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Indiana 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
$4,041.56 / $10,103.90 / $10,103.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $4,041.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,978.41 / $8,419.92 / $12,629.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.00 / $648.00 / $2,275.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,283.55 / $4,283.55 / $5,355.07
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,283.55 / $4,283.55 / $6,639.50
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $5,220.35