go back

Oklahoma 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
$1,356.75 / $1,356.75 / $2,306.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.00 / $1,356.75 / $1,390.25
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,356.75 / $1,424.59 / $8,883.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $2,053.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,775.50