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Indium In-111 Pentetreotide, Diagnostic

New York rates for HCPCS A9572

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

Rates data updated July 2026.

Facilitymedian $3,981 · 10th–90th $1,995$4,7860%20%10th90th$3,981Professionalmedian $3,981 · 10th–90th $3,715$5,7540%20%40%10th90th$3,981$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
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$3,715.35
Typical High
$9,549.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,235.94
Median
$3,715.35
Typical High
$3,981.07
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$2,089.30
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$4,365.16
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$8,511.38
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$8,511.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$4,365.16
Typical High
$6,918.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$20,892.96
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$6,760.83
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,981.07
Typical High
$3,981.07
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$4,168.69
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$3,981.07
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$53,703.18
Typical High
$75,857.76
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
$4,677.35
Typical High
$5,754.40
Univera
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$4,786.30
Univera
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$4,786.30