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Alaska rates for HCPCS A9568

Technetium Tc-99m arcitumomab, diagnostic, per study dose, up to 45 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.00 / $1,755.00 / $1,755.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,066.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,509.65 / $2,509.65 / $2,509.65
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.82 / $1,137.82 / $1,625.45
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,852.50 / $1,852.50 / $1,852.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,509.65 / $2,509.65 / $2,509.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,625.45 / $1,852.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,852.50 / $2,491.23