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Kansas 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
$1,675.00 / $1,675.00 / $1,675.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,340.00 / $1,675.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.00 / $204.37 / $340.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.90 / $157.90 / $157.90
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,340.00 / $1,675.00 / $2,144.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $10,274.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,675.00