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Michigan 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
$1,645.41 / $1,645.41 / $4,113.52
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
$867.81 / $1,195.17 / $2,125.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.22 / $802.34 / $962.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.09 / $1,748.25 / $1,748.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,681.65 / $1,851.08 / $3,044.01
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,816.81 / $2,180.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,851.09