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Texas rates for HCPCS A4642

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

Facilitymedian $4,467 · 10th–90th $1,380$5,0120%20%10th90th$4,467Professionalmedian $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 / $5,011.87 / $5,011.87
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
$1,445.44 / $3,388.44 / $9,772.37
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
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,862.09 / $5,011.87
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,380.38 / $1,698.24
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,737.80 / $4,466.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,445.44
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 / $1,659.59
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $269.15