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Oregon 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
$4,799.35 / $4,799.35 / $4,799.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,193.12 / $4,193.12 / $4,193.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,588.32 / $8,588.32 / $8,588.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,405.98 / $11,241.84 / $11,816.72
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,193.12 / $5,557.15 / $9,015.20
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,799.35 / $5,010.93 / $8,351.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,193.12 / $5,996.16 / $9,015.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $5,447.26 / $8,398.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,799.35 / $4,799.35 / $4,799.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,841.45