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Maine rates for HCPCS A9542

Indium In-111 Ibritumomab Tiuxetan Diagnostic Per Study Dose Up To 5 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,765.64 / $2,765.64 / $3,570.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.76 / $961.77 / $2,528.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,500.00 / $3,570.00 / $99,999.99
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $3,570.00 / $4,277.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,765.64 / $2,765.64 / $3,570.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $4,200.00 / $6,090.00