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Connecticut rates for HCPCS A4642

Indium In-111 Satumomad Pendetide Diagnostic Perstudy Dose Up To 6 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,423.75 / $1,423.75 / $2,227.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.75 / $1,423.75 / $1,423.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.70 / $228.01 / $283.11
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $120.00 / $120.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,541.00 / $1,675.00 / $1,758.75