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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
$2,696.25 / $2,696.25 / $2,696.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,288.57 / $2,696.25 / $3,162.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $3,500.00 / $20,024.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,800.00 / $3,500.00 / $3,500.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.22 / $1,069.02 / $1,301.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.84 / $975.55 / $1,224.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $4,200.00 / $7,344.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $8,285.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $7,560.00