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Illinois rates for HCPCS A4642

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

Facilitymedian $1,349 · 10th–90th $1,349–$2,8840%50%90th$1,349Professionalmedian $1,380 · 10th–90th $1,349–$1,6600%50%10th90th$1,380$50.0$200.0$1.0K$5.0K$20.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,380.38 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,884.03 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,445.44
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $346.74 / $2,570.40
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $39.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $1,778.28