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Massachusetts 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
$3,570.00 / $3,570.00 / $4,844.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,878.19 / $3,570.00 / $3,570.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,853.00 / $4,797.76 / $15,307.16
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,780.00 / $4,569.30 / $11,560.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,542.11 / $9,492.20 / $17,484.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $3,384.12 / $3,384.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$813.98 / $4,569.30 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,243.27 / $6,397.02 / $9,259.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $3,570.00 / $5,758.41
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,908.42 / $7,908.42 / $22,577.61
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $4,200.00 / $24,051.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $4,200.00 / $6,300.00