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Michigan 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 / $3,019.95 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,737.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,230.27 / $2,137.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,041.74 / $6,309.57
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,187.76 / $2,951.21
Priority Health
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 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,862.09