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Virginia 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
$1,748.25 / $1,748.25 / $1,748.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.11 / $1,748.25 / $1,748.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.34 / $1,692.94 / $2,727.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $2,023.19
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,645.41
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,660.83 / $1,953.92 / $2,219.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $2,056.76 / $2,884.61
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,281.62 / $2,748.00 / $3,771.79
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,628.27 / $1,953.92 / $2,519.54
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,628.27 / $1,953.92 / $2,519.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,056.76