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Tennessee rates for HCPCS A9558

Xenon Xe-133 gas, diagnostic, per 10 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.61 / $150.88 / $254.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.90 / $254.08 / $260.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.61 / $305.86 / $328.31
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.81 / $612.24 / $1,093.28
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.84 / $1,163.26 / $1,311.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $255.10 / $255.10