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Missouri 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 / $1,659.59 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $2,041.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,949.84 / $4,466.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,041.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $2,089.30 / $7,762.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $2,454.71
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 / $1,995.26