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Hawaii 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
$4,193.12 / $4,193.12 / $4,193.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $6,479.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,279.29 / $5,759.22 / $5,999.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $6,314.94 / $6,479.12