HCPCS A9572
Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries
Current code40 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $2,001 – $38,565 | $8,914 | $22,285 |
| Deaconess Medical Center | $2,001 – $25,624 | $9,488 | $23,719 |
| Harborview Medical Center | $3,202 – $4,345 | — | — |
| Highline Medical Center | $1,915 – $10,902 | $3,699 | $12,113 |
| Island Hospital | $3,740 – $4,207 | — | — |
| Kadlec Regional Medical Center | $3,382 – $8,035 | — | — |
| Mary Bridge Children's Hospital | $2,001 – $62,118 | $10,534 | $26,335 |
| MultiCare Auburn Medical Center | $2,001 – $19,225 | $10,534 | $26,335 |
| MultiCare Covington Medical Center | $2,001 – $19,225 | $10,534 | $26,335 |
| MultiCare Good Samaritan Hospital | $2,001 – $19,225 | $10,534 | $26,335 |
| MultiCare Valley Hospital | $2,001 – $25,624 | $9,488 | $23,719 |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | $1,723 – $5,262 | — | — |
| PeaceHealth Peace Island Medical Center | — | $6,682 | $10,281 |
| PeaceHealth Southwest Medical Cente | $800 – $6,492 | $6,682 | $10,281 |
| PeaceHealth St John Medical Center | $800 – $2,001 | $6,682 | $10,281 |
| PeaceHealth St Joseph Medical Center | $2,001 | $6,682 – $6,682 | $10,281 – $10,281 |
| PeaceHealth United General Medical Center | — | $6,682 | $10,281 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $3,382 – $7,118 | — | — |
| Providence Centralia Hospital | $3,382 – $7,482 | — | — |
| Providence Holy Family Hospital | $2,401 – $7,336 | — | — |
| Providence Regional Medical Center Everett | $2,401 – $7,118 | — | — |
| Providence St Mary Medical Center | — | $16,313 | $23,305 |
| Providence St Peter Hospital | — | $12,118 | $23,305 |
| Skagit Valley Hospital | $1,330 – $11,313 | $7,374 – $9,526 | $9,217 – $11,908 |
| St Anthony Hospital | $1,915 – $9,548 | $3,684 | $12,113 |
| St Clare Hospital | $1,915 – $9,548 | $3,492 | $12,113 |
| St Elizabeth Hospital | $1,915 – $10,902 | $4,280 | $12,113 |
| St Francis Community Hospital | $1,915 – $9,548 | $3,801 | $12,113 |
| St Joseph Medical Center | $1,915 – $9,548 | $4,012 | $12,113 |
| St Michael Medical Center | $4,463 – $10,902 | $5,346 | $12,113 |
| Swedish Edmonds Hospital | $3,001 – $7,205 | — | — |
| Swedish Issaquah | $3,001 – $8,487 | — | — |
| Swedish Medical Center | $3,001 – $8,487 | — | — |
| Swedish Medical Center / Cherry Hill | $3,001 – $8,487 | — | — |
| Tacoma General Allenmore Hospital | $2,001 – $19,225 | $9,646 – $10,534 | $24,116 – $26,335 |
| University of Washington Medical Ctr | $2,451 – $6,275 | — | — |
| Virginia Mason Medical Center | $1,915 – $11,280 | $7,191 | $14,100 |
| Wellfound Behavioral Health Hospital | $5,049 | — | — |
| Yakima Valley Memorial | $2,816 – $4,885 | $2,299 | $5,747 |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Hospital outpatient payment (national)
- $2,001 (APC 0779)
- Surgery center payment (national)
- $2,001