go back

Oklahoma 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
$3,761.64 / $3,761.64 / $3,761.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,761.64 / $3,854.52
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 / $3,947.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,914.61 / $4,137.80 / $8,220.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $7,587.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $4,102.20