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New York 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
$2,884.03 / $3,981.07 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,467.37 / $3,981.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.03 / $3,981.07
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,548.13 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,951.21 / $2,951.21
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,548.13 / $3,801.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $5,623.41
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,548.13 / $3,548.13
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,548.13 / $3,801.89