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Georgia rates for HCPCS A9542

Indium In-111 Ibritumomab Tiuxetan Diagnostic Per Study Dose Up To 5 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.44 / $2,933.46 / $2,933.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.44 / $2,933.46 / $3,395.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $1,403.72 / $2,928.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $3,572.05 / $3,845.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $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
$3,589.63 / $4,426.46 / $8,852.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $5,590.62