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Utah 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 / $4,193.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,193.12 / $4,193.12 / $4,193.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $4,821.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,799.35 / $5,913.76 / $6,224.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,209.96