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Wisconsin rates for HCPCS A9572

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

Facilitymedian $4,266 · 10th–90th $1,905–$12,5890%20%10th90th$4,266Professionalmedian $3,981 · 10th–90th $3,715–$15,4880%20%40%10th90th$3,981$100.0$500.0$2.0K$10.0K$50.0K

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
$3,715.35 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,890.45 / $5,623.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,265.80 / $4,466.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,981.07 / $19,498.45
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,248.07 / $10,964.78 / $17,782.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $9,120.11 / $12,589.25
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,677.35 / $6,760.83
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $204.17 / $6,606.93
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $3,981.07 / $6,760.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $9,772.37
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $5,128.61
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $6,606.93 / $6,606.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10,000.00 / $10,000.00 / $10,000.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,760.83 / $14,454.40 / $20,417.38
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $38,904.51
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $9,772.37 / $38,904.51
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,905.46 / $4,466.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $5,128.61