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Kentucky 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
$1,861.74 / $2,425.86 / $13,487.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.74 / $2,425.86 / $3,360.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $1,286.65 / $1,995.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,260.00 / $3,570.00 / $3,906.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,887.74 / $4,887.74 / $4,887.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,157.62 / $4,220.93 / $7,855.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $3,384.12 / $4,588.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,114.71 / $3,384.12 / $19,187.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,200.00