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Texas rates for HCPCS A9572

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

Facilitymedian $12,589 · 10th–90th $4,467–$23,9880%10%20%10th90th$12,589Professionalmedian $3,981 · 10th–90th $3,802–$5,6230%20%10th90th$3,981$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $20,417.38 / $20,417.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,677.35 / $5,623.41
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,623.41 / $14,125.38 / $26,302.68
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $9,549.93 / $26,915.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38,904.51 / $38,904.51 / $38,904.51
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38,904.51 / $38,904.51 / $38,904.51
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $5,495.41 / $20,417.38
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,801.89 / $5,495.41 / $6,165.95
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,677.35 / $12,302.69
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,995.26 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $3,981.07
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16