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Connecticut 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 / $4,578.97 / $13,779.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.62 / $5,883.17 / $11,600.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $3,870.00
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
ConnectiCare
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
$3,680.37 / $3,870.00 / $4,272.47