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Michigan rates for HCPCS A9526

Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.90 / $695.90 / $1,581.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.90 / $695.90 / $739.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.41 / $225.05 / $400.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.53 / $151.08 / $181.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.00 / $739.40 / $739.40
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.18 / $170.76 / $1,170.38
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.76 / $170.76 / $695.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.80 / $85.80 / $173.03