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Pennsylvania 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
$3,947.40 / $3,947.40 / $10,327.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,947.40 / $3,947.40
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $5,013.20 / $10,327.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,947.40 / $5,013.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,470.64 / $6,470.64 / $7,117.70
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,470.64 / $6,470.64 / $7,117.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $5,050.35