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Missouri rates for HCPCS A9572

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

Facilitymedian $3,981 · 10th–90th $1,995–$7,7620%20%10th90th$3,981Professionalmedian $3,802 · 10th–90th $3,467–$4,6770%20%40%10th90th$3,802$200.0$500.0$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 / $3,715.35 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $4,677.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $4,466.84 / $10,232.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,467.37 / $3,715.35 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $6,456.54 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $5,495.41 / $35,481.34
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $3,890.45 / $6,025.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,890.45 / $4,570.88