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Virginia 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 / $3,947.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,854.52 / $3,947.40 / $3,947.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,914.61 / $4,039.83 / $6,509.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,715.20 / $4,568.20
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.20 / $3,715.20 / $3,715.20
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,750.03 / $7,210.43 / $8,482.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $4,894.78 / $6,947.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,025.85 / $10,870.00 / $14,896.92
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,676.50 / $4,411.80 / $5,688.90
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,676.50 / $4,411.80 / $5,688.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $4,644.00