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Tennessee 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
$3,890.45 / $3,890.45 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,890.45 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,466.84 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,904.51 / $38,904.51 / $38,904.51
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,904.51 / $38,904.51 / $38,904.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,041.74 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $3,981.07