APC 9204

Tisotumab vedotin injection

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Inj tisotu vedotin-tftv, 1mg

Payers reporting APC 9204

Payer pricing summary

Low

$99

Average

$406

Median

$204

High

$3.6k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +3 other terms	174	$198	$197	$4	2%	—	$168 – $206
2	Humana fee schedule · outpatient · +4 other terms	161	$196	$203	$56	28%	—	$168 – $784
3	Aetna fee schedule · outpatient · +4 other terms	155	$198	$201	$21	11%	—	$168 – $318
4	WellCare fee schedule · outpatient · +2 other terms	131	$202	$204	$7	4%	—	$182 – $259
5	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	126	$196	$197	$7	3%	—	$175 – $262
6	Devoted fee schedule · outpatient · +1 other terms	122	$196	$196	$1	0%	—	$196 – $206
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	110	$204	$200	$6	3%	—	$196 – $212
8	Molina fee schedule · outpatient · +3 other terms	69	$289	$279	$109	39%	—	$182 – $514
9	Superior Healthplan fee schedule · outpatient	40	$206	$206	$0	0%	—	$206 – $206
10	Anthem fee schedule · outpatient · +1 other terms	31	$196	$195	$7	4%	—	$182 – $202
11	Oscar fee schedule · outpatient · +2 other terms	27	$192	$211	$38	18%	—	$192 – $318
12	Amerihealth Caritas fee schedule · outpatient · +1 other terms	17	$235	$233	$4	2%	—	$224 – $235
13	Cigna fee schedule · outpatient · +2 other terms	15	$200	$196	$11	5%	—	$182 – $212
14	Clover fee schedule · outpatient · +2 other terms	15	$206	$206	$0	0%	—	$206 – $206
15	Kaiser fee schedule · outpatient · +2 other terms	15	$200	$198	$5	2%	—	$186 – $200
16	Ambetter case rate · outpatient · +3 other terms	12	$340	$372	$38	10%	—	$340 – $417
17	Medicare case rate · outpatient · +1 other terms	8	$189	$189	—	—	—	$189 – $189
18	Optum fee schedule · outpatient · +1 other terms	8	$196	$293	$139	47%	—	$189 – $490
19	Highmark case rate · outpatient · +2 other terms	5	$189	$255	$90	35%	—	$189 – $414
20	Tricare facility · fee schedule · outpatient	5	$189	$189	—	—	—	$189 – $189
21	Excellus case rate · outpatient	4	$258	$263	$96	37%	—	$189 – $424
22	Bcbs Nj facility · other · outpatient	3	$196	$196	—	—	—	$196 – $196
23	Sanford Health Plan case rate · outpatient	3	$273	$275	$28	10%	—	$228 – $315
24	Aetna Better Health facility · case rate · outpatient	1	$146	$146	$47	32%	—	$99 – $193
25	Magellan fee schedule · outpatient	1	$196	$196	—	—	—	$196 – $196

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