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Indium In-111 Pentetreotide, Diagnostic

South Carolina 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 $3,467$15,4880%20%10th90th$3,981Professionalmedian $3,981 · 10th–90th $3,802$5,7540%20%40%10th90th$3,981$50.0$200.0$1.0K$5.0K

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
$3,801.89
Median
$3,801.89
Typical High
$15,488.17
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,801.89
Median
$3,890.45
Typical High
$5,754.40
BCBS
Setting
Professional
Modifier
Global
Typical Low
$4,265.80
Median
$4,786.30
Typical High
$5,623.41
Cigna
Setting
Facility
Modifier
Global
Typical Low
$4,466.84
Median
$5,888.44
Typical High
$10,000.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$3,981.07
Medcost
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$4,677.35
Typical High
$5,128.61
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
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
$3,890.45
Typical High
$4,168.69