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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
$4,073.80 / $10,000.00 / $10,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $4,168.69 / $4,265.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $2,754.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $5,011.87 / $15,488.17
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $5,370.32 / $7,244.36
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,570.88