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Nebraska 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
$2,041.74 / $3,311.31 / $3,311.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $2,041.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $501.19 / $977.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,412.54 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,344.23 / $3,715.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,819.70 / $7,762.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $3,715.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,698.24 / $2,041.74