go back

Indium In-111 Pentetreotide, Diagnostic

Wisconsin rates for HCPCS A9572

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

Rates data updated July 2026.

Facilitymedian $4,677 · 10th–90th $3,715$12,0230%20%10th90th$4,677Professionalmedian $4,677 · 10th–90th $3,715$19,4980%20%40%10th90th$4,677$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
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$3,715.35
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$4,677.35
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,265.80
Typical High
$4,466.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,981.07
Typical High
$19,498.45
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$9,549.93
Typical High
$16,218.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$11,220.18
Typical High
$12,589.25
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,677.35
Typical High
$6,760.83
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$204.17
Typical High
$6,606.93
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$3,981.07
Typical High
$6,760.83
Medica
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$9,772.37
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$5,128.61
Network Health
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$6,606.93
Typical High
$6,606.93
Network Health
Setting
Professional
Modifier
Global
Typical Low
$10,000.00
Median
$10,000.00
Typical High
$10,000.00
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,677.35
Typical High
$6,760.83
Quartz
Setting
Professional
Modifier
Global
Typical Low
$6,760.83
Median
$14,454.40
Typical High
$20,417.38
Quartz
Setting
Facility
Modifier
Global
Typical Low
$5,248.07
Median
$12,022.64
Typical High
$38,904.51
Quartz
Setting
Professional
Modifier
Global
Typical Low
$3,981.07
Median
$30,902.95
Typical High
$38,904.51
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$4,677.35
United
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$5,248.07