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New Hampshire rates for HCPCS A9572

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

Facilitymedian $6,026 · 10th–90th $3,090–$10,0000%10%10th90th$6,026Professionalmedian $3,981 · 10th–90th $3,715–$6,4570%50%10th90th$3,981$2.0K$5.0K$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
$3,981.07 / $3,981.07 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,981.07 / $3,981.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $7,079.46 / $10,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,981.07 / $4,466.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $8,511.38 / $10,964.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $7,585.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $3,981.07
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,888.44 / $8,317.64 / $10,964.78