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Oregon rates for HCPCS A9572

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

Facilitymedian $4,365 · 10th–90th $3,890–$6,3100%50%10th90th$4,365Professionalmedian $3,890 · 10th–90th $3,388–$4,6770%20%40%10th90th$3,890$100.0$200.0$500.0$1.0K$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
$3,890.45 / $4,365.16 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,890.45 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,943.28 / $7,943.28 / $7,943.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12,589.25 / $14,454.40 / $16,982.44
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,981.07 / $5,495.41
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $3,890.45 / $4,365.16
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $10,715.19
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,677.35 / $12,882.50
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $3,981.07 / $11,220.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $4,073.80 / $4,786.30
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,677.35