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New Jersey rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.24 / $260.20 / $466.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.90 / $254.08 / $260.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.01 / $260.20 / $305.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.20 / $260.20 / $260.20
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.20 / $260.20 / $260.20
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,785.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.96 / $260.20 / $260.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $269.13