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Missouri rates for HCPCS A9539

Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.51 / $30.08 / $376.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.08 / $30.08 / $31.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.20 / $75.20 / $75.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.20 / $30.08 / $37.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.96 / $31.96 / $31.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.96 / $31.96 / $31.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.08 / $44.88 / $138.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.96 / $37.60 / $54.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.85 / $37.60 / $43.24