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Massachusetts 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
$1,423.75 / $1,423.75 / $1,932.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,423.75 / $1,591.25
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.35 / $941.10 / $9,207.50
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.75 / $1,675.00 / $10,274.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,811.21 / $3,343.06 / $7,126.26
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,225.19 / $3,225.19 / $9,207.50
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.75 / $1,675.00 / $10,274.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.75 / $1,675.00 / $2,512.50