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Missouri 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
$1,691.84 / $3,997.39 / $4,596.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.84 / $2,105.41 / $3,997.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $853.88 / $2,866.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,150.00 / $3,150.00 / $3,990.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,691.84 / $4,200.00 / $21,783.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $4,200.00 / $6,052.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.00 / $4,200.00 / $4,859.39