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North Dakota 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
$4,220.17 / $4,220.17 / $4,220.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,220.17 / $4,378.42 / $5,275.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,903.13 / $2,378.91 / $4,483.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,252.85 / $4,483.93 / $7,174.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $10,220.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,802.73