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Iowa 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
$2,345.00 / $2,893.46 / $2,893.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,340.00 / $1,340.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.88 / $1,239.83 / $2,011.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,011.66 / $2,312.26 / $3,853.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $3,350.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.44 / $2,437.21 / $3,853.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,034.49 / $2,437.21 / $3,853.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,777.01