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Indium In-111 Ibritumomab Tiuxetan, Diagnostic

Wisconsin rates for HCPCS A9542

Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 mCi

Rates data updated July 2026.

Facilitymedian $4,074 · 10th–90th $2,291$9,5500%20%10th90th$4,074Professionalmedian $6,310 · 10th–90th $2,692$13,4900%10%10th90th$6,310$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$2,290.87
Typical High
$2,290.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2,290.87
Median
$2,691.53
Typical High
$3,162.28
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3,801.89
Median
$6,760.83
Typical High
$14,125.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5,495.41
Median
$5,754.40
Typical High
$10,715.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,548.13
Median
$6,918.31
Typical High
$7,762.47
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$3,630.78
Typical High
$4,570.88
Medica
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$3,548.13
Typical High
$4,570.88
Medica
Setting
Professional
Modifier
Global
Typical Low
$4,168.69
Median
$4,168.69
Typical High
$8,912.51
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$2,238.72
Network Health
Setting
Facility
Modifier
Global
Typical Low
$4,265.80
Median
$4,265.80
Typical High
$4,265.80
Network Health
Setting
Professional
Modifier
Global
Typical Low
$6,165.95
Median
$6,165.95
Typical High
$6,165.95
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$3,630.78
Typical High
$4,570.88
Quartz
Setting
Professional
Modifier
Global
Typical Low
$4,570.88
Median
$9,772.37
Typical High
$13,489.63
Quartz
Setting
Facility
Modifier
Global
Typical Low
$5,754.40
Median
$10,715.19
Typical High
$23,988.33
Quartz
Setting
Professional
Modifier
Global
Typical Low
$3,548.13
Median
$19,054.61
Typical High
$23,988.33
United
Setting
Facility
Modifier
Global
Typical Low
$4,073.80
Median
$4,073.80
Typical High
$9,549.93
United
Setting
Professional
Modifier
Global
Typical Low
$4,168.69
Median
$4,168.69
Typical High
$5,754.40