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Missouri 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 / $1,040.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,040.00 / $1,079.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $866.18 / $2,907.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,235.00 / $1,365.00
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$809.51 / $1,551.58 / $6,867.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.00 / $1,235.00 / $1,779.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.68 / $1,235.00 / $1,420.25