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Michigan 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
$15.56 / $209.19 / $1,023.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $15.56 / $15.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.51 / $95.74 / $170.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.06 / $64.27 / $77.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $17.32 / $17.32
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.84 / $135.11 / $1,023.17
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $3.40 / $15.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $20.38 / $21.62