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Colorado 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
$1,340.00 / $1,340.00 / $1,340.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,340.00 / $1,591.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.84 / $268.25 / $1,100.00
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
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,340.00 / $1,340.00 / $2,412.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,675.00