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Nebraska rates for HCPCS A4642

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

Facilitymedian $1,622 · 10th–90th $1,349–$2,6920%20%40%10th90th$1,622Professionalmedian $1,413 · 10th–90th $1,349–$2,4550%20%40%10th90th$1,413$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $2,691.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $2,290.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,479.11 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,445.44 / $3,715.35
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,570.40 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $6,309.57
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $3,981.07
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,981.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,691.53 / $4,265.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,659.59 / $1,659.59