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Maine rates for HCPCS A4642

Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,380.38 / $1,412.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $269.15 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $2,511.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,454.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,412.54 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $2,454.71