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Pennsylvania rates for HCPCS Q9969

Tc-99m from nonhighly enriched uranium source, full cost recovery add-on, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.08 / $16.50 / $35.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.94 / $2.94
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.38 / $532.07 / $1,035.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.81 / $10.81 / $10.81
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $44,999.55
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.91 / $21.05 / $42.65
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.93 / $479.46 / $1,023.39
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.08 / $21.40 / $40.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.94 / $3.97
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.68 / $15.99 / $22.13
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.81 / $10.81 / $10.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13