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West 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
$3,981.07 / $7,762.47 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,890.45 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $20,892.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $4,677.35