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Texas 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
$4,041.56 / $4,142.60 / $15,196.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,142.60 / $4,294.16
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
$6,007.77 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,142.60 / $5,051.95 / $9,015.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,390.39 / $4,390.39 / $4,390.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,193.12 / $5,051.95 / $6,863.07
Providence
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 / $4,298.37
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,799.35 / $6,479.12