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Indiana 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
$1,659.59 / $4,073.80 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $2,570.40 / $3,801.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,148.15 / $1,819.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,454.71 / $2,570.40
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,041.74