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Minnesota 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 / $4,644.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,854.52 / $4,644.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $2,147.80 / $6,535.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.03 / $1,775.04 / $1,775.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,835.35 / $12,529.62 / $30,141.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,973.09 / $4,615.60 / $4,995.85
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,956.97 / $11,455.08 / $23,733.63
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,933.75 / $3,933.75 / $4,917.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,914.61 / $4,644.00 / $10,941.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $8,127.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $7,628.54