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Missouri rates for HCPCS A9507

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,220.17 / $4,220.17 / $4,220.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,220.17 / $4,220.17 / $4,378.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,956.41 / $3,956.41 / $5,275.21
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,220.17 / $6,072.82 / $8,440.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $5,275.21 / $7,601.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,774.07 / $5,275.21 / $6,066.49