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Illinois 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
$2,406.92 / $2,406.92 / $3,630.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,764.82 / $2,425.86 / $3,956.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,093.28 / $28,560.00 / $59,346.00
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $200.00 / $6,470.10
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,464.60