go back

Alaska rates for HCPCS A9569

Technetium Tx-99m Exametazime Labeled Autologous White Blood Cells Diagnostic Per Study Dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,638.71 / $4,638.71 / $4,638.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,776.63 / $2,776.63 / $2,776.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,970.58 / $3,970.58 / $3,970.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,517.53 / $1,517.53 / $2,167.90
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,879.46 / $2,879.46 / $4,524.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,879.46 / $3,970.58 / $6,787.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,517.53 / $1,748.25 / $2,167.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $2,570.96 / $3,457.42