go back

Kentucky 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 / $20,656.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,715.20 / $3,854.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,914.61 / $4,566.60 / $7,740.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.00 / $5,789.52 / $5,801.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,200.97 / $5,721.07 / $8,321.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,420.82 / $5,721.07 / $8,009.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $7,064.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $20,778.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $4,144.77