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Indiana 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 / $1,340.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.00 / $1,100.00 / $2,123.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.00 / $1,100.00 / $1,562.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.31 / $1,945.89 / $2,245.26
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.84 / $1,871.05 / $2,245.26
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $2,094.59