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Indiana rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.90 / $371.37 / $583.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.90 / $244.90 / $244.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.07 / $510.20 / $765.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.88 / $32.81 / $50.85
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.48 / $273.48 / $382.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.48 / $273.48 / $437.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.20 / $260.20 / $260.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.20 / $260.20 / $306.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $319.00