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North Carolina 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
$5,789.52 / $5,789.52 / $6,695.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,854.52 / $5,789.52 / $5,789.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,490.01 / $4,490.01 / $5,986.68
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 / $4,644.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,944.02 / $6,470.64 / $8,646.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,470.64 / $6,470.64 / $6,470.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $5,108.39
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,220.07 / $9,671.09 / $35,376.98
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,920.43 / $38,920.43 / $38,920.43