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Washington rates for HCPCS A9572

Insium In-111 Penterotide Diagnostic Per Study Dose Up To 6 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $6,829.00 / $9,355.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,761.64 / $3,947.40 / $3,993.84
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,411.80 / $4,411.80 / $35,376.98
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,411.80 / $4,411.80 / $55,163.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $7,894.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,947.40 / $3,947.40 / $3,947.40
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,944.56 / $14,827.52 / $17,631.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,944.56 / $14,827.52 / $19,164.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $4,852.97 / $7,117.70
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,411.80 / $4,411.80 / $12,696.50
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,411.80 / $4,411.80 / $4,411.80
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,411.80 / $4,411.80 / $4,411.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,411.80 / $4,411.80 / $4,411.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,191.21 / $4,411.80 / $4,411.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.00 / $3,870.00 / $4,644.00