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Nebraska 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
$1,047.13 / $2,089.30 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $501.19 / $977.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,862.09 / $2,884.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,047.13 / $6,918.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $4,677.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,884.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,884.03 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $812.83 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,230.27 / $1,288.25