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Mississippi 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
$1,373.50 / $1,373.50 / $2,010.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,373.50 / $2,010.00 / $2,261.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.00 / $97.00 / $97.00
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $20.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,608.00 / $1,675.00 / $2,177.50