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New Jersey 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
$3,570.00 / $3,570.00 / $5,709.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,425.86 / $3,486.00 / $3,759.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,647.50 / $3,114.71 / $3,426.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,950.48 / $2,950.48 / $3,570.00
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.39 / $1,729.31 / $16,128.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,769.63 / $2,769.63 / $2,769.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,410.00