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Idaho rates for HCPCS A4642

Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 mCi

Facilitymedian $1,660 · 10th–90th $1,514–$2,0420%50%10th90th$1,660Professionalmedian $1,445 · 10th–90th $1,380–$1,6600%20%40%10th90th$1,445$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,412.54 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,621.81 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,445.44
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,513.56 / $2,041.74
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,445.44 / $1,698.24
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $77.62
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $1,659.59