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Missouri 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 / $5,051.95 / $5,304.55
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
$4,588.85 / $7,156.93 / $11,080.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,788.96 / $3,788.96 / $5,051.95
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,041.56 / $5,106.38 / $18,944.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,647.78 / $4,209.96 / $5,249.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,950.91