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Pennsylvania rates for HCPCS A4641

Radiopharmaceutical Diagnostic Not Otherwise Classified

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.88 / $59.88 / $1,042.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.31 / $13.31 / $13.31
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99,999.00 / $99,999.00 / $99,999.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.34 / $79.34 / $79.34
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.00 / $102.00 / $38,249.62
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.31 / $68.31 / $1,366.96
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.85 / $142.82 / $1,270.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.31 / $13.31 / $250.39
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.34 / $79.34 / $79.34
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.42 / $59.42 / $61.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.42 / $59.42 / $61.20