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Indium In-111 Satumomab Pendetide, Diagnostic

Utah rates for HCPCS A4642

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

Rates data updated July 2026.

Facilitymedian $1,380 · 10th–90th $1,380$1,3800%50%$1,380Professionalmedian $1,380 · 10th–90th $1,380$1,7780%50%90th$1,380$50.0$100.0$200.0$500.0$1.0K$2.0K

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
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$60.26
Select Health
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$2,041.74
Typical High
$2,137.96
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,584.89
Typical High
$1,778.28
United
Setting
Professional
Modifier
Global
Typical Low
$1,659.59
Median
$1,659.59
Typical High
$1,659.59