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Alaska rates for HCPCS A9521

Technetium Tc-99m Exametazime Diagnostic Per Study Dose Up To 25 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,776.63 / $2,776.63 / $2,776.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,970.58 / $3,970.58 / $3,970.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.40 / $1,438.40 / $2,054.85
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,879.46 / $2,879.46 / $4,524.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,879.46 / $3,970.58 / $6,787.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.40 / $1,748.25 / $2,054.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $2,570.96 / $3,457.42