 / $635.11 / $793.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,977.09 / $2,977.09 / $2,977.09
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.81 / $841.52 / $3,016.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.57 / $661.57 / $860.04