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Louisiana 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
$2,426.14 / $2,988.73 / $3,790.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,426.14 / $2,988.73 / $3,340.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,002.22 / $2,349.27 / $3,780.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,780.00 / $3,780.00 / $3,855.60
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
$4,116.00 / $4,200.00 / $4,830.00