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Texas 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
$2,920.77 / $3,406.72 / $11,098.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,328.82 / $2,949.98 / $3,553.25
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
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,154.43 / $4,200.00 / $6,433.39
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,761.94 / $3,761.94 / $3,761.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,384.12 / $4,033.49 / $5,081.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,200.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,769.63 / $3,570.00 / $3,739.00