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Montana rates for HCPCS A9542

Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 mCi

Facilitymedian $7,079 · 10th–90th $126–$9,7720%50%10th90th$7,079Professionalmedian $3,631 · 10th–90th $1,820–$6,7610%20%10th90th$3,631$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $3,467.37 / $3,981.07
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $9,772.37 / $24,547.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $6,456.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $7,079.46 / $7,079.46
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $7,079.46 / $7,079.46
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $6,456.54 / $24,547.09
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $3,548.13 / $7,943.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $4,168.69