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South 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
$5,051.95 / $5,051.95 / $5,051.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $5,051.95 / $5,051.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $5,948.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,051.95 / $6,501.87 / $12,458.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,799.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,879.91 / $6,065.54 / $10,142.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,065.54 / $6,337.76 / $10,147.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,630.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,209.96