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North Carolina 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
$1,105.00 / $1,105.00 / $1,105.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.00 / $1,105.00 / $1,105.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.63 / $871.63 / $1,162.17
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.30 / $1,235.00 / $1,685.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,235.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,630.20
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,493.27 / $2,493.27 / $7,117.97
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,425.58 / $10,975.35 / $10,975.35