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Connecticut rates for HCPCS A9521

Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,137.96 / $2,754.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,737.80 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,691.53 / $4,570.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,698.24 / $1,905.46