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Ohio 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
$2,425.86 / $5,530.96 / $6,743.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,425.86 / $2,425.86 / $4,183.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $1,197.03 / $1,995.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $4,536.00 / $6,930.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $3,384.12 / $3,384.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $798.02 / $798.02
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $5,212.20