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Connecticut 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 / $5,585.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $3,570.00 / $3,570.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $11,416.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,625.00 / $3,500.00 / $4,345.60
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,950.48 / $3,570.00 / $3,570.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,864.00 / $4,200.00 / $4,284.00