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Hawaii rates for HCPCS A9542

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,162.28 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $5,370.32
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,630.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,786.30 / $5,623.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $6,309.57