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Utah rates for HCPCS A9572

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

Facilitymedian $3,890 · 10th–90th $3,467–$4,5710%50%10th90th$3,890Professionalmedian $3,890 · 10th–90th $3,890–$4,6770%50%90th$3,890$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $60.26 / $7,244.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,890.45 / $5,495.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $5,888.44
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $6,456.54 / $8,317.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $3,890.45