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Maine 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
$4,294.16 / $4,294.16 / $4,294.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,016.78 / $13,016.78 / $13,016.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,294.14 / $4,294.14
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $5,144.83
Martin's Point
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 / $6,314.94