Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
OCTREOSCAN PER 3 MCI
Teaneck, NJ
See all hospitals reporting HCPCS A9572 →Price type
Holy Name’s median price of $6.8k is 72% above the median hospital's median price ($3.9k), higher than 71% of the 1,673 hospitals reporting HCPCS A9572. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 21 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna hmo/pos facility · other · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Aetna qualified health plans facility · other · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 3 | Aetna medicare prime facility · fee schedule · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 4 | Aetna golden medicare facility · fee schedule · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 5 | Clover clover facility · fee schedule · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 6 | UnitedHealthcare medicare facility · fee schedule · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 7 | WellCare medicare facility · fee schedule · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 8 | UnitedHealthcare medicaid facility · percent of total billed charges · outpatientfrom % of charges | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 9 | Aetna better health mcd/chip facility · percent of total billed charges · outpatientfrom % of charges | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 10 | Ambetter ambetter facility · percent of total billed charges · outpatientfrom % of charges | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 11 | Optum all products facility · fee schedule · outpatient | $6.4k | $6.4k | — | — | — | $6.4k – $6.4k |
| 12 | Aetna whole health facility · percent of total billed charges · outpatientfrom % of charges | $6.4k | $6.4k | — | — | — | $6.4k – $6.4k |
| 13 | First Health first health facility · percent of total billed charges · outpatientfrom % of charges | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
| 14 | Aetna worker's comp facility · percent of total billed charges · outpatientfrom % of charges | $7.2k | $7.2k | — | — | — | $7.2k – $7.2k |
| 15 | Cigna hmo/pos facility · percent of total billed charges · outpatientfrom % of charges | $10.0k | $10.0k | — | — | — | $10.0k – $10.0k |
| 16 | MultiPlan multiplan facility · percent of total billed charges · outpatientfrom % of charges | $13.0k | $13.0k | — | — | — | $13.0k – $13.0k |
| 17 | MultiPlan worker's comp facility · percent of total billed charges · outpatientfrom % of charges | $17.0k | $17.0k | — | — | — | $17.0k – $17.0k |
| 18 | MultiPlan auto accident medical facility · percent of total billed charges · outpatientfrom % of charges | $18.0k | $18.0k | — | — | — | $18.0k – $18.0k |
| 19 | Blue Cross Blue Shield indemnity facility · percent of total billed charges · outpatientfrom % of charges | $18.5k | $18.5k | — | — | — | $18.5k – $18.5k |
| 20 | Blue Cross Blue Shield managed facility · percent of total billed charges · outpatientfrom % of charges | $18.5k | $18.5k | — | — | — | $18.5k – $18.5k |
| 21 | Blue Cross Blue Shield ppo facility · percent of total billed charges · outpatientfrom % of charges | $18.5k | $18.5k | — | — | — | $18.5k – $18.5k |
Last updated: Nov 10, 2025
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