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Ohio 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
$2,809.74 / $6,016.00 / $13,620.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $4,294.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,113.90 / $1,849.80 / $9,851.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.59 / $2,740.29 / $5,136.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,232.43 / $4,232.43 / $7,195.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.31 / $4,232.43 / $4,232.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $5,051.95
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $6,434.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.93 / $140.96 / $226.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $5,481.37