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Minnesota 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
$5,011.87 / $5,011.87 / $5,011.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $4,168.69 / $5,011.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $3,981.07 / $6,309.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $6,456.54
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,309.57 / $6,309.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $5,011.87 / $8,709.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $7,585.78