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Indium In-111 Pentetreotide, Diagnostic

Ohio rates for HCPCS A9572

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

Rates data updated July 2026.

Facilitymedian $5,012 · 10th–90th $2,512$13,1830%10%10th90th$5,012Professionalmedian $5,623 · 10th–90th $3,715$10,4710%20%10th90th$5,623$50.0$200.0$1.0K$5.0K$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
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$8,912.51
Typical High
$13,182.57
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$5,623.41
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$4,466.84
Typical High
$12,882.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$4,677.35
Median
$8,128.31
Typical High
$11,748.98
CareSource
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$5,370.32
Typical High
$5,370.32
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$9,772.37
Typical High
$11,481.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$4,677.35
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$9,772.37
Typical High
$12,022.64
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$5,754.40
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$128.82
Typical High
$186.21
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$4,073.80
Median
$5,011.87
Typical High
$8,128.31
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$4,265.80
United
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$4,897.79