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Oklahoma 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
$2,297.92 / $2,297.92 / $3,849.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,264.13 / $2,425.86 / $3,835.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $2,527.71 / $7,908.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $5,149.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,452.00