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California rates for HCPCS A4642

Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,390.25 / $1,390.25 / $11,678.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.75 / $1,390.25 / $1,423.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.13 / $268.25 / $1,607.52
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.83 / $421.20 / $1,026.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.10 / $1,380.10 / $1,380.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.10 / $1,380.10 / $1,380.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $393.93 / $393.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,225.19 / $8,883.66 / $9,207.50
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,274.74 / $10,274.74 / $14,197.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.10 / $1,423.75 / $2,694.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.10 / $1,380.10 / $1,380.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $3,217.68