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Kansas 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
$708.02 / $2,527.71 / $4,155.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.84 / $2,105.41 / $4,155.05
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,691.84 / $3,975.95 / $4,200.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $24,051.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,727.93