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Minnesota 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
$2,056.76 / $2,056.76 / $2,056.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,707.11 / $2,056.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $793.08 / $1,393.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.15 / $231.44 / $231.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.54 / $930.89 / $1,083.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,327.98
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$538.71 / $846.26 / $1,230.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.34 / $2,056.76 / $3,420.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $3,381.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $3,177.70