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Michigan rates for HCPCS A9570

Indium In-111 labeled autologous white blood cells, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $10,103.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $4,294.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.55 / $1,536.36 / $2,732.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.82 / $1,031.39 / $1,237.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,647.78 / $4,294.16 / $4,294.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,130.57 / $4,546.76 / $7,476.89
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,462.56 / $5,355.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $5,051.95