go back

New Jersey 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 / $6,867.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,193.12 / $4,294.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,976.07 / $4,294.16 / $5,145.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,785.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,785.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,809.46