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Virginia 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
$4,294.16 / $4,294.16 / $4,294.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,193.12 / $4,294.16 / $4,294.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $4,969.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,041.56 / $4,041.56 / $4,041.56
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,079.45 / $5,648.71 / $6,645.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,294.16 / $5,051.95 / $7,085.36
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,898.81 / $6,752.00 / $9,798.95
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,999.46 / $4,799.35 / $6,188.64
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,999.46 / $4,799.35 / $6,188.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $5,051.95