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Pennsylvania rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $14.12 / $117.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $2.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.18 / $2.54 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.96 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.04 / $1.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $5.64 / $11.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $40.09 / $349.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.97 / $2.77
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.55 / $2.27
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.96 / $85.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $1.49 / $1.73
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.49 / $1.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.96 / $1.21