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Michigan 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
$1,040.00 / $1,040.00 / $2,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,040.00 / $1,105.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.57 / $1,205.84 / $2,144.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.03 / $809.51 / $971.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,105.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.00 / $1,274.51 / $2,600.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,274.51 / $1,529.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,333.80