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South Carolina 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
$4,325.67 / $4,325.67 / $17,488.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,325.67 / $4,325.67 / $4,483.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,340.54 / $1,340.54 / $1,340.54
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$664.30 / $3,568.78 / $5,363.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,275.21