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Pennsylvania 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
$1,000.00 / $2,238.72 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,737.80 / $2,041.74
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $758.58 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $2,290.87
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,511.89 / $2,630.27
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $3,715.35
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $2,238.72 / $10,715.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,737.80 / $2,089.30
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $851.14 / $1,023.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $588.84 / $1,905.46
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $588.84 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,137.96