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Montana rates for HCPCS A9572

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

Facilitymedian $10,965 · 10th–90th $195–$66,0690%50%10th90th$10,965Professionalmedian $3,890 · 10th–90th $3,715–$10,7150%50%10th90th$3,890$100.0$500.0$2.0K$10.0K$50.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,890.45 / $3,981.07
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14,125.38 / $64,565.42 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,000.00 / $15,848.93 / $39,810.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $10,000.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $10,715.19 / $10,964.78
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $10,715.19 / $10,964.78
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $10,471.29 / $39,810.72
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $3,981.07 / $12,882.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $3,890.45