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New Hampshire 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
$4,294.16 / $4,294.16 / $5,152.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,033.01 / $6,314.94 / $17,327.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,294.14 / $4,294.14
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 / $4,294.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $6,512.52 / $13,253.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $10,103.90
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,647.78 / $4,012.56 / $5,106.89