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South Carolina rates for HCPCS A9542

Indium In-111 Ibritumomab Tiuxetan Diagnostic Per Study Dose Up To 5 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,012.14 / $3,012.14 / $12,178.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,012.14 / $3,012.14 / $3,559.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,696.00 / $4,200.00 / $5,040.00
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,512.83 / $3,012.14 / $4,620.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,200.00