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Indium In-111 Satumomab Pendetide, Diagnostic

Montana rates for HCPCS A4642

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

Rates data updated July 2026.

Facilitymedian $2,884 · 10th–90th $2,630$3,3110%50%10th90th$2,884Professionalmedian $1,660 · 10th–90th $1,380$2,8840%20%10th90th$1,660$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,380.38
Typical High
$1,380.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$2,754.23
Typical High
$10,000.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$2,630.27
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$2,884.03
Median
$2,884.03
Typical High
$2,951.21
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$2,884.03
Median
$2,884.03
Typical High
$2,951.21
Providence
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$3,235.94
Typical High
$10,000.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,445.44
Typical High
$3,235.94
United
Setting
Professional
Modifier
Global
Typical Low
$1,659.59
Median
$1,659.59
Typical High
$1,659.59