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Wisconsin rates for HCPCS A9571

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

Facilitymedian $4,365 · 10th–90th $4,074$10,2330%50%10th90th$4,365Professionalmedian $4,169 · 10th–90th $4,074$10,0000%50%10th90th$4,169$10.0$50.0$200.0$1.0K$5.0K$20.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,168.69 / $4,265.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,168.69 / $12,022.64
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $6,606.93 / $13,182.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $6,918.31 / $7,762.47
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,265.80 / $5,370.32
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,265.80 / $5,370.32
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $8,912.51
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $54.95 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,365.16 / $4,365.16
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,165.95 / $6,165.95 / $6,165.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,370.32 / $11,481.54 / $21,379.62
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $15,135.61
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $5,370.32 / $22,908.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $4,677.35 / $10,964.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $5,495.41