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Maryland 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 / $3,947.40 / $5,582.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,854.52 / $3,947.40 / $3,947.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,715.20 / $3,715.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,750.03 / $4,411.80 / $8,246.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $4,644.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,030.07 / $3,030.07 / $3,030.07