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Arizona 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
$3,761.64 / $3,761.64 / $3,761.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,927.32 / $11,117.07 / $17,611.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,882.38 / $5,176.51 / $25,073.73
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,808.08 / $5,379.15 / $35,376.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $8,397.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $3,870.00