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Utah 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
$3,486.00 / $3,486.00 / $3,486.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,486.00 / $3,486.00 / $3,486.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,384.12 / $3,384.12 / $3,384.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $4,718.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,990.00 / $4,916.47 / $5,175.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,200.00 / $4,200.00 / $4,200.00