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Minnesota rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $933.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $251.19 / $309.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $75.86 / $117.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $30.20 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $141.25 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $371.54 / $407.38
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $151.36 / $263.03
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $436.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $309.03 / $562.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $467.74