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Pennsylvania rates for HCPCS A9554

Iodine I-125 Sodium Iothalamate M Diagnostic Per Study Dose Up To 10 Microcuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.25 / $38.25 / $54.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $38.25 / $38.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.25 / $38.25 / $38.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.25 / $38.25 / $38.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.70 / $35.70 / $42.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.03 / $571.03 / $571.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.25 / $48.58 / $546.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $38.25 / $48.58
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.25 / $38.25 / $38.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.25 / $38.25 / $38.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.90 / $39.90 / $43.89
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.90 / $39.90 / $43.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $37.50 / $51.79