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Hawaii 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
$3,854.52 / $3,854.52 / $3,854.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $8,735.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,852.97 / $5,294.16 / $5,514.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $5,805.00 / $8,735.36
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,850.00 / $3,850.00 / $3,850.00