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
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | $8,914 | $22,285 |
| Deaconess Medical Center | — | $9,488 | $23,719 |
| Highline Medical Center | — | $3,699 | $12,113 |
| Mary Bridge Children's Hospital | — | $10,534 | $26,335 |
| MultiCare Auburn Medical Center | — | $10,534 | $26,335 |
| MultiCare Covington Medical Center | — | $10,534 | $26,335 |
| MultiCare Good Samaritan Hospital | — | $10,534 | $26,335 |
| MultiCare Valley Hospital | — | $9,488 | $23,719 |
| Providence St Mary Medical Center | — | $16,313 | $23,305 |
| Providence St Peter Hospital | — | $12,118 | $23,305 |
| Skagit Valley Hospital | $1.91 – $3.28 | $7,374 – $9,526 | $9,217 – $11,908 |
| St Anthony Hospital | — | $3,684 | $12,113 |
| St Clare Hospital | — | $3,492 | $12,113 |
| St Elizabeth Hospital | $3,392 – $4,018 | $4,280 | $12,113 |
| St Francis Community Hospital | — | $3,801 | $12,113 |
| St Joseph Medical Center | — | $4,012 | $12,113 |
| St Michael Medical Center | — | $5,346 | $12,113 |
| Tacoma General Allenmore Hospital | — | $9,646 – $10,534 | $24,116 – $26,335 |
| Virginia Mason Medical Center | — | $7,191 | $14,100 |
| Yakima Valley Memorial | — | $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