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Massachusetts 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
$4,294.16 / $4,294.16 / $5,827.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,294.16 / $4,799.35
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.35 / $941.10 / $10,103.90
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $19,197.41
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $6,926.48
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,106.38 / $5,106.38 / $10,103.90
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $19,197.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $7,367.43