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Massachusetts rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.25 / $260.20 / $353.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.90 / $260.20 / $290.81
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.81 / $818.35 / $941.10
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $276.97 / $700.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.38 / $103.42 / $190.49
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 / $260.20
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.91 / $617.64 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.57 / $547.27 / $792.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.20 / $260.20 / $419.70
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.81 / $290.81 / $612.24
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $1,163.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $432.58