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Alaska rates for HCPCS A9571

Indium In-111 labeled autologous platelets, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,820.13 / $6,820.13 / $6,820.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,752.79 / $9,752.79 / $9,752.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,704.72 / $3,704.72 / $5,292.45
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,072.73 / $7,072.73 / $11,114.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,072.73 / $9,752.79 / $16,671.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,704.72 / $4,294.16 / $5,292.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $6,314.94 / $8,492.33