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Minnesota 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
$1,675.00 / $1,675.00 / $1,675.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,390.25 / $1,675.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $831.25 / $4,893.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.00 / $831.25 / $831.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,227.79 / $3,159.28 / $7,600.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,001.79 / $1,259.68 / $1,343.66
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,754.16 / $2,888.34 / $5,984.31
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.88 / $991.88 / $1,239.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,423.75 / $2,547.67 / $3,078.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $3,304.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $3,036.44