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Arizona rates for HCPCS A9567

Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.91 / $11.91 / $1,113.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $11.92 / $55.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.90 / $83.16 / $131.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.05 / $38.72 / $187.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.32 / $17.32 / $17.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $17.32 / $17.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.92 / $21.86 / $111.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $20.38 / $44.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $20.38 / $20.38