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Indiana 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
$17.50 / $195.39 / $2,926.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.40 / $13.01 / $17.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.00 / $648.00 / $1,250.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.00 / $648.00 / $894.24
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 / $17.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $20.38 / $27.22