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Colorado 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
$3,715.20 / $3,715.20 / $3,715.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,715.20 / $6,470.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,151.26 / $6,733.80 / $12,384.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $6,381.91 / $6,381.91
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 / $5,914.90
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.20 / $3,947.40 / $6,687.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,875.00 / $9,875.00 / $9,875.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $3,870.00