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Wisconsin rates for HCPCS A4642

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

Facilitymedian $1,622 · 10th–90th $1,349–$3,8020%20%40%10th90th$1,622Professionalmedian $1,622 · 10th–90th $1,349–$4,4670%20%40%10th90th$1,622$1.0$5.0$20.0$100.0$500.0$2.0K$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,380.38 / $1,659.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $3,019.95 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,754.23 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $2,290.87 / $3,162.28
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,412.54 / $1,995.26
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,089.30 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,479.11 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $3,548.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $54.95 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $2,511.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,981.07 / $5,495.41
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $10,232.93
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $2,454.71 / $10,232.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $3,801.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $2,187.76