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Alaska rates for HCPCS A9542

Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,486.00 / $4,344.14 / $4,344.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,212.12 / $6,212.12 / $6,212.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,685.43 / $3,685.43 / $5,264.90
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,985.00 / $5,985.00 / $5,985.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,212.12 / $6,212.12 / $6,212.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $5,264.90 / $6,000.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $6,300.00 / $8,472.24