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Kentucky 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 / $4,041.56 / $22,471.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $4,193.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,765.99 / $4,964.58 / $4,967.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.00 / $1,934.59 / $2,275.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,074.48 / $4,481.93 / $6,519.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,463.31 / $4,481.93 / $6,274.70
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 / $6,415.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,508.87