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Louisiana 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
$1,288.25 / $1,288.25 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,096.48 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $977.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,348.96