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North Carolina 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
$3,976.07 / $3,976.07 / $3,976.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,976.07 / $3,976.07 / $4,294.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,967.35 / $2,967.35 / $3,956.47
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 / $5,051.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,162.19 / $3,976.07 / $6,916.06
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,162.19 / $2,162.19 / $2,162.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $6,525.44
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,106.38 / $6,007.77 / $10,103.90
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,197.41 / $19,197.41 / $22,733.78