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North Carolina 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
$3,559.58 / $3,559.58 / $3,570.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,559.58 / $3,559.58 / $3,570.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,764.73 / $2,764.73 / $3,686.30
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,562.64 / $3,559.58 / $5,345.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,990.00 / $3,990.00 / $3,990.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $5,460.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,908.42 / $7,908.42 / $22,577.61
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,051.83 / $34,812.83 / $34,812.83