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North Carolina rates for HCPCS A4642

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

Facilitymedian $1,413 · 10th–90th $1,413–$2,6920%50%90th$1,413Professionalmedian $1,413 · 10th–90th $1,175–$1,6600%20%40%10th90th$1,413$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
$1,412.54 / $1,412.54 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,412.54 / $1,659.59
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,137.96 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,445.44
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,479.11 / $2,137.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,691.53 / $3,019.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $2,187.76
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,232.93 / $10,232.93 / $10,232.93
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10,232.93 / $14,125.38 / $14,125.38