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Utah 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
$4,378.42 / $4,378.42 / $4,378.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,378.42 / $4,378.42 / $4,378.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,483.93 / $4,483.93 / $4,483.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $4,029.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.24 / $1,029.18 / $1,083.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,275.21 / $5,275.21 / $5,275.21