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Pennsylvania rates for HCPCS A9504

Technetium Tc-99m Apcitide Diagnostic Per Study Dose Up To 20 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.00 / $425.00 / $607.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $425.00 / $425.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.08 / $9.50 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.50 / $9.50 / $9.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $425.00 / $38,249.62
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.00 / $425.00 / $1,096.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.00 / $425.00 / $1,045.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.48 / $46.48 / $46.48
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.48 / $46.48 / $46.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $500.00 / $652.50