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Nebraska 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 / $4,644.00 / $8,022.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,715.20 / $3,715.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.45 / $500.30 / $975.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,701.31 / $5,941.36 / $6,001.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,933.75 / $4,917.18 / $14,821.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,914.61 / $3,715.20 / $35,376.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $5,805.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,159.11 / $7,681.51 / $14,566.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,681.51 / $9,811.49 / $15,346.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,676.50 / $3,870.00 / $4,644.00