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California rates for HCPCS A9571

Indium In-111 Labeled Autologous Platelets Diagnostic Per Study Dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,193.12 / $4,193.12 / $35,222.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,485.85 / $4,193.12 / $4,193.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,864.74 / $4,673.06 / $6,062.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,782.67 / $4,294.16 / $8,244.78
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $10.00 / $25.01
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 / $4,294.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $393.93 / $393.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,007.77 / $10,103.90 / $18,944.81
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,681.83 / $19,197.41 / $22,733.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,193.12 / $4,685.64 / $5,999.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $5,051.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $8,676.73