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Washington rates for HCPCS A9571

Indium In-111 labeled autologous platelets, diagnostic, per study dose

Facilitymedian $7,586 · 10th–90th $4,266–$10,9650%10%20%10th90th$7,586Professionalmedian $4,266 · 10th–90th $4,074–$7,0790%50%10th90th$4,266$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,265.80 / $5,011.87
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $8,317.64 / $8,511.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $4,265.80
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,570.88 / $9,332.54 / $10,964.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,754.40 / $9,332.54 / $12,302.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $5,248.07
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $8,317.64
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $5,011.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $10,964.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $5,011.87
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,786.30 / $5,495.41 / $6,309.57