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Maryland rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $331.13 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $257.04 / $363.08
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $302.00 / $380.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $302.00 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $263.03 / $309.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90