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New Jersey 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 / $2,276.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,390.25 / $1,423.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.99 / $1,330.58 / $1,463.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.10 / $1,380.10 / $1,380.10
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.50 / $1,417.50 / $1,417.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,758.75