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Michigan rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.14 / $244.90 / $453.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.90 / $244.90 / $260.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.14 / $58.03 / $103.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.01 / $38.96 / $46.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.90 / $260.20 / $260.20
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.21 / $270.41 / $453.07
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.90 / $270.41 / $324.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $278.82