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California rates for HCPCS A9572

Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 mCi

Facilitymedian $4,677 · 10th–90th $3,981–$16,9820%20%10th90th$4,677Professionalmedian $3,981 · 10th–90th $3,715–$5,7540%20%10th90th$3,981$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $19,054.61 / $37,153.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,890.45 / $4,677.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $4,466.84 / $8,128.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $4,168.69 / $7,585.78
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $4,265.80 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $7,943.28 / $9,772.37
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $5,888.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38,904.51 / $38,904.51 / $38,904.51
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38,904.51 / $38,904.51 / $38,904.51
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $5,495.41 / $10,471.29
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $21,877.62 / $21,877.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $7,762.47