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Indium In-111 Pentetreotide, Diagnostic

Pennsylvania rates for HCPCS A9572

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

Rates data updated July 2026.

Facilitymedian $4,677 · 10th–90th $2,399$14,7910%20%10th90th$4,677Professionalmedian $3,981 · 10th–90th $3,715$3,9810%50%10th$3,981$2.0K$5.0K$10.0K$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
$3,981.07
Median
$3,981.07
Typical High
$24,547.09
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,981.07
Typical High
$3,981.07
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$13,803.84
Typical High
$14,791.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$3,981.07
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,981.07
Typical High
$3,981.07
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$6,456.54
Median
$6,456.54
Typical High
$6,456.54
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,025.60
Median
$6,025.60
Typical High
$6,025.60
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$5,011.87
Typical High
$24,547.09
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,981.07
Typical High
$3,981.07
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$7,079.46
Median
$7,943.28
Typical High
$9,332.54
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$5,128.61
Typical High
$7,585.78
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$6,456.54
Median
$6,456.54
Typical High
$7,079.46
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$1,995.26
United
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$5,011.87