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New York 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
$1,148.15 / $1,380.38 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,380.38 / $1,659.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $69.18 / $123.03
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,445.44 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $7,762.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,018.94 / $38,018.94 / $38,018.94
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $2,238.72
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,412.54 / $1,412.54