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Nebraska 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 / $8,726.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $4,041.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.45 / $500.30 / $975.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,767.88 / $3,926.53 / $3,966.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $6,145.64 / $9,795.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,041.56 / $4,291.50 / $18,944.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $6,314.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,879.91 / $6,094.97 / $9,321.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,115.71 / $6,408.98 / $10,015.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,999.46 / $4,209.96 / $5,051.95