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Washington rates for HCPCS A9572

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

Facilitymedian $7,413 · 10th–90th $1,995–$16,9820%20%10th90th$7,413Professionalmedian $3,981 · 10th–90th $3,802–$10,4710%20%40%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
$3,981.07 / $3,981.07 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,801.89 / $3,981.07 / $4,677.35
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $7,585.78 / $7,943.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,244.36 / $14,125.38 / $17,782.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8,912.51 / $14,454.40 / $19,498.45
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $4,897.79
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,570.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,677.35
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $5,754.40 / $9,120.11