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California 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
$3,486.00 / $3,486.00 / $33,545.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,425.86 / $3,486.00 / $3,835.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.09 / $1,717.66 / $3,768.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $3,570.00 / $6,854.40
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,440.19 / $3,486.00 / $8,497.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,490.46 / $3,490.46 / $4,188.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $393.93 / $393.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,908.42 / $21,783.39 / $22,577.61
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,051.83 / $24,051.83 / $34,812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $6,018.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,384.12 / $4,200.00 / $4,987.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,486.00 / $3,834.60 / $5,926.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $8,068.20