go back

Minnesota 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
$2,691.53 / $2,691.53 / $2,754.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,884.03 / $3,548.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,951.21 / $19,498.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,467.37 / $3,467.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,122.02 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $6,025.60
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,071.52 / $1,258.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $6,309.57 / $6,309.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $4,168.69 / $7,413.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $7,585.78