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Georgia rates for HCPCS A9521

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,707.11 / $1,707.11 / $1,707.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,707.11 / $1,707.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.34 / $1,713.97 / $2,944.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.52 / $1,655.66 / $1,713.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,799.67 / $3,509.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $2,636.00 / $4,084.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.59 / $643.42 / $702.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,056.76