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New York rates for HCPCS A9572

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

Facilitymedian $3,981 · 10th–90th $1,995–$19,4980%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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,235.94 / $8,317.64 / $23,988.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,981.07 / $4,466.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $2,089.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,365.16
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $8,511.38
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8,511.38 / $8,511.38 / $8,511.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $7,413.10 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $20,892.96
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $6,760.83
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $4,168.69
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $53,703.18 / $75,857.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,995.26 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,897.79 / $5,754.40
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $4,786.30
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $4,786.30