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Pennsylvania 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 / $1,403.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,105.00 / $1,105.00
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,118.30 / $1,315.65 / $1,315.65
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,105.00 / $1,403.35 / $1,580.15
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,105.00 / $1,403.35
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,066.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,066.90
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,358.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,358.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,611.68