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Georgia 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
$1,698.24 / $1,698.24 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,862.09 / $9,332.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,862.09
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,511.89 / $3,467.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,548.82 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,187.76