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Wisconsin rates for HCPCS Q9969

Tc-99m From Non-Highly Enriched Uranium Source Full Cost Recovery Add-On Per Study Dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $9.94 / $94.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $2.94 / $2.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.50 / $21.50 / $22.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.95 / $0.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.28 / $26.13 / $37.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.81 / $10.88 / $13.59
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2.94 / $2.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $2.65 / $10.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.03 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2.94 / $2.94
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.81 / $10.81 / $10.81