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Virginia 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
$3,403.99 / $3,403.99 / $3,898.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.33 / $3,486.00 / $3,570.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.02 / $1,683.82 / $2,713.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,570.00 / $3,570.00 / $4,389.67
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,360.00 / $3,360.00 / $3,360.00
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,391.50 / $4,840.10 / $5,694.26
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,683.75 / $4,200.00 / $5,890.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,864.58 / $6,717.00 / $9,674.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,132.17 / $4,200.00 / $4,410.00