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Texas 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 / $4,325.67 / $15,867.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,220.17 / $4,325.67 / $4,483.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,349.51 / $10,114.15 / $20,797.49
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,483.93 / $7,450.04 / $7,450.04
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,220.54 / $10,220.54 / $11,487.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,378.42 / $5,275.21 / $9,413.60
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,241.33 / $1,241.33 / $1,241.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,378.42 / $5,275.21 / $7,121.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $4,483.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,275.21
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.07 / $3,568.78 / $4,817.85