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Nebraska 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
$3,136.90 / $5,489.57 / $6,773.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,136.90 / $3,136.90 / $3,136.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.45 / $500.30 / $975.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,510.57 / $3,658.40 / $3,695.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $5,971.32 / $9,460.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $4,200.00 / $21,783.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $6,300.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,316.73 / $4,988.72 / $9,272.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,988.72 / $6,063.24 / $9,460.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,990.00 / $4,200.00 / $4,200.00