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Tennessee 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
$4,193.12 / $4,193.12 / $7,337.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,193.12 / $4,193.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,630.96 / $5,047.75 / $5,418.22
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,106.38 / $10,103.90 / $18,944.81
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,681.83 / $19,197.41 / $22,733.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,209.96