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Arkansas rates for HCPCS A9542

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,570.00 / $3,570.00 / $3,570.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,486.00 / $3,570.00 / $3,570.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,990.00 / $3,990.00 / $3,990.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,990.00 / $3,990.00 / $3,990.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,287.42 / $3,384.12 / $3,384.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,787.56 / $4,200.00 / $4,200.00