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Idaho rates for HCPCS A9507

Indium In 111 Capromab Pendetide Diagnostic Per Study Dose Up To 10 Millicuries Special Coverage Instructions Apply. See Mcm: 1502

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$835.24 / $835.24 / $835.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.24 / $4,483.93 / $4,536.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $4,483.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $4,483.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,667.17 / $4,536.68 / $6,487.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $638.96 / $1,628.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.24 / $1,002.29 / $1,044.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $7,385.29