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North Carolina 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
$1,423.75 / $1,423.75 / $1,423.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,390.25 / $1,423.75 / $1,423.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.50 / $1,127.50 / $1,503.33
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.00 / $1,591.25 / $3,376.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.25 / $1,591.25 / $1,591.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $2,211.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,225.19 / $3,225.19 / $9,207.50
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,274.74 / $14,197.28 / $14,197.28