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South Dakota 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
$1,675.00 / $1,675.00 / $1,675.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,390.25 / $1,423.75 / $1,675.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.88 / $1,239.83 / $1,239.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,916.20 / $2,547.67 / $4,130.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,842.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.44 / $2,437.21 / $3,853.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.44 / $2,437.21 / $4,077.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.00 / $1,675.00 / $1,842.50