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Illinois 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
$1,234.77 / $1,645.41 / $2,159.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,748.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.76 / $2,933.67 / $21,537.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,056.76 / $2,056.76 / $2,056.76
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.40 / $2,167.46 / $2,616.12
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,936.79