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Virginia 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
$1,423.75 / $1,423.75 / $1,554.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,390.25 / $1,423.75 / $1,423.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.25 / $268.25 / $329.84
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,649.45 / $2,322.21 / $2,364.30
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.70 / $1,765.45 / $2,505.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,525.69 / $2,870.00 / $3,945.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,647.95 / $1,675.00 / $1,758.75