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Tennessee 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
$2,138.91 / $2,656.39 / $2,656.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,138.91 / $2,656.39 / $3,622.35
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,908.42 / $22,577.61 / $22,577.61
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,051.83 / $24,051.83 / $34,812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,990.00 / $4,200.00 / $4,200.00