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New Hampshire rates for HCPCS A9542

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

Facilitymedian $3,548 · 10th–90th $0–$5,7540%20%10th90th$3,548Professionalmedian $3,548 · 10th–90th $2,884–$5,8880%50%10th90th$3,548$0.0$0.2$2.0$20.0$200.0$2.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $4,265.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,548.13 / $3,981.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $7,585.78 / $9,772.37
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $3,548.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $6,760.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,318.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $4,168.69 / $4,168.69
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $5,495.41 / $7,244.36