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Missouri 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 / $2,056.76 / $2,159.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,707.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.34 / $2,737.58 / $4,511.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,542.57 / $1,542.57 / $2,056.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,645.41 / $2,077.92 / $7,712.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.09 / $1,713.97 / $2,137.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,679.69 / $1,713.97 / $2,015.62