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Pennsylvania rates for HCPCS A9569

Technetium Tx-99m Exametazime Labeled Autologous White Blood Cells Diagnostic Per Study Dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $5,192.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.53 / $2,079.80 / $3,181.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $2,409.92 / $5,192.30
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,748.25 / $2,220.28
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,087.46 / $3,000.00 / $4,646.43
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,742.49 / $1,742.49 / $1,917.07
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,742.49 / $1,742.49 / $1,917.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,366.98