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Idaho 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
$1,953.92 / $1,953.92 / $1,953.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,768.81 / $1,953.92
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$633.83 / $1,768.81 / $2,529.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,494.75 / $3,810.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,953.92 / $2,344.69 / $2,442.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,742.35