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Michigan rates for HCPCS A9572

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

Facilitymedian $3,715 · 10th–90th $1,995–$9,3330%20%10th90th$3,715Professionalmedian $3,890 · 10th–90th $2,188–$5,7540%20%10th90th$3,890$1.0K$2.0K$5.0K$10.0K$20.0K

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
$3,715.35 / $6,918.31 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,890.45 / $5,623.41
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,951.21 / $5,128.61
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,905.46 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $5,754.40 / $5,754.40
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,677.35 / $19,952.62
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $6,760.83 / $9,332.54
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $5,754.40 / $5,754.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,265.80