go back

Montana rates for HCPCS A9570

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,193.12 / $4,193.12 / $4,193.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,584.86 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,442.44 / $9,739.87 / $24,819.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $6,554.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,442.44 / $9,739.87 / $24,819.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,604.44 / $5,106.38 / $7,370.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,209.96