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Tennessee rates for HCPCS A4642

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

Facilitymedian $2,188 · 10th–90th $1,380–$10,2330%20%10th90th$2,188Professionalmedian $1,380 · 10th–90th $1,380–$1,6600%50%90th$1,380$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
$1,380.38 / $1,380.38 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,380.38 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,187.76 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,445.44
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,232.93 / $10,232.93 / $10,232.93
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10,232.93 / $14,125.38 / $14,125.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,691.53 / $2,691.53 / $3,467.37
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,659.59 / $1,659.59