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Indium In-111 Pentetreotide, Diagnostic

South Dakota 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 $3,715$9,1200%20%40%10th90th$4,677Professionalmedian $3,981 · 10th–90th $3,890$4,8980%20%10th90th$3,981$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,677.35
Typical High
$4,677.35
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$4,677.35
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$4,897.79
Medica
Setting
Facility
Modifier
Global
Typical Low
$4,677.35
Median
$7,079.46
Typical High
$11,481.54
Medica
Setting
Professional
Modifier
Global
Typical Low
$3,311.31
Median
$3,890.45
Typical High
$4,365.16
Midlands
Setting
Professional
Modifier
Global
Typical Low
$9,772.37
Median
$9,772.37
Typical High
$9,772.37
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$3,981.07
United
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$8,128.31
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$4,168.69
Median
$4,168.69
Typical High
$4,168.69