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Maryland 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
$2,189.33 / $2,189.33 / $3,403.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.33 / $3,403.99 / $3,570.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,360.00 / $3,360.00 / $3,360.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,391.50 / $3,990.00 / $5,535.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,452.00