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Illinois 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
$1,641.76 / $4,220.17 / $4,220.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,220.17 / $4,220.17 / $5,011.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,209.60 / $7,445.73 / $21,171.13
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,395.50 / $2,192.13 / $4,660.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,134.29 / $2,134.29 / $2,134.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,607.55