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Washington, DC 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
$3,403.99 / $3,403.99 / $3,403.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.33 / $3,403.99 / $3,403.99
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,360.00 / $3,360.00 / $3,360.00
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,391.50 / $3,391.50 / $5,219.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $6,807.28