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Alabama rates for HCPCS A9569

Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.54 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,633.41 / $1,713.97 / $2,056.76