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Missouri 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 / $1,390.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,256.25 / $1,256.25 / $1,675.00
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 / $1,999.15 / $8,883.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,507.50 / $1,675.00 / $2,413.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.25 / $1,675.00 / $1,931.28