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Georgia 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
$1,390.25 / $1,390.25 / $1,390.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,390.25 / $1,473.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.25 / $1,456.74 / $1,537.67
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
$1,533.46 / $1,805.18 / $3,610.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,811.68