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Indium In-111 Pentetreotide, Diagnostic

Michigan rates for HCPCS A9572

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

Rates data updated July 2026.

Facilitymedian $3,715 · 10th–90th $1,995$9,3330%10%20%10th90th$3,715Professionalmedian $3,715 · 10th–90th $1,995$6,7610%20%10th90th$3,715$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
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$6,918.31
Typical High
$9,332.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,235.94
Median
$3,715.35
Typical High
$3,981.07
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$3,090.30
Typical High
$5,370.32
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,905.46
Median
$1,995.26
Typical High
$1,995.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$5,754.40
Typical High
$5,754.40
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$4,168.69
Median
$4,677.35
Typical High
$19,952.62
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$6,760.83
Typical High
$9,332.54
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$5,754.40
Median
$5,754.40
Typical High
$5,754.40
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$3,311.31
United
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$4,677.35