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Utah 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
$3,854.52 / $3,854.52 / $3,854.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,854.52 / $3,854.52 / $3,854.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $7,305.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,411.80 / $5,436.22 / $5,722.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $3,870.00