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Indium In-111 Pentetreotide, Diagnostic

Washington rates for HCPCS A9572

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

Rates data updated July 2026.

Facilitymedian $4,365 · 10th–90th $1,995$16,5960%20%10th90th$4,365Professionalmedian $3,981 · 10th–90th $3,802$9,3330%50%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
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$9,332.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,801.89
Median
$3,890.45
Typical High
$3,981.07
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$2,398.83
Typical High
$4,365.16
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$4,365.16
Median
$4,365.16
Typical High
$4,365.16
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$7,585.78
Typical High
$7,943.28
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$3,981.07
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$7,244.36
Median
$14,125.38
Typical High
$19,054.61
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$7,244.36
Median
$14,454.40
Typical High
$19,054.61
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$4,897.79
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$4,365.16
Median
$4,365.16
Typical High
$4,365.16
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,365.16
Median
$4,365.16
Typical High
$4,365.16
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$4,365.16
Median
$4,365.16
Typical High
$4,365.16
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$1,905.46
Typical High
$4,365.16
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$4,365.16
Median
$4,365.16
Typical High
$4,570.88
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$1,995.26
United
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$4,786.30
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$4,365.16
Median
$5,754.40
Typical High
$9,120.11