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New Jersey 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 / $1,767.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,079.00 / $1,105.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$817.38 / $961.62 / $1,066.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,066.90
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.65 / $1,315.65 / $1,315.65
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,754.21 / $2,966.04 / $3,657.37
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.30 / $1,398.00 / $1,469.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,300.00