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North Dakota 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 / $4,041.56 / $4,041.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,193.12 / $5,051.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,757.39 / $4,435.93 / $4,499.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $6,408.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,041.56 / $5,254.03 / $7,199.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $17,681.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,715.16