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Idaho rates for HCPCS A9568

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,235.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,118.00 / $1,235.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,066.90
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
$1,105.00 / $1,118.00 / $1,598.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $944.78 / $2,408.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,482.00 / $1,543.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,729.00