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Idaho 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
$4,411.80 / $4,411.80 / $9,196.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,993.84 / $4,411.80
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $4,233.47 / $5,711.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $4,950.04 / $12,617.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,411.80 / $5,294.16 / $5,514.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $5,418.00