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Louisiana 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
$4,644.00 / $4,644.00 / $6,130.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,644.00 / $4,644.00 / $4,644.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.55 / $445.34 / $4,411.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,411.80 / $4,411.80 / $4,500.04
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $5,208.21