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West 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
$1,412.54 / $1,412.54 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,380.38 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,659.59 / $1,659.59