go back

Massachusetts 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
$1,737.80 / $1,737.80 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $2,041.74
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $2,137.96 / $2,951.21
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,698.24 / $3,019.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $3,981.07 / $6,309.57
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,288.25 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $977.24 / $1,412.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,884.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $2,137.96 / $2,951.21
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,698.24 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $933.25 / $1,737.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,737.80 / $2,398.83