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Nebraska 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
$1,340.00 / $2,345.00 / $2,893.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,340.00 / $1,340.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.68 / $1,507.03 / $1,507.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.88 / $1,380.10 / $3,745.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,340.00 / $2,546.00 / $8,883.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $2,512.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,011.66 / $2,435.21 / $3,745.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,034.49 / $2,449.04 / $3,858.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.25 / $1,675.00 / $1,675.00