go back

North Dakota 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 / $3,715.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,854.52 / $4,644.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,453.98 / $4,077.72 / $4,136.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,933.75 / $3,947.40 / $4,995.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.20 / $4,829.76 / $6,617.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $38,920.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $4,334.39