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Indiana 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
$0.02 / $0.02 / $3,237.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,086.69 / $3,237.96 / $3,360.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $1,596.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,260.00 / $2,260.00 / $3,570.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,119.81 / $4,398.10 / $5,138.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,197.09 / $4,220.93 / $4,955.00
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $5,586.00