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Pennsylvania rates for HCPCS A9500

Technetium Tc-99m sestamibi, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.14 / $278.19 / $1,414.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.48 / $116.95 / $745.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $266.80
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.89 / $127.95 / $2,674.15
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.27 / $62.27 / $62.27
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.84 / $428.05 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.05 / $428.05 / $428.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.99 / $109.99 / $109.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.99 / $109.99 / $109.99
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.47 / $134.66 / $134.66
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.80 / $345.87 / $847.28
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $134.66
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.89 / $124.27 / $2,567.50
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.27 / $62.27 / $62.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.89 / $482.17 / $1,414.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.48 / $148.84 / $710.40
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,051.89 / $2,109.21 / $2,733.45
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.07 / $363.89 / $499.24
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.99 / $109.99 / $109.99
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.99 / $109.99 / $109.99
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.70 / $121.70 / $121.70
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.28 / $121.70 / $121.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.58 / $450.58 / $636.37