go back

Alaska rates for HCPCS A9572

Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,269.40 / $6,269.40 / $6,269.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,965.24 / $8,965.24 / $8,965.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,963.72 / $5,963.72 / $8,519.60
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,709.54 / $9,709.54 / $9,709.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,965.24 / $8,965.24 / $8,965.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $8,519.60 / $9,709.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $5,805.00 / $7,806.56