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Montana 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
$4,193.12 / $4,193.12 / $4,193.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,442.44 / $9,739.87 / $24,819.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $6,554.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,442.44 / $9,739.87 / $24,819.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,604.44 / $5,106.38 / $7,370.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,209.96