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Virginia rates for HCPCS A9572

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

Facilitymedian $3,981 · 10th–90th $1,995–$6,3100%20%10th90th$3,981Professionalmedian $3,890 · 10th–90th $3,715–$5,6230%20%40%10th90th$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,981.07 / $5,623.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,981.07 / $6,760.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $6,309.57
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,715.35
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $7,762.47 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $6,025.60 / $8,709.64
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $4,677.35 / $7,244.36
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,365.16 / $5,754.40
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,365.16 / $5,754.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,344.23 / $4,677.35
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,677.35