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Washington rates for HCPCS A9562

Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.13 / $880.00 / $1,516.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.83 / $771.67 / $926.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.00 / $1,150.00 / $1,150.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$883.24 / $883.24 / $4,203.77
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.24 / $883.24 / $6,913.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.23 / $853.23 / $1,248.78
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$753.92 / $1,774.98 / $2,180.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.92 / $1,774.98 / $2,227.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $971.56
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$883.24 / $883.24 / $1,591.25
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$883.24 / $883.24 / $883.24
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.24 / $883.24 / $883.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$883.24 / $883.24 / $883.24
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.08 / $883.24 / $883.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.24 / $883.24 / $1,059.89