go back

North Dakota rates for HCPCS A9542

Indium In-111 Ibritumomab Tiuxetan Diagnostic Per Study Dose Up To 5 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.15 / $3,500.15 / $3,500.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,696.25 / $3,486.00 / $3,622.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,123.75 / $3,687.86 / $3,740.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $5,971.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.15 / $4,550.20 / $5,985.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $24,051.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,620.00