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Montana rates for HCPCS A9571

Indium In-111 labeled autologous platelets, diagnostic, per study dose

Facilitymedian $7,079 · 10th–90th $6,310–$9,7720%50%10th90th$7,079Professionalmedian $4,169 · 10th–90th $4,074–$7,0790%50%10th90th$4,169$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,168.69 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $9,772.37 / $24,547.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $6,606.93
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,309.57 / $7,079.46 / $7,244.36
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,309.57 / $7,079.46 / $7,244.36
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $6,606.93 / $24,547.09
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $3,890.45 / $8,511.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $4,168.69