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Hawaii 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
$1,707.11 / $1,707.11 / $1,707.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,637.79
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.00 / $455.00 / $476.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,149.31 / $2,344.69 / $2,442.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $2,570.96 / $2,637.79