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Maryland 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
$25.70 / $1,862.09 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,737.80 / $2,041.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,737.80 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,949.84 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,041.74
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34