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South Carolina 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
$3,019.95 / $10,964.78 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,467.37 / $3,981.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,365.16 / $5,011.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,890.45 / $4,168.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,365.16