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Michigan rates for HCPCS A9540

Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.80 / $184.25 / $1,103.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.80 / $28.80 / $32.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.26 / $94.01 / $167.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.95 / $63.11 / $75.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.82 / $29.50 / $38.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.06 / $44.17 / $58.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.60 / $30.60 / $30.60
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.80 / $151.25 / $1,171.32
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.80 / $31.80 / $38.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $32.40