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Hawaii rates for HCPCS A9507

Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,378.42 / $4,378.42 / $4,378.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.57 / $4,483.93 / $4,483.93
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,855.00 / $1,855.00 / $1,942.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.76 / $1,002.29 / $1,044.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.57 / $5,275.21 / $7,912.82