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Louisiana 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
$5,051.95 / $5,051.95 / $6,668.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,051.95 / $5,051.95 / $5,051.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,546.76 / $4,546.76 / $6,820.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,546.76 / $4,546.76 / $4,637.70
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 / $4,294.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $5,051.95