go back

Arkansas rates for HCPCS A9572

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,854.52 / $3,947.40 / $3,947.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,470.64 / $6,470.64 / $6,470.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,470.64 / $6,470.64 / $6,470.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $3,986.10